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IVIg vs. SCIg

IVIg vs. SCIg

Immunoglobulin replacement therapy is generally administered either intravenously (IVIg), or subcutaneously (SCIg). IVIg administration every 3 to 4 weeks and weekly SCIg are regarded as therapeutically equivalent treatments for PIDD and CIDP. The healthcare provider and patient or caregiver should discuss which route of administration is most appropriate for each patient.1

IVIg

Intravenous Immunoglobulin (IVIg) infusions are given by a medical professional through an IV cannula in the arm every 3-4 weeks at a specific, prescribed dose. These treatments must be scheduled in advance and are typically done in an infusion suite, physician office, or at home. For patients with poor venous access, subcutaneous immunoglobulin (SCIg) should be the considered route of Ig administration.

Some common side effects of IVIg include headache, nausea, fever and chills, flushing, wheezing, vomiting, backache, muscle aches, joint aches, or chest tightness. In most cases, these side effects are related to the rate of the infusion.2

SCIg

Subcutaneous Immunoglobulin (SCIg) infusions are given by slowly administering immunoglobulin into fatty tissue (subcutaneous layer) just underneath the skin using an electronic or mechanical infusion pump (such as our Freedom syringe drivers) or by manual push by hand with a syringe. Typical infusion sites are the abdomen, thighs, or outer buttocks. Local site reactions are the most common side effects of SCIg.2

Sub Q Sites

The total monthly dose, number of infusion sites (needles) and flow rate tubing is calculated by the pharmacist or other health care provider depending on the body weight, volume and the concentration of the SCIg medication to be infused.

SCIg is typically self-administered and can be done at home, thus eliminating the need for monthly hospital or infusion center visits. This allows patients more flexibility and promotes independence.2 

Deciding What’s Best for You

If you are new to treatment, make sure you talk to your healthcare provider when deciding which option is best for you. Here is a breakdown of the differences between IVIg and SCIg.4

 

IVIg

SCIg

Venous access required

Infuse into fat tissue, not vein

Healthcare professional required

Patient self-administered

Administer every 3-4 weeks

Administer e.g. weekly

Rapid absorption

Gradual absorption (24-72 hours)

High peak and low trough levels, increasing risk for fatigue and infections3

Fewer peaks and troughs due to more consistent IG levels – leading to less infections3

Pre-medication commonly required

Pre-medication often not required

 

SCIg_ChartSubcutaneous_Chart.

 

References:

  1. Institute of Allergy and Infectious Diseases. Primary immune deficiency diseases (PIDDs). niaid.nih.gov/diseases-conditions/primary-immune-deficiency-diseases-PIDDs. Accessed Aug 19, 2020
  2. Immune Deficiency Foundation. IDF Guide to IG Therapy, 6th Edition. 2018. primaryimmune.org
  3. Shrestha et al. Impact of IVIG vs. SCIG on IgG trough level and infection incidence in primary immunodeficiency diseases: A systematic review and meta-analysis of clinical studies. World Allergy Organization Journal (2019) 12: 10068
  4. Shapiro R. Subcutaneous Immunoglobulin. Immunol Allergy Clin NA. 2020. In press.

 

Related Publications

Subcutaneous immunoglobulin replacement in primary immunodeficiencies

Quantitative Evidence of Wear-Off Effect at the End of the Intravenous IgG (IVIG) Dosing Cycle in Primary Immunodeficiency

Impact of IVIG vs. SCIG on IgG Trough Level and Infection Incidence in Primary Immunodeficiency Diseases: A Systematic Review and Meta-Analysis of Clinical Studies

Poster: Patient IVIg to SCIg Case Study

Hospital vs. Homecare

Treatment Options

Hospitals save lives while home health care improves lives. Homecare increases patient function and enhances an independent lifestyle. Most people need hospitalization at least once in their lives, but a growing number of individuals are choosing long-term treatment in the comfort of their own homes. Patients report a variety of reasons to opt for homecare, including convenience, care, confidence, and cost.1,2

With home health care, patients can avoid the inconvenience of a hospital stay and reduce associated expenditures associated with hospitalization. Benefits of outpatient clinic or at home-based care include avoiding hospital admissions, reduced length of hospital stay, less healthcare associated infections, and the ability to return to work faster and to resume daily activities of living.1-3

According to the US Centers for Disease Control, 1 in 31 patients in the hospital get healthcare associated infections.4 Medical advances have brought lifesaving care to patients in need, yet many of these advances come with a risk of healthcare-associated conditions, including infections. These infections could lead to significant patient illnesses and deaths (morbidity and mortality); prolong the duration of hospital stays; and require additional testing and therapeutic involvement, which generate added costs.5

Homecare is especially practical for those with chronic illnesses. If you are immunocompromised, it is a particularly important time to stay safe, healthy, and reduce your exposure to germs. Learn how our Freedom Infusion System delivers peace of mind in this brief overview:
Subcutaneous Infusion: Your Peace of Mind During an Uncertain Time

References:

  1. Polinski et al. Home infusion: Safe, clinically effective, patient preferred, and cost saving. Healthcare. 2017; 5:68-80.
  2. Home Infusion: Benefits and Barriers. www.carecentrix.com Accessed Aug 19, 2020
  3. Infusion therapy: No place like home. https://www.optum.com/business/health-insights/infusion-therapy.html Accessed Aug 19, 2020
  4. Magill S et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med 2018;379(18):1732-1744.
  5. Premier Safety Institute. Healthcare Associated Infections. https://www.premiersafetyinstitute.org/safety-topics-az/healthcare-associated-infections-hais/hai/ Accessed June 30, 2020

 

Related Publications

Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial

Managing Cost of Care and Healthcare Utilization in Patients Using Immunoglobulin Agents

 

Resources

CDC Healthcare-associated Infections

Optimizing Infusions

Infusions

Several variables involved with SCIg allow optimization of the infusion experience for patients. Some of these variables include number of needle-sticks, infusion sites, volume infused/site, needle length and pump type.

SCIg is delivered using a small needle attached to tubing and a syringe that is placed in a mechanical pump or an electronic programmable pump. Both pumps are portable. Several needle and tubing sizes are available for mechanical pumps and troubleshooting problems with SCIg often involves reviewing that the equipment being used, such as needle sets, tubing, and pump are appropriate for the individual receiving the therapy.

 

Choosing an Infusion Device

There are different options when it comes to infusion pumps and devices, the main two being electronic pumps (constant flow systems) and mechanical pumps (constant pressure systems).

Constant Flow Systems

Constant Pressure Systems (KORU Freedom systems)

Electronic devices

Mechanical devices

Programmed to a specific flow rate

No programming

Respond to tissue saturation by increasing pressure

Respond to tissue saturation by slowing down the infusion to maintain the same safe pressure throughout the infusion

Constant Flow Constant Pressure

 

Dynamic Equilibrium

Our Freedom infusion systems are designed to function based on how well the patient's body absorbs medication. This benefit, known as DynEQ® (Dynamic Equilibrium), means that the system responds to building pressure in the subcutaneous tissue during SCIg infusions, by slowing down the infusion to ensure a balanced infusion.

Selecting the Right Infusion Device

Secrets to Finding the Best Infusion Sites

Infusion Pump Design for SCIg

Needle Design

If the patient is having local site reactions, the healthcare provider can consider changing the needle type before changing the medication. Compared with tricuspid needles, lancet-type needles may cause more coring of the skin, resulting in increased bleeding and tissue trauma.  The tricuspid needle tip design of HigH-Flo Subcutaneous Safety Needle Sets™ minimizes damage and scarring, resulting in less site reactions.1

Needle Design

 Importance of Ancillary Supplies for Subcutaneous Immunoglobulin Infusion

Troubleshooting SCIg Site Reactions

When patients are trained correctly, site reactions could become a rare occurrence. When site reactions do occur, patients can experience redness, irritation, drug leakage, itching, pain, and discomfort.


