Home therapy with Immunoglobulin

You have been diagnosed with antibody deficiency and you require Immunoglobulin (antibodies) replacement therapy. In most cases this is a life-long treatment. The treatment is either given via the Intravenous (into the vein) or the subcutaneous (under the skin) route. Immunoglobulin preparations can be given safely at home. The training programme at Salford Royal teaches suitable and willing patients and their carers how to self-administer a sub-cutaneous infusion of Immunoglobulin. How do I get on to the programme? We offer home therapy for all patients and we teach patients and their carers how to self-administer a sub-cutaneous infusion of Immunoglobulin. In special circumstances it may be possible for you to have your infusion at home administered by a trained nurse i.e. you may be elderly or have health issues or home circumstances which make it difficult to carry out the infusion independently. We will inform your GP that you are self-administering the infusions at home. The Immunology nursing team will arrange the application and establishment of the homecare service with a private healthcare company funded by the NHS. How will I be prepared for this training? Prior to commencing training, we will discuss with you your home environment and the process of taking delivery and storing the Immunoglobulin and equipment which may include a small fridge. You will start this training on a day care unit at Salford Royal with the Immunology specialist nurse during your infusion appointment time. You will be given a home therapy training pack giving you information regarding the self-administration of Immunoglobulin. If your relative/carer is to be trained, then they will need to accompany you for all weekly training sessions. 1

What will happen during the training? On the first training session: The specialist nurse will administer the infusion and show you all of the equipment required. There will be plenty of time to familiarise yourself with the process and equipment and ask questions. On subsequent sessions: You will self-administer your infusion on several occasions during your training. 6-8 weekly sessions are usually sufficient but sometimes more might be needed. We can adapt the teaching to your learning style and use appropriate guides and aids i.e. photos to help you complete the home therapy programme. You will be given a short questionnaire to complete to ensure that you have understood all aspects of immunoglobulin therapy at home, any issues that arise will be discussed with you before you self-administer at home. During the training the Immunology nurses will instruct the homecare company to deliver Immunoglobulin and equipment to your home ready for you to start selfadministering. A home visit can be carried out to identify any further problems or issues with selfadministering the treatment at home. Benefits of home therapy? You can self-administer in the comfort of your own home at a time which suits you. You will not need to take time off work or college to attend the hospital for infusions. You will have more independence and control over your treatment. What are the consequences of not complying with regular home treatment? You will have recurrent and frequent infections. You may have serious infections, such as pneumonia and possible severe life-threatening infections such as septicaemia and meningitis. Are there any alternatives to home therapy? You can receive infusions at Salford Royal administered by a different nursing team. You can receive infusions at a hospital nearer to your home if that can be arranged. 2 3

What happens once I am self-administering at home? Step by step guide to self-administering You must fill in infusion/ infection logs, recording the batch numbers of the infused immunoglobulin bottles and send completed ones to the Immunology team via post or e-mail. All batch numbers from your immunoglobulin are recorded on a national immunoglobulin database by the nurses. Bloods are monitored every 6 months, we will discuss arrangements for obtaining regular blood samples at your clinic visits. You must attend your Immunology follow-up appointment which is booked at least once per year. You will receive an appointment letter via post. If you have any worries or concerns regarding your treatment, you can contact the Immunology nurses or the secretary on the number below. We do not however, provide 24 hour or emergency cover. If you need urgent attention contact your GP or emergency service. 1 2 3 Wash your hands with soap and water. Clean infusion tray with soap and water and then with an alcohol wipe. Leave to dry. You will need to be assessed every 18-24 months to check you are self-administering correctly. Gather all equipment needed for infusion. 4 Check your Immunoglobulin product name, the dose and expiry date. Always make sure liquid is clear (without particles). Check you have the correct dosage and volume. 4 5

5 Wash your hands with soap and water or use hand gel. 9 Clean area of skin where needles are to be inserted. Sites that can be used: Abdomen Thighs Arms 6 Draw up at least 10mls of air. Then draw up the Immunoglobulin infusion contained in the vials into one or two separate 50ml syringes depending on volume to be infused. 10 Insert the needles by pinching skin (as shown). 7 Attach tubing to the syringe (F600, F900, F1200). Making sure not to touch any key parts. 11 Tape the needles in place. 8 Attach needle set to the tubing. Push the syringe plunger to fill the tubing with Immunoglobulin as far as the needles. 12 Pull back slightly on the syringe to ensure correct position of needles and to check for any bleeding back into the tubing. Clamp off any sites which have blood present. DO NOT RESITE NEEDLES 6 7

13 Insert syringe into the Freedom 60 pump and switch on (as shown). If you require further information or wish to discuss any issues with the immunology specialist nurses please contact us: Notes 14 Once infusion has finished, remove tape and needle from skin and cover area with gauze and tape. Immunology Specialist Nurses Secretary: Email: 0161 206 5576 0161 206 5022 salfordimmunology. nurses@nhs.net 15 Dispose of all needles (as shown) Other useful resources www.srft.nhs.uk (Clinical Immunology section) 16 Record batch numbers and all other relevant information required on the log sheets provided. www.piduk.org www.ipopi.org 8 9

G17031502W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: CS20(17) Review Date: April 2019 For further information on this leaflet, it s references and sources used, please contact 0161 206 5576 Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients