Create standardized IVIG and SCIG medication directions by selecting dose, route, frequency, and other key details. Notes to Pharmacy and SIG/Directions are generated automatically as you complete the form. How to use: Complete the required fields on the left to automatically generate Notes to Pharmacy and SIG/Directions on the right. Options Enter Prescription Details Administration Route - Select - Intravenous Immunoglobulin (IVIG) Subcutaneous Immunoglobulin (SCIG) Patient Type - Select - Adult Pediatric Age (Optional) - None - <2 y.o. 2-5 y.o. 6-12 y.o. Weight (Optional) Unit (Optional) - Select - Pounds Kilograms Vascular Access (Optional) - Select - Peripheral Central Port IV Method (Optional) - Select - Gravity Pump Infusion Method (Optional) - Select - Pump Subcutaneous Push Dose (Optional) Infuse ___gms intravenously Dose (Optional) Infuse ___gms subcutaneously Frequency every __ weeks Pump RateInfusion rates per manufacturer recommendation as tolerated. Split total dose (where clinically appropriate, round to nearest vial size) (Optional) Yes No Over how many days? (Optional) Hydration (Optional) N/A 0.9% Normal Saline D5W How Much (Optional) - Select - 250 mL 500 mL 1000 mL Infused over how many min? (Optional) - Select - 30 min 60 min Timing (Optional) - Select - Pre-IG Infusion Post-IG Infusion Pre and Post -IG infusion Concurrently with IG infusion Flushing Orders 0.9% Normal Saline 3mL intravenous (peripheral line) before and after infusion, or as needed for line patency. Heparin 10 units per mL 3mL intravenous (peripheral line) as needed for final flush. Flushing Orders 0.9% Normal Saline 10mL intravenous (central line/port) before and after infusion, or as needed for line patency. Heparin 100 units per mL 5mL intravenous (central line/port) as needed for final flush. Additional Prescription DirectionsInfuse total dose of immune globulin subcutaneously in 1 to multiple sites. Premeds (30 min before infusion) Diphenhydramine 25mg PO for mild reactions, may increase to 50mg for moderate/severe. Acetaminophen 650mg PO. PRN Meds Diphenhydramine 25mg PO q4-6hrs for mild reactions, may increase to 50mg for moderate/severe. Max 4 doses/day. Acetaminophen 650mg PO q4-6hrs for fever/headache/chills. Max 4 doses/day. Lidocaine 4% cream applied topically before needle insertion PRN site pain. Adverse Reaction Meds Epinephrine auto-inject 0.3mg IM for anaphylaxis Diphenhydramine 25mg PO for mild reactions, increase to 50mg for moderate/severe. Premeds (30 min before infusion) Diphenhydramine 1mg/kg for mild reactions, increase to 6.25mg for moderate/severe. Diphenhydramine 6.25mg for mild reactions, increase to 12.5mg for moderate/severe. Diphenhydramine 12.5mg for mild reactions, increase to 25mg for moderate/severe. Acetaminophen 10-15mg/kg PO PRN Meds Diphenhydramine 1mg/kg for mild reactions, increase to 6.25mg for moderate/severe. Max 4 doses/day. Diphenhydramine 6.25mg for mild reactions, increase to 12.5mg for moderate/severe. Max 4 doses/day. Diphenhydramine 12.5mg for mild reactions, increase to 25mg for moderate/severe. Max 4 doses/day. Acetaminophen 10-15mg/kg PO q4-6hrs for fever/headache/chills. Max 4 doses/day. Lidocaine 4% cream applied topically before needle insertion PRN site pain. Adverse Reaction Meds Diphenhydramine 1mg/kg for mild reactions, increase to 6.25mg for moderate/severe. Diphenhydramine 6.25mg for mild reactions, increase to 12.5mg for moderate/severe. Diphenhydramine 12.5mg for mild reactions, increase to 25mg for moderate/severe. Epinephrine auto-inject 0.15mg IM for anaphylaxis Epinephrine auto-inject 0.3mg IM for anaphylaxis Sig/Notes Section Copy Generated Content Notes to Pharmacy (Optional) Dispense 1 month of drug,pre_meds,PRN meds,DME,needles,syringes&ancillary supplies to establish access&administer med. Skilled nursing PRN to establish access,administer med&assess status&response to therapy. Action needed SIG/Directions (Optional)