Flow Rate

Selecting the correct flow rate tubing is important when starting SCIg therapy. It may be trial and error to find which flow rate works best for you/your patients. For patients who experience site reactions, a slower flow rate tubing set is recommended.

The Freedom infusion systems slow down the infusion automatically if the resistance in the tissue increases. However, by choosing the slower flow rate, it is possible to minimize or prevent the tissue saturation.


Needle Length

Choosing the correct needle length is very important when getting started on SCIg. Every ‘body’ is different but generally: infants use 4 mm, children (up to age 9) and patient sites with extremely low body fat use 6 mm, over age 9 and adults use 9 mm and/or 12 mm, and very large adults use 14 mm.1

Incidence of Drug Leakage When Giving SCIg and fSCIg Treatments

Dry Priming

Short needles can cause:

Leaking from the sites

Bumps around the sites

Needle site discomfort

Extended infusion times 


Dry Priming

It is recommended to insert the needles dry, as drug leaking needles can cause irritation to the site.3

Reducing Incidences of Local Infusion Site Reactions


Drug Volume

Volume per site is a key factor to consider, especially because every body-type is different. Patients with more adipose/fatty tissue will be able to accept Ig easier. Thinner patients may experience longer infusion times and more substantial site reactions. The volume per site needs to be weighed against the subcutaneous tissue available. Many times, spreading the volume out to more sites will help keep volume per site low and can eliminate site reactions.2


Site Location

The abdomen is the most common place to infuse, but the upper buttocks/side of upper hips, the outer side of the thighs, and the back of the upper arms are also used. It is important that the site(s) chosen has a good amount of subcutaneous tissue. Some medications require that sites be 2+ inches (5 cm) apart, and that the needles are inserted at a 90° angle. If and how to rotate infusion sites should be a subject for discussion between the patient and healthcare provider. You may achieve better results by periodically returning to sites that have worked well in the past.3

StomachNeedle Insertion

Adhesive Dressing

The dressing used can make a difference. 3M Tegaderm™ dressing, provided with every HIgH-Flo subcutaneous needle set, provides gentle adhesion without building to excessive levels over time, for easy removal.4 To release the adhesive, pull and stretch it out horizontally parallel to the skin. Any redness to skin should be only temporary.

References:

  1. Duff et al. Importance of Ancillary Supplies for Subcutaneous Immunoglobulin Infusion. J Infus Nurs. 2013; 36:384-390
  2. Younger ME et al. Nursing Guidelines for Administration of Immunoglobulin Replacement Therapy. J Inf Nurs. 2013; 36:58-64
  3. Duff et al. Nuts and Bolts of Subcutaneous Therapy. Immunol Allergy Clin N Am 2020; 40:527-537
  4. 3M, 3M™ Tegaderm™ Transparent Film Dressings Product Profile, https://multimedia.3m.com/mws/media/447983O/tegaderm-transparent-film-dressing-brochure.pdf Accessed Aug 19, 2020.

 

Related Publications

Importance of ancillary supplies for subcutaneous immunoglobulin infusion: management of the local infusion site

Nursing guidelines for administration of immunoglobulin replacement therapy

Nuts and Bolts of Subcutaneous Therapy

Quality Improvement Study to Evaluate Patient-Centered Outcomes and Infusion Parameters Using the HIgH-Flo Super26

Freedom Flow Rate
Calculator

Determine the tubing & needle combination for desired flow rate/infusion time
The Freedom Flow Rate Calculator is provided as a guide to assist healthcare providers in selecting the optimal Precision Flow Rate Tubing set and HIgH-Flo Subcutaneous Safety Needle Set for use with Ig in the FREEDOM60® and FreedomEdge® Syringe Infusion Systems.

Calculate in a few simple steps:

1. Choose your device
2. Choose the medication & input the dose
3. Choose flow rate tubing & needle set
4. Make sure that the flow rate per site and total infusion
time are within the range of medication prescribing information.

