Application Rapid push method in praxis

Report
Immunology nursing in the Czech republic
today
Teplá Ilona
Králíčková Pavlína
Institute of Allergy and Clinical Immunology
University Hospital Hradec Kralove
Czech Republic
sources: foto oficial pages in the Internet
Introduction
sources : oficial pages in the Internet / foto learning centre of the University Hospital Hradec Kralove
The main points
• Statistical survey of our patients in the Czech PID database
• Practical aspects in the administration
• Immunoglobulin supplementation therapy and comparison
IVIG x SCIG
• Most frequent questions/difficulties with the administration
• Conclusion
• Discussion
Statistical survey of PID patients
/Czech republic/
Actual status
• general descriptions of database / immunoglobulin therapy/
• comparison of status in particular centres /referential values/
Czech PID registry, export of data 09/2014
Statistical survey of PID patients
/Czech republic
Total evidence
Actual monitored
number of patients
% of valid cases
684
664
88,6%
88,7%
Centre
Number of
patients
valid
FNUSA Brno - Ústav klin. imunolog. a alergolog.
FN Motol - Ústav imunologie
FNHK - ÚKIA
VFN Praha - Ústav imunologie a mikrobiologie
FN Plzeň - Ústav imunologie a alergologie
ZÚ ÚnL - Odd. klin. imunologie a alergologie
IKEM Praha - Klinická a transplantační medicína
FN Olomouc - Odd. alergologie a klin. imunologie
Nemocnice České Budějovice - Imunologické oddělení
Zlín - Plicní oddělení, KNTB a.s.
ZÚ Ostrava - Oddělení imunologie a alergologie
FN Brno - Pediatrická klinika
FNHK - Klinika dětského lékařství
FNKV Praha - Odd.alergologie a klin. imunologie
FN Olomouc a LF UP - Dětská klinika
Tábor-Kasmed s.r.o., alerg., imunolog, neurolog.
FN Ostrava - Alergologie
Krnov SSZ - interní oddělení
156
151
79
59
43
35
29
21
18
14
14
13
11
11
3
3
2
2
98,0%
92,4%
93,7%
100,0%
64,3%
97,0%
86,2%
100,0%
88,9%
100,0%
100,0%
91,7%
100,0%
90,9%
66,7%
100,0%
50,0%
100,0%
Statistical survey of PID patients
/Czech republic/
N=664
(Currently monitored)
Male (N=300)
Female (N=364)
Basic characteristics
Replacement therapy
Practical aspects in the administration
• Optimal IgG doses and target trough levels are individual
(clinical symptoms, comorbidities, genetic factors)
• The route of administration could be the result of discussion
(patient X nurse X doctor)
Negative influence
- financial conditions in hospital
- statement of insurance company
- economical tender of immunoglobulin
preparation
Practical aspects in the administration
IVIG therapy
Advantages
- cheaper in the Czech Rep.
- administration ones/twice a month
- more often checking of clinical status and
laboratory results
Disadvantages - administration at outpatient department
(traveling, day off work)
- higher risk of adverse events
- more often intolerance of administered
preparation
- necessary good venous access
Practical aspects in the administration
SCIG therapy
Advantages
- home therapy with independence
- comfort, flexibility
- less frequent visits at the doctor
- better tolerance of Ig preparations
- low side effect profile (no severe systemic)
- alternative for patients with poor venous access
- benefit in case of gastrointestinal losses, malnutrition
- flexibility of dosing and ease of administration
Practical aspects
the administration
SCIGintherapy
Disadvantages/limitations
- fear from the inject or the needle
- administrations 1-3 times a week
- intolerance (local skin reactions, scars, stretch marks)
- risk of lower compliance
SCIG therapy
It is important to doing difference between methods of subcutaneous
administrations, preparations
• Individual approach to each patient
• Choose areas from recommended sites
for the administration /abdomen, outer/
inner thighs, hips, upper arms/
• Specific role of trained nurses in
the education of patients
It depends on the constitution of the patient,
the thickness of the subcutis and type of needles
SCIG therapy
Subcutaneous administration
• method rapid push /patient can adjust the rate of the infusion
according to his tolerance without using the infusion pump/
….Rapid push significantly higher infusion rate (60ml/h x 20ml/h)
….Patients with 10ml and less per one site prefer rapid push
• by the infusion pump /there should keep recommended rate
of the infusion/
….Infusion pumps provide pharmaceutical firms
….Comparable efficacy and tolerability
Our own experience – centre Hradec Kralove,
Czech Rep.
• 47 patients regularly on Ig substitution therapy
• 27/47 IVIG
• 20/47 SCIG
• SCIG with pump since … 2007 to Oct 2014: 9 patients
(3 died, 1 switched to IVIG – medication intolerance)
• Rapid push since …2012 to Oct 2014: 11 patients
(2 switched to IVIG – 1 case patient preference, one case
unsatisfactory IgG level and patients reluctance to increase Ig
doses)
Side effects – pump x rapid push
No serious systemic reaction
• including patient experienced moderate systemic reaction - IgA
antibodies
• 1 case - intolerance of two different preparations (fatigue)
Local reactions:
Pump: infrequently haematoma
Rapid push:
→ 2/11 mild itching, erythema
→ 2/11 pain during administration
(change of the injection site to the inner thigh)
Often problems with administration / by patients
and nurse´s view
a view on our daily centre
/outpatient ward/
Practical experience
• Giving enough practical information to the patient by a nursespecialist
• Explanation of the whole procedure (initiation of SCIG therapy)
or providing an instructional video
• Demonstration of administration
• Reassurance of the patient (patient in home therapy after regaining
certainty in the administration)
Question 1:
There are enlarged pores, which are usually disappear for a day, the
area is painful. Shall I continue with the application?
There is the skin apparently attenuated (stretch marks, etc.) …
You will try to change the site. We choose a different area from the
recommended injection sites. Mainly it depends on the tolerance of the
patient ..
We had same patient in our department with this problem and she
solved it just changing of the injection site. She started to administer to
the inner side of thigh and she was satisfy.
Practical experience
- possibility of the administration
Question/difficulties 2:
There are stretch marks around the abdomen and it is very limited
the choice to other site.
• outside stretch marks (scars)
• it depends again on the constitution of the patient,
the thickness of the subcutis
Question 3:
The injection site is after the infusion leakage or wet …
There was probably made too shallow the introducing of the needle.
The needle was only a little bent or it was just a poor implementation.
We have tested for example bending the needle to the angle of 90
degrees /method rapid push/, the introduction of the needle is deep
enough to the preparation is well absorbed and well tolerated by the
patient.
the bending of the needle to 90°degrees is recommended in the administration
to the abdomen (special type of the needle) and there is stronger thickness of
the subcutis
Practical experience
- possibilty of administration
Question 4:
The injection site is after administration indurated and painful and it
has been disappear for a long time..…
The dose of the liquid is probably too large on the thickness of the
subcutis. We will try to divide the dose into two or more
administrations. New sites should be at lest 2 inches apart.
We should have been always consulted with the doctor.
Conclusion
Immunoglobulin supplementation therapy represents a corner stone in
the treatment of patients with disturbance of specific antibody
production. The correctly guided treatment leads to decrease of severe
illnesses and improve the quality of life. I am glad that I can
participate in it.
There were used information from the official websites www. hizentra.com and the Internet .
Discussion
Immunology nursing in the Czech republic
today
Thank you for your attention.
sources : foto oficial pages in the Internet

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