| Desensitization protocol instructions: | |||||||
| 1. Confirm written consent is in medical record. Initial desensitization is performed in the medical ICU. | |||||||
| 2. Please ensure preceding dose of beta-blockers was held, unless otherwise advised by supervising physician. | |||||||
| 3. Obtain IV access, and vital signs (temperature, HR, BP, RR, oxygen saturation, peak flow). | |||||||
| 4. Have at bedside: Epinephrine 0.3 mg (for adult) for IM injection, peak flow meter, and BP cuff. | |||||||
| 5. A nurse must closely observe the patient throughout the protocol (one-to-one). | |||||||
| Premedications: Give diphenhydramine (25 mg IV) and famotidine (20 mg IV) 20 minutes before starting protocol. For patients with flushing during their initial hypersensitivity reaction, give aspirin (325 mg po) the night before and the morning of the protocol. For patients with respiratory symptoms during their initial reaction, give montelukast (10 mg po) the night before and the morning of the protocol. | |||||||
| Administration: Hang each solution successively, changing the rate every 15 minutes, per protocol. The IV tubing should be pre-flushed with the appropriate solution (1, 2, or 3) and attached at the IV hub, prior to starting infusion with each bag. There is no reason to wait between bags. Vital signs should be taken and recorded every 15 minutes, and every 30 minutes during the last step (step 12). | |||||||
| Name of medication: | Carboplatin | ||||||
| Target dose (mg) | 400 | ||||||
| Standard volume per bag (mL) | 250 | ||||||
| Final rate of infusion (mL/hr) | 75 | ||||||
| Calculated target concentration (mg/mL) | 1.6 | ||||||
| Standard time of infusion (minutes) | 200 | ||||||
| Total mg per bag | Amount of bag infused (mL) | ||||||
| Solution 1 | 250 | mL of | 0.016 mg/mL | 4.000 | 8.67 | ||
| Solution 2 | 250 | mL of | 0.160 mg/mL | 40.000 | 17.58 | ||
| Solution 3 | 250 | mL of | 1.588 mg/mL | 397.049 | 250.00 | ||
| PLEASE NOTE: The total volume and dose dispensed are more than the final dose given to patient because the initial solutions are not completely infused | |||||||
| Step | Solution | Rate (mL/hr) | Time (min) | Volume infused per step (mL) | Dose administered with this step (mg) | Cumulative dose (mg) | Fold increase per step |
| 1 | 1 | 1.9 | 15 | 0.47 | 0.0075 | 0.0075 | – |
| 2 | 1 | 4.7 | 15 | 1.17 | 0.0188 | 0.0263 | 2.5 |
| 3 | 1 | 9.4 | 15 | 2.34 | 0.0375 | 0.0638 | 2 |
| 4 | 1 | 18.8 | 15 | 4.69 | 0.0750 | 0.1388 | 2 |
| 5 | 2 | 4.7 | 15 | 1.17 | 0.1875 | 0.3263 | 2.5 |
| 6 | 2 | 9.4 | 15 | 2.34 | 0.3750 | 0.7013 | 2 |
| 7 | 2 | 18.8 | 15 | 4.69 | 0.7500 | 1.4513 | 2 |
| 8 | 2 | 37.5 | 15 | 9.38 | 1.5000 | 2.9513 | 2 |
| 9 | 3 | 9.4 | 15 | 2.34 | 3.7223 | 6.6736 | 2.481554688 |
| 10 | 3 | 18.8 | 15 | 4.69 | 7.4447 | 14.1182 | 2 |
| 11 | 3 | 37.5 | 15 | 9.38 | 14.8893 | 29.0076 | 2 |
| 12 | 3 | 75.0 | 186.875 | 233.59 | 370.9924 | 400.0000 | 2 |
| Total time: 351.875 minutes = 5.86 hours | |||||||
| Monitoring and charting during desensitization: | |||||||
| Please clearly document any reaction, including: | |||||||
| a. Patient's symptoms, vital signs, and physical findings; | |||||||
| b. Exactly when the reaction occurred (ie, what step, how many minutes into that step); | |||||||
| c. Treatment administered, how and when the reaction resolved, and when the protocol was restarted. | |||||||
| Treatment of allergic reactions: | |||||||
| 1. For mild reactions: In case of isolated itching, flushing, hives, mild chest tightness, nausea, abdominal pain, or back pain, with normal vital signs, stop the infusion and treat with IV diphenhydramine. Observe patient until the reaction subsides, and then resume the protocol at the last step that was tolerated. | |||||||
| 2. For severe reactions: In case of hypotension, throat swelling, wheezing/respiratory distress, or decreased oxygen saturation, stop the infusion and treat with Epinephrine 0.3 mg IM × 1, diphenhydramine and methylprednisolone IV, oxygen, nebulized albuterol for bronchospasm, and IV fluids (normal saline), per AHA guidelines. Place patient in a recumbent position if hypotensive. Consider glucagon 1-2 mg IV bolus if patient has taken beta-blockers, followed by infusion at 1-5 mg/hr. Immediately alert the housestaff and supervising physician. When the patient is stable, the protocol will be resumed as instructed by the supervising physician. Patient should be discharged with prescription for an epinephrine auto injector. | |||||||
| Contact the supervising physician for ANY severe or prolonged reaction, or any questions regarding the protocol, reactions, and appropriate management. | |||||||