*The Freedom Flow Rate Calculator does not dose, nor is it intended to override or substitute for the directions of the prescribing medical professional. It is also the responsibility of the medical professional to have a complete understanding of the IgG drug’s package insert before use.

Calculate Now

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Step-by-Step Training Videos

Watch video on YouTube

FREEDOM60® Step-by-Step SCIg Training Video

Watch video on YouTube

FreedomEdge® Step-by-Step SCIg Training Video

Online Training

KORU is here to help! We offer regular online training sessions for nurses, healthcare providers, and pharmacists. In these sessions, we will provide an overview of the Freedom Integrated Infusion system and will allow all attendees the opportunity to ask questions.

Transitioning Patients to SCIg Therapy Training Session

Learn the best practices for successfully transitioning patients from IVIg to SCIg in light of recent reimbursement challenges for the Medicare population.

Register for Training

Freedom Systems Training for Nurses and Healthcare Providers

This 45 minute training session will explain how to get the best results with the FREEDOM60® & FreedomEdge® Syringe Infusion Systems from the start and minimize patient dropout. We will also focus on the benefits of HIgH-Flo Subcutaneous Safety Needle Sets™.

Register for Training

Resources

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Freedom Infusion Systems Patient Guide

Get a quick overview of the Freedom Infusion System, the benefi­ts of SCIg with Freedom and how to prevent adverse effects with the proper ancillary supplies.

Download

FREEDOM60® SCIg Infusion Mat

Use this tool to help walk you through your SCIg infusions with the FREEDOM60®.

Download

Download Spanish Version

FreedomEdge® SCIg Infusion Mat

Use this tool to help walk you through your SCIg infusions with the FreedomEdge®.

Download

IDF Resource Center

The Immune Deficiency Foundation's online Resource Center has an abundance of materials and tools to help patients and family members of those with Primary Immunodeficiencies stay informed.

www.primaryimmune.org/resource-center

IG Living

Join the immune globulin community with access to IG Living magazine, advocacy groups, expert opinions, and patients with rare diseases.

www.igliving.com

Jeffrey Modell Foundation

The Jeffrey Modell Foundation directs efforts toward early diagnosis, meaningful treatments, equal access to care, and ultimately, a cure for Primary Immunodeficiency.

www.info4pi.org

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Connections Blog

We think it's important to be able to share some of the amazing stories we come across and give a stronger voice to the rare disease community. Here you will find patient testimonials and can connect with others who have similar experiences.

We hope these stories will inspire, motivate, inform, and encourage!

*Please note that all blog posts are the opinion of the author, which may not necessarily reflect those of KORU Medical Systems and should not be taken as medical advice.

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Partners & Sponsors

As the leading manufacturer of Syringe Infusion Systems and Medical Suction devices, we are proud to partner with and support the leading organizations within our industries to provide valuable information to our customers.

The Immune Deficiency Foundation (IDF), founded in 1980, is the national non-profit patient organization dedicated to improving the diagnosis, treatment and quality of life of persons with PI through advocacy, education and research. IDF provides accurate and timely information for patients and families living with PI and offers valuable resources.

www.primaryimmune.org

NHIA is a trade association that represents and advances the interests of organizations that provide infusion and specialty pharmacy products and services to the entire spectrum of home-based patients. The website is available to serve its members, the infusion patient, physicians and others interested in learning about the infusion field.

www.nhia.org

The Infusion Nurses Society (INS), is a national nonprofit organization representing infusion nurses and all other clinicians who practice infusion therapy. Since 1973, INS has continued its commitment to bringing innovative new resources and learning opportunities to the wide range of healthcare professionals involved in the specialty practice of infusion therapy.

www.ins1.org

The GBS/CIDP Foundation International is working for a future when no one with Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and related syndromes such as multifocal motor neuropathy (MMN) suffers alone and that everyone has access to the right diagnosis and the right treatment, right away.

www.gbs-cidp.org

The Immunoglobulin National Society (IgNS) is a professional organization dedicated to the advancement of Ig therapy practice, across clinical indications and areas of practice with focus on promoting patient-centric initiatives.

www.ig-ns.org