Guide – Setting up a Subcutaneous Immunoglobulin (SCIg) program in a hospital
ASCIA HP Guide setting up SCIg Program 2019236.51 KB
Immunoglobulin replacement therapy (IRT) is the standard treatment for most children and adults with primary immune deficiencies and some other medical conditions. The aim is to replace immunoglobulin to maintain normal IgG levels. The dose used is individualised for each patient. IRT may be given as intravenous immunoglobulin (IVIg) or subcutaneous immunoglobulin (SCIg) and pharmacokinetics differ according to administration route.
When prescribing SCIg or IVIg, you must ensure that doses are rounded to the full vial size. Immunoglobulin is a plasma derived product and is a limited resource. Prescribing a dose that uses a partial vial results in unnecessary wastage. Vial sizes vary between different products. This must be taken into account before prescribing.
Whilst there are multiple brands that may change over time and rates of administration vary for different products, both IVIg and SCIg:
- Are effective at reducing infections and hospitalisations
- Preserve organ function and reduce long term damage from recurrent infections
- Are associated with significant benefits to patient quality of life
- Improve the lifespan of patients
Issues to consider when setting up a SCIg service
- Australian hospitals are required to be ‘SCIg approved’ by the National Blood Authority (NBA). For further information go to www.blood.gov.au/Ig-governance
- Once a hospital is “SCIg Approved” the site needs to be NBA Bloodstar (Australia) registered. To gain access to SCIg for their patients, all medical officers or nurse practitioners (prescribers) and nurses involved in the management of patients requiring SCIg also need to be registered on NBA Bloodstar. The health site does not need to register the patient. A patient is registered on Bloodstar when the Australian Red Cross Blood Service (ARCBS) approves them for SCIg use. For further information go to blood.gov.au/bloodstar
- In New Zealand individual clinicians are required to seek authorisation from New Zealand Blood Service for the administration of immunoglobulin to individual patients. Where treatment is managed under the care of a District Health Board (DHB) approval must also be gained from that DHB’s local immunoglobulin authority (e.g. immunoglobulin committee). For further information go to
www.nzblood.co.nz/Clinical-information/Transfusion-medicine/Information-for-Health-Professionals/Request-forms
- Does your hospital or region have an immunoglobulin (SCIg/ IVIg) policy or guidelines in place?
What teaching/training resources are available? To review the ASCIA Position Statement on SCIg go to
www.allergy.org.au/hp/papers/scig
Other ASCIA resources are available at www.allergy.org.au/immunodeficiency
For further information contactThis email address is being protected from spambots. You need JavaScript enabled to view it.
- What SCIg products are available in Australia and New Zealand?
For further information go to blood.gov.au/SCIg or www.nzblood.co.nz/clinical-information/transfusion-medicine/health-professionals-medicine-datasheets/immunoglobulins/
- What are the pros and cons of SCIg delivery methods? (refer to table 2 in this document)
- SCIg product ordering process for the hospital and collection process for the patient. Issues to consider include:
- Nursing resources
- Cold chain and transport
- Prescription (if required) and associated dispensing fee to the patient
- Frequency and place of collection
- Special consideration for rural and remote patients
- Long term management of patients on SCIg. Issues to consider include:
- Trouble shooting with SCIg and contact details of dedicated staff readily available to patients when assistance is required or when things do not go to plan (these details should be noted in treatment plan)
- Nursing resources
- Reporting and management of adverse reactions
- Traveling with SCIg
- Patient diaries
- Supply of consumables
Table 1: Comparison of Pros and Cons of IVIg and SCIg therapy
|
Pros |
Cons |
IVIg |
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|
SCIg |
|
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Source: Adapted from APIIEG
Table 2: Comparison of Pros and Cons of SCIg infusion methods
|
Pros |
Cons |
Manual: Rapid Push |
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Mechanical infusion pumps: Spring loaded (e.g. Springfusor, SCIG 60, Freedom 60) |
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Mechanical infusion pumps: Battery powered (e.g. Nikki T 34, T34L) |
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Table 3: Suppliers of SCIg equipment - pumps and consumables
Supplier | Website | ||||
Niki T34 syringe driver |
Caesarea Medical Electronics IDFNZ will fund members in NZ |
www.remsystems.com.au/suppliers/caesarea-medical-electronics/ |
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SCIg 60 infusion system |
EMED Technologies |
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Go Medical Springfusor® |
LTR Medical |
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Freedom 60 infusion system |
Medical Devices |
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Freedom Edge infusion system |
Medical Devices |
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Winged infusion sets (25 or 24 gauge) |
Terumo |
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Soft-Glide single lumen or double lumen sets (various gauge sizes) |
EMED Technologies |
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Neria® single lumen or multi-lumen sets |
Clinect |
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HIgH Flo single lumen or multi-lumen sets |
Medical Devices |
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Go Medical FCT (flow control tubing) for Springfusor® (various flow rates) |
LTR Medical |
© ASCIA 2019
ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.
ASCIA resources are based on published literature and expert review, however they are not intended to replace medical advice.
This resource has been developed independently by ASCIA as part of the ASCIA SCIg project. Whilst CSL Behring provided an educational grant to assist this project, the content is not influenced by any commercial organisations.
Content updated December 2019