IVIG BOOSTER INFUSION (ST. JOHNS - DEFAULT PT SUPPLIED)		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	1 time a week	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	1 time a week	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	1 time a week	S	Until discont'd	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	1 time a week	S	Until discont'd	
		Vital Signs PRE & POST Infusion.		
	☐	sodium chloride 0.9% flush 10 mL	1 time a week	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	sodium chloride 0.9% infusion 250 mL	1 time a week	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	1 time a week	S	Until discont'd	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	diphenhydrAMINE (BENADRYL) injection 12.5 mg	1 time a week	S	Until discont'd	
		12.5 mg, intravenous, once, Starting when released
	Administer 30 minutes before infusion.		
	☐	acetaminophen (TYLENOL) tablet 650 mg	1 time a week	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Administer 30 minutes before infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	IMMUNE GLOBULIN (IGG) 10% ORDERABLE FOR THERAPY PLANS	1 time a week	S	Until discont'd	
		intravenous, once, Starting 30 minutes after treatment start time
	Initiate infusion at 30 mL/hr for 30 minutes then double rate every 30 minutes as tolerated to a goal rate of 120 mL/hr in the inpatient setting and a maximum rate of 4.8mL/kg/hr in the outpatient setting. The patient is not tolerating the infusion if they develop headache, flushing, itching, rash, nausea & vomiting, muscle pain, tachycardia (heart rate >100 BPM), a temperature elevation of 1.8 degrees Fahrenheit, hypotension (SBP < 90 mmHg), hypertension (SBP > 180 mmHg), chills, problems breathing, or chest tightness.		

Post-Procedure 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9% flush 10 mL	PRN	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, Until Discontinued		
	☐	HEParin, porcine injection 500 Units	PRN	S	Until discont'd	
		500 Units, intra-catheter, PRN, line care, Starting when released, Until Discontinued