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:
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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)
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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
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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 |
| The same symptoms as mild reactions and
| The same symptoms as moderate reactions and
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Action to be taken:
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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:
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