Intravenous immunoglobulin is not an ordinary item on a long-term care medication cart. It is a plasma-derived product released through provincial or regional controls and administered at a prescribed rate with observation. A person who receives IVIG every few weeks needs an unbroken chain from the authorizing consultant to the blood bank, infusion clinic, travel provider and nursing team receiving the person back.
Before a move, show homes exactly how a complex recurring treatment operates, assign responsibility for medicine and consultant follow-up, and compare Canadian long-term care homes by location and services.
Draw the complete product-to-patient chain
Start with the indication, provincial authorization, ordering physician, product source, dispensing blood bank and infusion location. Add the person who renews the order and the date authorization is next reviewed. Canadian guidance directs clinicians to the applicable provincial or regional criteria; an approval in one jurisdiction or hospital does not necessarily travel with the patient.
Mark every handoff with a name and telephone number. The long-term care prescriber needs awareness of the regimen, but should not be assumed to take over a neurologist’s, immunologist’s or hematologist’s authorization. The family should not carry privately obtained product between sites unless the supplying program expressly directs it.
Create a one-page IVIG passport
Use a concise document that travels with the person: diagnosis, treatment goal, current product, prescribed dose, usual rate, last infusion, next due date, venous-access history, allergies and prior reactions. Include relevant kidney, thrombosis and fluid-balance risks, baseline weight, laboratory requirements and emergency contacts. Label the issue date so an obsolete copy is obvious.
Attach the authoritative order rather than transcribing it into family notes. A product or rate may change because of supply or tolerance. The clinic and facility should reconcile the passport after each alteration, while the formal medication and blood-product records remain the legal clinical source.
List the exact reaction history by product, rate and timing. “Allergic to IVIG” is less useful than a dated description of headache at one rate, rash after another brand or an emergency intervention. The authorizing and administering clinicians decide what that history means for the next dose.
Calculate the door-to-door burden
Measure the entire cycle: early preparation, wheelchair or stretcher transfer, check-in, cannulation, gradual rate increases, observation, delayed finish and return. A four-hour infusion may consume most of a day. Compare homes using road reliability, winter conditions, accessible vehicles and the clinic’s actual booking window, not kilometres alone.
Decide who accompanies a person with cognitive, communication or mobility needs and who pays. Pack continence supplies, mobility aids, permitted food, warm clothing and the IVIG passport. Create a backup for a ride that fails after the clinic closes; do not assume an ambulance will be appropriate or publicly funded.
Check whether the clinic chair, washroom and transfer equipment suit the person for several hours. A patient who cannot tolerate prolonged sitting may need positioning directions and pressure-area support agreed in advance, not an improvised solution after cannulation.
Use a day-before decision gate
The infusion program should specify which symptoms, recent infections, hospital admissions, laboratory results, weight changes or new drugs must be reported before travel. Turn that requirement into a dated nursing check. The residence should telephone the clinic about a material change instead of sending the person to be assessed at the door.
Hydration, premedication, diuretics and drugs to hold are individualized orders. Frailty, heart or kidney disease may change what is safe. Staff should follow the current instruction sheet, never a universal “IVIG routine” copied from another patient.
Name who reviews laboratory results and weight before release of the dose. If blood was collected at the facility, verify that the result reached the correct clinic and is recent enough under its protocol. A completed blood draw is not the same as a cleared infusion.
Close the loop on infusion day
Canadian Blood Services describes slow initiation, repeated vital signs and rate escalation according to tolerance. Those decisions belong to the administering clinicians. The outgoing handover should state baseline condition and recent concerns; the return note should state product, dose, maximum rate, reaction, interventions, follow-up and next proposed date.
On arrival back, record time, cognition, mobility, intake and symptoms against baseline. Follow the clinic’s observation and escalation directions. Headache, chills, fever, nausea or rash may occur, while serious reactions are uncommon but require prompt recognition. Staff must not dismiss a new deficit as routine fatigue.
Give evening and night staff the return time and delayed-reaction directions at handover. Document which number is used for a non-emergency concern and which symptoms require emergency assessment. The protocol must remain usable after the daytime nurse and family have left.
Protect venous access and supply continuity
Repeated difficult cannulation deserves reassessment by the infusion team. If a device is proposed, document who maintains it, what other uses are permitted and which signs trigger urgent assessment. The care facility should not access a line merely because it is present.
Product availability can change. Keep the clinic’s rescheduling contact and ask the prescriber what interval variation is acceptable for this indication. Never borrow another patient’s stock, change brands independently or double a later dose after cancellation.
Audit benefit and burden every few cycles
Bring the consultant a short trend: completed and missed doses, reaction severity, recovery time, falls, fatigue, functional goal and relevant laboratory or disease measures. The point is not for the facility to decide whether IVIG continues; it is to give the authorizer enough evidence to judge response, dose, interval and alternatives.
Revisit the logistics after functional decline or a provincial move. Subcutaneous immunoglobulin or another delivery arrangement may suit some indications, but requires clinical approval, training and supply. It is not a family-led substitution for travel difficulty.
Can long-term care nurses hang IVIG in the facility?
Routine registered-nurse coverage does not establish blood-product storage, pharmacy release, vascular access, infusion pumps, monitoring competence and emergency support. Some specialized programs may operate differently. Obtain written confirmation from both the facility and responsible blood-product program; otherwise plan for an external clinic.
What happens when a scheduled dose is postponed?
Contact the infusion clinic and authorizing physician for case-specific directions. Record why it was delayed, any symptoms and the replacement date. Do not shorten the interval to the next dose, change the rate or treat a booking as proof that product will be available.
Which IVIG facts must be settled before move-in?
Settle authorization, prescriber, product source, infusion unit, order, laboratory checks, preparation, travel, companion, reaction directions, return observation and reassessment directly with the consultant, clinic and facility. Provincial rules and supply can change. This guide does not determine eligibility, dose, infusion setting or treatment suitability.