Intragram IVIG Immunoglobulin Safety Precautions

Step	Action
1	Any vial opened should be used promptly.
2	Partially used vials must be discarded.
3	Do not use if solution is turbid.
4	Infusion to be commenced within 15 minutes from leaving Blood Bank (allow this time for it to reach room temperature).
5	Intragam P may be placed in fridge in Neonatal Unit for short period while intravenous cannula is resited.

Adverse Effects and Management

Adverse Reactions

Symptoms

The following symptoms may occur.

Hypotension, facial flushing or pallor, dyspnoea, non-urticarial skin rash, itching, vomiting.
May get delayed adverse reactions to Intragam such as vomiting or rigors. These occur after the infusion has stopped but usually within 24 hours.
The low pH of IVIG should be considered in any sick babies with acid/base problems. Undiluted, it is hyperosmolar. If the baby has high osmolarity or low pH, there is a potential problem.
Intragam may be given diluted with equal volumes of 0.45% or 0.9% sodium chloride or 5% dextrose.

Step	Action
1	If any reaction to Intragam P, it tends to be related to the infusion rate and is most likely to occur in the first hour of infusion.
2	Stop the infusion temporarily.
3	Inform Doctor/NS-ANP.
4	Wait until infant has improved clinically (5-10 minutes).
5	Doctor/NS-ANP orders Intragam P to be recommenced at a slower rate.
6	All adverse reactions should be reported to the Blood Bank on NZBS Notification and Investigation of Adverse Transfusion form.

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