Subcutaneous immunoglobulin (SCIg) therapy

pdfASCIA PCC SCIg general information 2018307.11 KB

Immunoglobulins (commonly known as antibodies) are used to treat adults and children with primary immune deficiencies (and other medical conditions), who are unable to make enough of their own antibodies, or who have antibodies that don’t work properly.  Replacing these antibodies helps to protect against infection and can prevent long term damage from ongoing infections (such as chronic lung disease).

Subcutaneous Immunoglobulin (SCIg) infusions are given by slowly injecting purified immunoglobulin into fatty tissue just underneath the skin.  SCIg can be given at home, using a mechanical infusion pump (spring loaded or battery powered) or by rapid push (a manual method that does not require a pump - infusion is pushed by hand through a syringe).

What are the risks associated with SCIg? 

SCIg is very well tolerated and safe.  SCIg is made from plasma (the liquid part of blood), which comes from blood donors who are checked to make sure they are healthy and do not have certain infectious diseases. This means that there is an extremely low (almost zero) chance of blood borne viruses (such as Hepatitis B, Hepatitis C, HIV and Variant Creutzfeldt-Jakob disease (also called “mad cow disease”).   

Reactions or side effects to SCIg include:

If a reaction occurs you must inform your nurse specialist or doctor as soon as possible and get advice before having any more infusions. For information about managing reactions see pages 5 and 6 of this document.

What needs to be done before starting SCIg? 

Before you start on SCIg, your nurse specialist will provide you with information and training on how to give SCIg at home. You will need to sign a consent form to say that you understand the need for treatment and the chance of reactions that may occur with the treatment. 

Choosing a SCIg infusion site

Using the same site for infusions can help reduce the amount of local swelling and redness that can occur after an infusion.  Usually the lower abdomen will be used. However, the outer edge of the thigh or back of the upper arm can also be used for SCIg infusions.  Avoid bony areas such as the hips.

When using the lower abdomen in adults and most children, the needle should be inserted at least 5cm away from the belly button. If using more than one site at a time, make sure they are at least 5cm apart.

Before you infuse, have your equipment ready (see checklist). It is recommended you have a cold pack, a non-drowsy antihistamine and an analgesic (pain medication) available in case of a mild reaction.

The shaded areas shown below can be used for insertion of the needle:

SCIg infusion site

Note: Do not insert the needle where the skin is scarred, bruised, broken or inflamed (such as eczema).

Examples of SCIg infusions:

Boy having SCIg infusion using a pump

boy with infusion pump

Patient inserting needle in the fat under the skin in order to give a SCIg infusion

needle insertion

Documenting the SCIg infusion

The details of each infusion session must be recorded in a SCIg Infusion diary. Your nurse specialist or doctor will give you a SCIg infusion diary and will explain the information you will need to record. Completed diaries must be available for review by your nurse specialist or doctor at each outpatient clinic visit.

Ordering, collection, transport and storage of SCIg 

If you have a power or refrigerator failure and are unable to keep SCIg refrigerated:

Product from a vial is for single use only:

SCIg Product - Hizentra®

SCIg Product - Evogam®

Checking SCIg vials before an infusion

All SCIg vials should be checked for the following prior to an infusion:

Contact your nurse specialist if any of the above happens.

Travelling with SCIg 

Travelling with SCIg requires planning well beforehand. A dose of Intravenous Immunoglobulin G (IVIg) before you travel may be a convenient alternative option. For shorter periods of travel, you may give the SCIg doses due as extra SCIg infusions before and after the trip.  Speak to your doctor or nurse specialist for advice well before travelling, especially overseas. 

When planning a trip:

If unwell, pregnant or breastfeeding

Contact your doctor or nurse specialist for further advice if:

Your doctor and nurse specialist will work with you to develop a plan for who, how and under what circumstances you will need to contact someone if you or your child have an adverse reaction.

SCIg and vaccinations

Some immunisations may not be required while on SCIg.  Discuss this with your doctor.

