Version June 2024
| Solution | Total volume | Concentration | Dose | |||
| Solution 1 | 250 mL | 0.080 mg/mL | 20 mg | |||
| Solution 2 | 250 mL | 0.800 mg/mL | 200 mg | |||
| Solution 3 | 250 mL | 7.937 mg/mL | 2000 mg | |||
| Step | Solution | Rate (mL/hour) | Time (minutes) | Volume infused per step (mL) | Dose administered with this step (mg) | Cumulative dose (mg) |
| 1 | 1 | 2.0 | 15 | 0.50 | 0.040 | 0.040 |
| 2 | 1 | 5.0 | 15 | 1.25 | 0.100 | 0.140 |
| 3 | 1 | 10.0 | 15 | 2.50 | 0.200 | 0.340 |
| 4 | 1 | 20.0 | 15 | 5.00 | 0.400 | 0.740 |
| 5 | 2 | 5.0 | 15 | 1.25 | 1.000 | 1.740 |
| 6 | 2 | 10.0 | 15 | 2.50 | 2.000 | 3.740 |
| 7 | 2 | 20.0 | 15 | 5.00 | 4.000 | 7.740 |
| 8 | 2 | 40.0 | 15 | 10.00 | 8.000 | 15.740 |
| 9 | 3 | 10.0 | 15 | 2.50 | 19.843 | 35.583 |
| 10 | 3 | 20.0 | 15 | 5.00 | 39.685 | 75.268 |
| 11 | 3 | 40.0 | 15 | 10.00 | 79.370 | 154.638 |
| 12 | 3 | 80.0 | 174.375 | 232.50 | 1845.362 | 2000.000 |
| NOTE: Each step is administered over 15 minutes. At conclusion of protocol, observe patient for 30 minutes. Next dose can be full therapeutic dose given by the desired route. | ||||||
| Total time = 339.37 minutes (5 hours 39 minutes). | ||||||
| Desensitization protocol instructions: | ||||||
| 1. Confirm written consent is in medical record. | ||||||
| 2. Ensure preceding dose of beta-blockers was held, unless otherwise advised by supervising clinician. | ||||||
| 3. Obtain IV access and vital signs (temperature, HR, BP, RR, oxygen saturation, peak flow). | ||||||
| 4. Have at bedside: Epinephrine 0.3 mg (for adults) for IM injection, oxygen, normal saline, peak flow meter, and BP cuff, albuterol, injectable preparation of diphenhydramine, and methylprednisolone. | ||||||
| 5. A nurse must closely observe the patient throughout the protocol (one-to-one). | ||||||
| Administration: Hang each solution successively. Each step is administered over 15 minutes per protocol. 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. | ||||||
| Monitoring and charting during desensitization: | ||||||
| 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: | ||||||
| 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 by repeating the step at which the reaction occurred. | ||||||
| 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 (adult dose) IM x 1, diphenhydramine and methylprednisolone IV, oxygen, inhaled albuterol for bronchospasm, and IV fluids (normal saline). Place patient in a recumbent position if hypotensive. Consider glucagon 1 to 2 mg IV bolus if patient has taken beta-blockers, followed by infusion at 1 to 5 mg/hour. Immediately alert the housestaff and supervising clinician. When the patient is stable, the protocol will be resumed as instructed by the supervising clinician. | ||||||
| Contact the supervising clinician for ANY severe or prolonged reaction or any questions regarding the protocol, reactions, and appropriate management. | ||||||
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
