New YouTube Video - Gamma Daily Push

[susank]

@justy @Daffodil

Edit: Youtube link not working so:

Google:

Youtube - "My daily infusion process" by Shamandagans - 5/15/15
This is a great video. I do mine pretty much the same way.
Though....
I infuse thighs i/o belly.
I do not unwrap the Tegaderm cover until I am ready to use it. Sticky stuff!!
I use a different brand. Her vial says 20% - Hizentra? I use Gamunex 10%.
I think the higher the percentage the thicker is the solution? But not by much.
I don't use the RMS "thumback needle" infusion sets.
The RMS and other infusion needle sets typically are 26 or 27 gauge with 20-24" tubing.
The smaller the needle gauge means smaller tubing "gauge" - both making pushing a wee bit more difficult.
I also use smaller syringes. I have found the larger the syringer the harder to push.
I use 25g 3/4" butterfly needles.* 12" tubing which is larger "gauge" tubing.
Very easy to push through 25g 12" tubing with smaller syringe.
For those self paying - the BF's are about 50 cents. The RMS et al not that cheap.
I use the spikes to draw up the meds. But one could use a regular large gauge straight needles.
Again for self-payers - regular needles cheaper than spikes. And the needles don't create the bubbles.
Ask you doctor if you need Tegaderm. Yes, it keeps the needle in place and protects the site but
per box they can be kind of expensive. Perhaps there is a less expensive alternative?

Justy - thinking of you in regards to your upcoming appt. Hoping to help you understand how you can economically and easiy infuse Gamma SubQ. If you are planning to infuse small quantities make sure in advance that they have the smallest vials in stock. I think Gammanorm's smallest is 6cc? Once the vial is entered the contents must be used within a certain amount of time. You cannot use part of a vial and save the rest for another day.

*http://en.wikipedia.org/wiki/winged_infusion_set

 

[justy]

thanks, ill try and see if I can bookmark this page for reference before I go!

 

[justy]

no, I cannot work out the bookmark thingy - its too hard!!

 

[garcia]

 

[justy]

Good video, so no pump needed then?

 

[susank]

@garcia - thanks for uploading the video.
@justy - right - no pump.

The vid is great - but it is all easier than even that makes it look.
FWIW you probably could not get the tubing the gal uses anyway.
The RMS and others
like it are primarily used for those with immune deficiencies - infusing large volumes - with a pump and flow rate tubing. Those supplies typically come from a special infusion pharmacy.
You might note that she struggles a bit with the 20% Hizentra, the syringe and the thin, long tubing and tiny gauge needle.
It's so much easier with a butterfly needle/tubing and a syringe. (Read Dr. Shapiro's articles about this). BF's are also easier to find/purchase.

FWIW the manufacturers and the FDA (I think) say the SubQ Gamma must be infused with a pump. Any other way is considered "off label". Gamma is primarily Rx'd for immune deficiencies. I also don't know the "laws" about this in other countries. But of course doctors can Rx for SubQ push. Using just the infusion sets or butterfly needles and a syringe. No pump.

I have read where for very low doses one could even forego the pump AND the tubing.
Instead of injecting IM - inject it SubQ. Just needle and syringe.
Perhaps using diabetic needles on appropriately sized syringes.
Or using needles and syringes that folks use to give themselves B12 injections. ie 25g 5/8".

I am sure KDM has his way of doing these things - I just want to help you prepare - have in mind what the options are.

The thing with Gamma though is one really wants to infuse/inject much more slowly than with most other drugs.
For IVIG infusion rate can make a big difference in how tolerated. For SubQ some folks also think slower is better.

That's why using butterfly needles are so helpful. The needle is taped in place - you don't need a hand to hold it in place. That would be tedious and tiresome assuming you want to infuse/inject slowly. Even using the smallest vial of 6 cc.

KDM might offer you the option of using diabetic needles. The ones that are not permanently attached to a 1cc syringe. 26 or 27g 1/2" needles that you attach to the appropriate syringe size.
KDM probably has patients who (for small doses) (6cc/day) do something like three injections - different sites - of 2cc each - taking a break between injections.