Managing side effects of SCIg

Common reactions at the injection site include swelling (egg sized lump), “hardness”, blanching and redness at the infusion site. These local reactions are normal and short lived (usually gone by the next day).  They are more common in people who have just started SCIg, especially in the first few months.

Using the same site for SCIg infusions can help to reduce the amount of local swelling and redness that can occur after an infusion.  Over time, the skin will “get used” to the repeated infusions, and local reactions will lessen.  Most people start to notice a decrease in local reactions after about 8-10 weeks.

If an injection site reaction occurs:

 Mild infusion site reaction:

mild reaction at site

Moderate infusion site reaction:

moderate reaction at site

Pictures courtesy of Wasserman RL.  Patient Prefer Adherence. 2008; 2: 163–166 

Management guide for SCIg infusion site reactions and problems 

Site Issue

Possible Cause/s

Management Options

Redness

Common reaction, which usually settles over 24 hours.

If redness is excessive:

  • In some cases it may be due to an allergy or sensitivity to tape. 
  • Needle may not have been inserted correctly or needle may be too short.
  • If it does not cause discomfort, do nothing.
  • Warm or cold pack for short periods may help with discomfort
  • Wrap warm/cold packs in a cloth - do not apply directly to the skin
  • Slow the infusion rate if uncomfortable
  • Try using an over the counter non-drowsy antihistamine
  • Check correct needle placement/length with your nurse specialist
  • Consider alternative tapes/dressings to secure needle/s with your nurse specialist

Swelling

Common reaction, which usually settles over 24 hours, resulting from the amount of fluid being infused underneath the skin (amount of swelling should relate to the volume being infused).

  • If it does not cause discomfort, do nothing
  • A warm pack for short periods may help with absorption.
  • A cold pack for short periods may help with discomfort, but delays absorption 
  • Wrap warm/cold packs in a cloth - do not apply directly to the skin
  • Take a walk to help with absorption
  • Check correct needle placement/length with your nurse specialist
  • May need to decrease volume at the site, reduce the rate or change the infusion site. This should be discussed with your nurse specialist

Itching or burning

  • Incorrect needle placement
  • Incorrect needle length
  • Irritation from tape
  • Ig at needle tip, causing skin irritation
  • Do not scratch or rub
  • Check needle placement and length
  • Try using an over the counter non-drowsy antihistamine
  • Consider alternative tapes/ dressings to secure needle/s
  • Apply cold pack for short periods - wrap pack in a cloth - do not apply directly to the skin
  • Discuss dry priming with your nurse specialist

Pain with infusions

  • Incorrect needle placement
  • Incorrect needle length
  • Infusion going too fast
  • Check needle placement/length
  • Apply cold pack for short periods - wrap pack in a cloth - do not apply directly to the skin  
  • Slow infusion rate
  • Try simple pain medication (such as paracetamol) before starting the infusion
  • Take a walk to provide a distraction
  • Check tape placement for pulling on skin or body hair
  • Discuss with your nurse specialist

Blanching (whiteness)

Normal tightening of tissue that can occur as SCIg infuses into the fatty tissue under the skin.

  • Do nothing, usually goes away on its own when the fluid is absorbed
  • Warm pack for short periods (may assist absorption) - wrap pack in a cloth - do not apply directly to the skin

Leaking from the infusion site

  • Incorrect needle insertion
  • Incorrect needle length
  • Amount of volume infused at the site
  • Check needle insertion
  • May need to consider changes to volume, needle length or rate of infusion.
  • Speak to your nurse specialist or doctor.

Management guide for other reactions to SCIg

Management guide for other reactions to SCIg 

© ASCIA 2018

ASCIA is the peak professional body of clinical immunology and allergy specialists in Australia and New Zealand  

Disclaimer

This document has been adapted with permission from resources developed by Princess Margaret Hospital Immunology Department (Department of Health, Western Australia).  It has been peer reviewed by ASCIA members and is based on expert opinion and the available published literature at the time of review.  Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner. Development of this document is not influenced by commercial organisations.

Content updated June 2018