IMMUNOLOGY NURSING AT AUCKLAND CITY HOSPITAL

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IMMUNOLOGY NURSING AT AUCKLAND CITY HOSPITAL
AUCKLAND NEW ZEALAND - AOTEAROA SANCHIA
VOS CLINICAL NURSE SPECIALIST
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21 DISTRICT HEALTH BOARDSPopulation of 4.2
million-http//www.stats.govt.nz/
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GEOGRAPHICAL AREA SERVED
Consultants 3 part-time Fellow 1
full-time Registrar 1 full-time CNS
1 full-time RN research 1 part-time Dietician
1 part-time
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The Day Ward
One of our CVID patients receiving IVIG
replacement therapy
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PATIENTS ON Ig REPLACEMENT
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INTRAGAMP (Human immunoglobulin)

• Pooled plasma donated by NZ blood donors (Unique
  to NZ plasma from other countries is not used to
  make the NZ product)
• Sent to CSL Bioplasma in Australia for processing
  and returned to NZ
• Resulting product is a sterile preservative free
  solution 90 IgG, trace of IgA and IgM.
• Licensed in NZ as replacement therapy in PID
  certain disease conditions e.g. Guillain-Barre
  syndrome, ITP.

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IMMUNOGLOBULIN REPLACEMENT THERAPY

• Calculated at 400mg/kg body weight
• 74 intravenous IgG (IVIG) 3-4 weekly
• infused through peripheral vein via electronic
  infusion pump
• no after hour service
• work time lost
• stigma visible evidence impact choice of
  venous access
• 21 home subcutaneous infusions (SCIG)
• Graseby syringe drivers
• CSL Bioplasma trial in progress
• 5 home IVIG infusions

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ADVERSE EVENTS

• Rare
• patient with anti-IgA antibodies risk of
  haemolysis
• Often related to infusion rate
• infusions commenced at 60ml/hour, increased every
  15 min by 60ml if patient tolerant to a maximum
  rate of 240ml/hour
• those demonstrating side-effects rate not more
  than 150ml/hour
• premedication with antihistamine and paracetamol
  effective ( or NSAID)
• Observed events
• hypertension, back pain, rigor and headache
• Reported
• lethargy and mild backache 12 to 24 hrs post
  infusion

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SUPPORT GROUPS

• The Immune Deficiencies Foundation of New
  Zealand (member of IPOPI) www.idfnz.org.nz

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ACKNOWLEDGMENTS

• A sincere thank you to Dr Penny Fitzharris
  (Clinical Director) and Dr Miriam Hurst
  (Immunology Fellow).

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REFERENCES/RESOURCES

• www.stats.govt.nz
• www.nzblood.co.nz