A colleague in Toronto, Canada wonders if patients receiving IVIG should be monitored in the same fashion as those receiving a blood product transfusion. At her hospital, patients who receive IVIG are monitored in a similar fashion as are patients who receive blood products. However, the Immunology Service at this hospital suggested that the monitoring of patients receiving IVIG can be less rigorous under certain circumstances, specifically if an IVIG recipient has not had any problems with receiving IVIG after several treatments. Do colleagues agree with this premise?

The Toronto colleague has shared her hospital's transfusion monitoring protocol for the sake of this discussion. Basically, her hospital policy is for each patient receiving a blood transfusion to have vital signs recorded pre-transfusion, 15 minutes into the transfusion and immediately post-transfusion. The patient is also to be assessed every 30 minutes up to 1 hour post-transfusion, with additional vital signs to be taken and recorded if necessary. Although this is their routine policy, areas such as the PICU, NICU and Emergency Department practice more rigorous monitoring, according to the patient's overall clinical needs. The above policy applies to all blood products, components and plasma derivatives. The Immunology Service, however, has recommended that new patients receiving IVIG infusions would be rigorously monitored when transfused with IVIG for the first two times, and if they tolerate the product without incident they will be taught to self-monitor and report to staff with any problems at the third infusion. If they do well with the third infusion, at the fourth and subsequent infusions, the patient would only need to have pre-transfusion vital signs routinely recorded.

The inquiring Canadian has read the package inserts from various IVIG products. While these inserts are not identical in their recommendations, several state that 'the patient's vital signs should be monitored continuously, throughout the infusion'. The Canadian colleague would appreciate input from e-network forum colleagues regarding what other facilities do regarding the monitoring of patients who receive IVIG infusions.

The following comments have been received.

ADDENDA May 27, 2003

1. The Editor suggests that the earlier issue on this forum offers information that might be germane to this discussion.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator