Adult Hypersensitivity (HSR)/Allergic Reaction Management

Transcription

1 Page 1 of 5 Patient with HSR to medication (For blood product related HSR see Page 2) PRESENTING SYMPTOMS Fever 1, chills, and/or rigors Acetaminophen within 4 hours or Stem Cell Transplant patient? Call the Attending or On-Call Physician for additional instructions Give Acetaminophen 1,000 mg PO for 1 dose per order set STOP Infusion and monitor vital signs every 5 minutes Call the On-Call Physician STAT and notify the Attending Physician Itching, facial flushing hives (urticaria), rash Hypotension 2, wheezing, shortness of breath, facial/lip/ tongue swelling Other signs or symptoms of HSR/ allergic reaction Give Diphenhydramine 50 mg IV push over 2 minutes Place pulse oximeter. Start O 2 at 2 liters/minute by nasal cannula if saturation less than or equal to 92%. Start rmal saline at 150 ml/hour Call the On-Call Physician for instructions 1 Fever defined as greater than 38.3 C or greater than or equal to 38 C for 1 hour or longer 2 Hypotension defined as a systolic blood pressure (SBP) less than 90 mmhg or a drop in SBP of more than 20 mmhg from baseline 3 HSR/Allergy Kit includes the following (all in tamper-evident bag): Epinephrine 1:1,000 vial Tuberculin syringe (1 ml) with needle Diphenhydramine 50 mg vial Tuberculin syringe (1 ml) with needle Hydrocortisone 100 mg vial 3 ml syringe and 20 G, 1 inch needle Improvement within 5 minutes? Hydrocortisone 100 mg IV push over 1 minute and repeat Diphenhydramine 50 mg IV push over 2 minutes Epinephrine 1:1, ml subcutaneously, followed by Diphenhydramine 50 mg IV push over 2 minutes (if not administered within last 30 minutes), followed by Hydrocortisone 100 mg IV push over 1 minute te: Utilize HSR/Allergy Kit 3 in Pyxis and order set Evaluation and disposition by On-Call physician; re-evaluate need for IVF Additional orders per On-Call Physician Documentation 1) Use HSR/Allergy Order Set to document management utilized for an individual patient. 2) Enter as Observed Adverse Drug Reaction (ADR) in Nursing Documentation in OneConnect.

2 Patient with HSR to blood product transfusion PRESENTING SYMPTOMS Fever 1, chills, and/or rigors Itching, facial flushing, hives (urticaria), rash Hypotension 2, wheezing, respiratory distress 3, facial/lip/tongue swelling Other signs or symptoms 4 of HSR/ allergic reaction Management of Blood Product Transfusion Reaction-ADULT STOP blood product transfusion and monitor vital signs every 5 minutes Call the On-Call Physician for instructions Give diphenhydramine 25 mg IV push over 2 minutes Continue transfusion Monitor vital signs every 5 minutes STOP blood product transfusion and monitor vital signs every 5 minutes Call the On-Call Physician for instructions Place pulse oximeter Start O 2 at 2 liters/minute by nasal cannula if saturation less than or equal to 92% Start rmal saline at 150 ml/hour STOP blood product transfusion and monitor vital signs every 5 minutes Call the On-Call Physician for instructions Improvement within 15 minutes? STOP blood product transfusion and monitor vital signs every 5 minutes Hydrocortisone 100 mg IV push over 1 minute and repeat Diphenhydramine 50 mg IV push over 2 minutes Epinephrine 1:1, ml subcutaneously, followed by Diphenhydramine 50 mg IV push over 2 minutes (if not administered within last 30 minutes), followed by Hydrocortisone 100 mg IV push over 1 minute te: Utilize HSR/Allergy Kit in Pyxis and Order Set or SmartSet HSR/Allergy Kit includes the following (all in tamper-evident bag): Epinephrine 1:1,000 vial Tuberculin syringe (1mL) with needle Diphenhydramine 50 mg vial Tuberculin syringe (1mL) with needle Hydrocortisone 100 mg vial 3 ml syringe and 20 G, 1 inch needle Evaluation and disposition by On-Call Physician; re-evaluate need for IVF Page 2 of 5 1 Fever defined as greater than 38.3 C or greater than or equal to 38 C for 1 hour or longer 2 Hypotension defined as a systolic blood pressure (SBP) less than 90 mmhg or a drop in SBP of more than 20 mmhg from baseline Adult Hypersensitivity (HSR)/Allergic Reaction Management Additional orders per On-Call Physician See Page 3 for Transfusion Reaction Work-up and Reporting 3 Respiratory distress may include, but is not limited to: shortness of breath, hypoxia, dyspnea or labored respiration, wheezing, orthopnea, stridor 4 Other signs and symptoms may include, but are not limited to: Chest pain, tachycardia, tachypnea, hypertension Low back pain and/or flank pain Headache occurring during transfusion Discoloration of urine (tea, cola, or blood colored urine)

3 Page 3 of 5 Management of Blood Product Transfusion Reaction-ADULT TRANSFUSION REACTION WORK-UP AND REPORTING Laboratory tests: Anti-IgA antibodies Urinalysis for presence of hemoglobin Other appropriate laboratory tests Reporting: Place a Transfusion Medicine consult Complete a Patient Safety Event report Complete a Transfusion Reaction Investigation request Return the remaining blood tubing to Blood Bank

4 Page 4 of 5 SUGGESTED READINGS Al-Riyami, A. Z., Al-Hashmi, S., Al-Arimi, Z., Wadsworth, L. D., Al-Rawas, A., Al-Khabori, M., & Daar, S. (2014). Recognition, investigation and management of acute transfusion reactions: consensus guidelines for Oman. Sultan Qaboos University medical journal, 14(3), e306. Gomes E.R. & Demoly P. (2005). Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol, 5, Lenz, H. J. (2007). Management and preparedness for infusion and hypersensitivity reactions. The Oncologist, 12(5), Lieberman, P., Kemp, S. F., Oppenheimer, J., Lang, D. M., Bernstein, I. L., Nicklas, R. A.,... & Greenberger, P. A. (2005). The diagnosis and management of anaphylaxis: an updated practice parameter. Journal of Allergy and Clinical Immunology, 115(3), S483-S523. Link, M. S., Berkow, L. C., Kudenchuk, P. J., Halperin, H. R., Hess, E. P., Moitra, V. K.,... & White, R. D. (2015). Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 132 (18 suppl 2), S444-S464. National Guideline Clearinghouse (NGC) Guideline summary: Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); Accessed October 31, 2017 Rushton, F.A. (2007). Recognition and management of patients with anaphylaxis. Nursing Standards, (21), 37, UTMDACC Institutional Policy #CLN1115 Blood Component Administration and Transfusion Reaction Policy Zanotti K.M. & Markman, M. (2001). Prevention and management of antineoplastic induced hypersensitivity reactions. Drug Safety, 24,

5 Page 5 of 5 DEVELOPMENT CREDITS This practice consensus algorithm is based on majority expert opinion of the Adult Hypersensitivity Reaction work group at the University of Texas MD Anderson Cancer Center. It was developed using a multidisciplinary approach that included input from the following experts: Amin Alousi, MD (Stem Cell Transplantation) Carmen Escalante, MD (General Internal Medicine) Olga N. Fleckenstein Firoze Jameel, MSN, RN, OCN Huifang Linda Lu, MD, PhD (General Internal Medicine) Wenli Liu, MD (Integrative Medicine Program) Ellen Manzullo, MD (General Internal Medicine) Laura Michaud, PhD, PharmD, RPh (Pharmacy Clinical Programs) Rina Patel, PharmD, RPh (Pharmacy Clinical Programs) Goley Richardson, BSN, RN, OCN (Nursing Administration) Leonard Roes, PharmD, RPh (Pharmacy Inpatient) Gloria Trowbridge, MSN, RN Clinical Effectiveness Development Team