Presentation on theme: "Immunology nursing in the Czech republic today"— Presentation transcript:
1Immunology nursing in the Czech republic today Teplá IlonaKrálíčková PavlínaInstitute of Allergy and Clinical Immunology University Hospital Hradec KraloveCzech Republicsources: foto oficial pages in the Internet
2Introductionsources : oficial pages in the Internet / foto learning centre of the University Hospital Hradec Kralove
3The main pointsStatistical survey of our patients in the Czech PID databasePractical aspects in the administrationImmunoglobulin supplementation therapy and comparisonIVIG x SCIGMost frequent questions/difficulties with the administrationConclusionDiscussion
4Statistical survey of PID patients /Czech republic/Actual status • general descriptions of database / immunoglobulin therapy/ • comparison of status in particular centres /referential values/Czech PID registry, export of data 09/2014
5Statistical survey of PID patients /Czech republicnumber of patients% of valid casesTotal evidence68488,6%Actual monitored66488,7%CentreNumber of patientsvalidFNUSA Brno - Ústav klin. imunolog. a alergolog.15698,0%FN Motol - Ústav imunologie15192,4%FNHK - ÚKIA7993,7%VFN Praha - Ústav imunologie a mikrobiologie59100,0%FN Plzeň - Ústav imunologie a alergologie4364,3%ZÚ ÚnL - Odd. klin. imunologie a alergologie3597,0%IKEM Praha - Klinická a transplantační medicína2986,2%FN Olomouc - Odd. alergologie a klin. imunologie21Nemocnice České Budějovice - Imunologické oddělení1888,9%Zlín - Plicní oddělení, KNTB a.s.14ZÚ Ostrava - Oddělení imunologie a alergologieFN Brno - Pediatrická klinika1391,7%FNHK - Klinika dětského lékařství11FNKV Praha - Odd.alergologie a klin. imunologie90,9%FN Olomouc a LF UP - Dětská klinika366,7%Tábor-Kasmed s.r.o., alerg., imunolog, neurolog.FN Ostrava - Alergologie250,0%Krnov SSZ - interní oddělení
6Statistical survey of PID patients /Czech republic/N=664(Currently monitored)Male (N=300)Female (N=364)
9Practical aspects in the administration Optimal IgG doses and target trough levels are individual(clinical symptoms, comorbidities, genetic factors)The route of administration could be the result of discussion (patient X nurse X doctor)Negative influence - financial conditions in hospital- statement of insurance company- economical tender of immunoglobulinpreparation
10Practical aspects in the administration IVIG therapyAdvantages - cheaper in the Czech Rep.- administration ones/twice a month- more often checking of clinical status andlaboratory resultsDisadvantages - administration at outpatient department (traveling, day off work)- higher risk of adverse events- more often intolerance of administered preparation- necessary good venous access
11Practical aspects in the administration SCIG therapyAdvantages - home therapy with independence- comfort, flexibility- less frequent visits at the doctor- better tolerance of Ig preparations- low side effect profile (no severe systemic)- alternative for patients with poor venous access- benefit in case of gastrointestinal losses, malnutrition- flexibility of dosing and ease of administration
12Practical aspects in the administration SCIG therapyPractical aspects in the administrationDisadvantages/limitations- fear from the inject or the needle- administrations 1-3 times a week- intolerance (local skin reactions, scars, stretch marks)- risk of lower compliance
13SCIG therapyIt is important to doing difference between methods of subcutaneous administrations, preparationsIndividual approach to each patientChoose areas from recommended sitesfor the administration /abdomen, outer/inner thighs, hips, upper arms/Specific role of trained nurses inthe education of patientsIt depends on the constitution of the patient,the thickness of the subcutis and type of needles
14SCIG therapy Subcutaneous administration method rapid push /patient can adjust the rate of the infusion according to his tolerance without using the infusion pump/….Rapid push significantly higher infusion rate (60ml/h x 20ml/h)….Patients with 10ml and less per one site prefer rapid pushby the infusion pump /there should keep recommended rateof the infusion/….Infusion pumps provide pharmaceutical firms….Comparable efficacy and tolerability
15Our own experience – centre Hradec Kralove, Czech Rep. 47 patients regularly on Ig substitution therapy27/47 IVIG20/47 SCIGSCIG with pump since … 2007 to Oct 2014: 9 patients(3 died, 1 switched to IVIG – medication intolerance)Rapid push since …2012 to Oct 2014: 11 patients(2 switched to IVIG – 1 case patient preference, one case unsatisfactory IgG level and patients reluctance to increase Ig doses)
16Side effects – pump x rapid push No serious systemic reaction• including patient experienced moderate systemic reaction - IgA antibodies• 1 case - intolerance of two different preparations (fatigue)Local reactions:Pump: infrequently haematomaRapid push:→ 2/11 mild itching, erythema→ 2/11 pain during administration (change of the injection site to the inner thigh)
17Often problems with administration / by patients and nurse´s view
19Practical experienceGiving enough practical information to the patient by a nurse-specialistExplanation of the whole procedure (initiation of SCIG therapy)or providing an instructional videoDemonstration of administrationReassurance of the patient (patient in home therapy after regaining certainty in the administration)
20Question 1:There are enlarged pores, which are usually disappear for a day, the area is painful. Shall I continue with the application?There is the skin apparently attenuated (stretch marks, etc.) …You will try to change the site. We choose a different area from the recommended injection sites. Mainly it depends on the tolerance of the patient ..We had same patient in our department with this problem and she solved it just changing of the injection site. She started to administer to the inner side of thigh and she was satisfy.
21Practical experience- possibility of the administration
22Question/difficulties 2: There are stretch marks around the abdomen and it is very limited the choice to other site.outside stretch marks (scars)it depends again on the constitution of the patient,the thickness of the subcutis
23Question 3: The injection site is after the infusion leakage or wet … There was probably made too shallow the introducing of the needle. The needle was only a little bent or it was just a poor implementation. We have tested for example bending the needle to the angle of 90 degrees /method rapid push/, the introduction of the needle is deep enough to the preparation is well absorbed and well tolerated by the patient.the bending of the needle to 90°degrees is recommended in the administration to the abdomen (special type of the needle) and there is stronger thickness of the subcutis
24Practical experience- possibilty of administration
25Question 4:The injection site is after administration indurated and painful and it has been disappear for a long time..…The dose of the liquid is probably too large on the thickness of the subcutis. We will try to divide the dose into two or more administrations. New sites should be at lest 2 inches apart.We should have been always consulted with the doctor.
26ConclusionImmunoglobulin supplementation therapy represents a corner stone in the treatment of patients with disturbance of specific antibody production. The correctly guided treatment leads to decrease of severe illnesses and improve the quality of life. I am glad that I can participate in it.There were used information from the official websites www. hizentra.com and the Internet .