Can Intravenous Immunoglobulin (IVIG) be administered through a peripheral intravenous line?

From the Guidelines

IVIG can be administered through a peripheral intravenous line in most cases, as long as a large vein is used to minimize irritation and phlebitis. When administering IVIG peripherally, it's essential to follow the specific product's guidelines and start the infusion at a slow rate (usually 0.5-1 mg/kg/min) and gradually increase as tolerated by the patient 1. Some patients may require premedication with acetaminophen, diphenhydramine, or hydrocortisone to reduce infusion reactions. The decision between peripheral and central access should consider the patient's vascular status, the planned duration of therapy, the concentration and volume of the IVIG preparation, and the patient's risk factors for infusion-related adverse events. Key considerations for peripheral IVIG administration include:

• Using a large vein to minimize irritation and phlebitis
• Starting the infusion at a slow rate and gradually increasing as tolerated
• Following the specific product's guidelines
• Considering premedication for patients at risk of infusion reactions
• Evaluating the patient's vascular status and risk factors for infusion-related adverse events. It is also worth noting that while the provided evidence does not directly address the administration of IVIG via peripheral line, clinical practice and other studies support its use in this manner, as seen in the treatment of Kawasaki disease where IVIG is administered as a single infusion over 10 to 12 hours 1.

From the Research

Administration of IVIG

• IVIG can be administered through a peripheral line, but the provided studies do not directly address this specific question 2, 3, 4, 5, 6.

Considerations for Administration

• The administration of IVIG requires consideration of the patient's condition, specific IVIG product used, history of migraine, and previously failed and successful therapies 3.
• Pre-treatment with analgesics, NSAIDs, antihistamines, or low-dose intravenous corticosteroids may be beneficial to avoid infusion-related rigors, headaches, and other adverse events 2.

Routes of Administration

• IVIG can be administered intravenously, and subcutaneous immunoglobulin (SCIG) is also an option for patients with primary immunodeficiency diseases 5.
• SCIG does not require venous access and is associated with fewer systemic adverse infusion reactions than IVIG 5.