| Description |
| Intravenous (IV) administration of infliximab, a tumor necrosis factor-alpha antagonist biologic therapy. Infliximab, a chimeric antibody, is administered in the form of periodic infusions (zero, two, and six weeks and, depending on the subsequent course of the disease, every six to eight weeks thereafter). |
| Contraindications to treatment |
| Known hypersensitivity to the drug or murine proteins |
| Active systemic or localized infections |
| History of infection related to a prosthesis that remains in place |
| Infection with human immunodeficiency virus |
| Active infection with hepatitis B virus |
| Congestive heart failure classified on the New York Heart Association scale as functional class III/IV |
| History of demyelinating disease |
| History of cancer (except when there has been no recurrence in the preceding five years and in the case of patients with basal cell carcinoma) |
| Patients with a history of systemic lupus erythematosus |
| Live vaccines should not be administered during treatment: yellow fever, German measles, measles, polio, or bacillus Calmette-Guérin (BCG) |
| Patient care during IV administration of infliximab |
| Objectives |
| To prepare patients physically and psychologically so that they undergo treatment in the best possible conditions |
| To ensure the patient's safety throughout the infusion process |
| To prevent treatment-related problems and ensure prompt detection of any such problems |
| Preparation of the patient before the procedure |
| Ascertain what the patient knows about the treatment they are about to receive |
| Patients may eat breakfast or lunch and take their usual medication unless they have a history of moderate to severe infusion reactions (risk of vomiting) |
| Make the patient comfortable in a seat or bed, depending on the preference and physical state of each individual |
| Check whether the patient's chart includes an order for laboratory testing before the procedure, and whether premedication has been prescribed |
| Personnel: nursing staff |
| Procedure |
| Personnel: nursing staff |
Materials:
- Esmarch bandage
- Cotton
- Antiseptic
- 20 G catheter
- Catheter securement dressings
- Pump
- Filter (pore size ≤1.2 microns)
- Infusion pump
- 10 mL syringe
- 21 G needle
- 10 mL of double-distilled water for each vial of infliximab
- Infliximab (store in refrigerator at between 2 and 8°C)
- 250 mL of 0.9% saline solution
|
| Implement laboratory testing order, if any, prior to infusion. Administer prescribed premedication, if any. This can only be diphenhydramine or hydrocortisone. |
| Check arterial blood pressure, heart rate, respiratory rate, and temperature at the start and after completion of infusion and whenever required by the patient's physical condition |
| Preparation of the drug |
| Aseptic technique |
| Reconstitute each 100 mg vial of infliximab with 10 mm of double-distilled water |
| Aim the double-distilled water against the side of the vial to prevent foaming |
| Ensure that the contents of the vial have dissolved completely, but avoid prolonged and energetic movements |
| Allow the solution to stand for five minutes |
The solution should be colorless to slightly yellowish and may contain translucent particles (protein)
- The solution should not be administered if it is inappropriately colored or contains visible opaque particles
|
| From the bottle of saline solution, withdraw a volume of saline equal to the volume of infliximab solution to be used in order to obtain a final volume of 250 mL and a concentration of between 0.4 and 4 mg/ml |
| The solution must be infused within three hours of reconstitution |
| Never dissolve infliximab in dextrose solution |
| Cannulate the venous line |
Administer the drug using a volumetric infusion pump
- The first, second, third, and fourth infusions should be administered over two hours (125 mL/hour)
- Starting with the fifth infusion, the dose can be infused in one hour (250 mL/hour)
|
| Assess response to treatment; if the patient does not present any anomalous symptoms, he or she can be discharged and return to normal daily activity |
| Patients must be instructed to telephone their clinician or the nursing staff if they experience any reaction symptoms after the infusion |
| Observations |
| Infusion time can be modified by the clinician responsible for the patient |
| Description of problems related to the procedure and remedial action |
| Acute infusion reactions |
| Mild in the presence of | Moderate in the presence of | Severe in the presence of |
- Headache
- Diaphoresis
- Throat irritation
- Lumbar pain
- Hyperemia
- Nausea
- Palpitations
- Itching
- Cutaneous eruption
- Flushing
- Vertigo
- Vomiting
| The same symptoms as mild reactions and - Dysphagia
- Hypotension or hypertension (± 20 mmHg with respect to baseline)
- Chest pain or tightness
- Edema of the face, hands, or lips
- Suffocating sensation
- Hyperemia (accompanied by a sensation of heat or fever)
- Hyperthermia (<39°C)
- Palpitations, tachycardia
- Urticaria
| The same symptoms as moderate reactions and - Severe hypotension or hypertension (± 40 mmHg with respect to baseline)
- Hyperthermia and chills (≥39°C)
- Swelling of the larynx or pharynx with stridor
- Dyspnea
- Severe bronchospasm
- Convulsive seizure
- Clinically significant chest pain
|
Action to be taken:
- Stop the infusion
- Monitor blood pressure, heart rate, respiratory rate, and temperature
- Notify the treating clinician
- If the reaction does not resolve, follow appropriate procedures for management of an acute reaction to infusion of infliximab
- If extravasation occurs, stop the infusion immediately, notify the treating clinician, attempt to aspirate the extravasated fluid with a 10 to 20 mL syringe, withdraw the IV line, mark the affected area, and follow the hospital's treatment protocol covering such events
|
| Important points |
| To ensure early detection of infusion reactions, monitor the patient's response to treatment |
| Ensure that the intravenous line is open |
| Assessment indicators |
| The nursing record should include details of the results of vital signs monitoring before and after treatment |
| The nursing record should provide details of the assessment of tolerance to treatment, that is, the occurrence or absence of incidents |
| Records |
The following information should be recorded:
- Vital signs
- The assessment and preparation of the patient prior to treatment
- Incidents (presence or absence) related to the procedure
- Assessment of the patient's condition after treatment
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