Gamunex – Infusion Administration Process
-
-
July 28, 2010 at 1:47 pm
My husband was diagnosed with CIDP in April and has received 5 loading doses of Gamunex and nine maintenance doses. We are receiving inconsistent information about the administration of Gamunex infusions. Some centers say hydrate with saline (using a bag of solution), they then use new tubing prior to administering the Gamunex. The same IV port is used and the vein is flushed with dextrose prior to administering the Gamunex. At the end of the infusion, one syringe of dextrose is used for flushing the vein.
We’re concerned about this process since the documentation states that Gamunex is not compatible with saline at all and may be flushed before and after the infusion with dextrose.
Since this process is new for us, we’re curious about others’ experiences and knowledge. Is anyone hydrated with dextrose before and after the infusion – if so, how much is given? Other experiences/knowledge also welcome.
Thanks for your input!
Confused!
-
July 30, 2010 at 5:57 am
They hydrated me with saline when I was in the hospital 4 years ago at the same time as my IVIg… they dripped into the same line simultaneously. I can’t say whether it had any detrimental effects as I was in such bad shape at the time and it didn’t occur to anyone not to hydrate me. Later… when I went to Hopkins and got a proper diagnosis, they were alert to not mixing saline and Ig solutions and my hydration was left to me – drinking as much as I possibly could. It was tough on my body to have that much fluid pumped into my veins, my kidneys always hurt, my lungs filled with fluid etc… I felt much better having those two processes split, getting the IVIg in my veins and drinking 48+oz liquids per infusion.
Now I get subcutaneous Ig and have few problems with hydration or fluid overload. 🙂
-
July 30, 2010 at 7:31 am
Hi, Julie, thanks so much for your response. We’ve been concerned because even though my husband’s legs have responded to the Gamunex infusions positively, his hands have worsened, i.e., no feeling in his fingers and tremendous pain. We want to ensure he receives the maximum benefit from the treatments. One day I called the manufacturers of Gamunex, and a pharmacist told us that Gamunex should not touch saline – could cause a clump in the IV line or crystalization, which was kinda scary.
What are subcutaneous IG’s? I hope you have responded positively to the treatments.
-
July 30, 2010 at 10:59 am
When they administer the dextrose that is pushing the saline through the line & it doesn’t come into contact with the IVIG. Basically the dextrose is being used as a barrier between the two.
My daughter gets Gammaguard & her port is flushed before & after each infusion with saline & then heparin.
Hope that helps.
Kelly -
July 30, 2010 at 11:09 am
Thanks for your response on this. Like I said, we’re very new to this process, so it’s helpful to get input from people like you to help us along the way. As you know, it’s extremely stressful!
-
July 31, 2010 at 10:00 am
Bonnie,
Subcutaneous Ig is a concentrated Ig solution that goes just into your skin, it is not designed to go into your veins (check out [url]www.vivaglobin.com[/url] for details) and therefore it is absorbed more slowly into my system. I am responding well to the treatment but it may be that it is more of a maintenance treatment than an urgent one. If I were in the middle of a full blown relapse I do not think it would be as effective as IVIg… my version of CIDP is relapsing and remitting but the ups and downs are ripples on a pond now, rather than tidal waves crashing on shore as they were four years ago… so the slow but steady subcutaneous Ig is all I need right now to surf the waves of relapse and remission.That being said I cannot even tell you how much better I feel overall not getting the IVIg solution anymore… I know because sometimes when I take the subcutaneous needles out I scrape a surface vessel so some of the Vivaglobin gets into the smaller veins… not much, not enough to really hurt me, but enough to give me a headache and reminder of how bad I used to feel. I am grateful I am stable enough to use Vivaglobin but I do not think I could have done this when I was in my most critical phase.
Keep questioning and learn as much as you can – you will be your husband’s best advocate and likely the most knowledgeable about his condition aside from him.
-
August 3, 2010 at 3:46 pm
Bonnie:
Saline should never be used with Gamunex as it can cause crystallization. D5W (5% dextrose and water) only, should be used at the beginning and end to fllush. If desired, a heparin syringe flush can be used after the final D5W flush is completed. -
August 4, 2010 at 3:10 pm
Dear Goodney, Thanks for your response. Is there a certain amount of the D5W that is used before and after the Gamunex infusion?
-
August 7, 2010 at 10:20 am
Bonnie:
I don’t know of any set amount. My home nurse makes sure there is a sufficient amount left over to flush at the end of my IVIG. Anyone qualified to do infusions should know the proper amount to flush. Be on your guard; even those qualifed to do infusions will sometimes mistakenly believe they can flush with saline, especially if they are not familiar with Gamunex. -
August 24, 2010 at 12:47 pm
[QUOTE=Julie]They hydrated me with saline when I was in the hospital 4 years ago at the same time as my IVIg… they dripped into the same line simultaneously. I can’t say whether it had any detrimental effects as I was in such bad shape at the time and it didn’t occur to anyone not to hydrate me. :)[/QUOTE]
What they did was dangerous and contraindicated.
-
