Rapid push SCIG

[barbfrombc]

I was wondering if anyone here has tried rapid push subq infusions? In Canada this is apparently the only way you can currently get subq and its being used now by some people who have trouble with ivig. Its expected to become quite common in the next few years. Anyone have experience with this?

Barb

[willo]

Hi Barb

I have not experienced rapid push but, have just done a search on google and found this:

onlinelibrary.wiley.com/doi/10.1111/j.1365-2249.2009.04027.x/full#ss5

The thing that stood out for me:

"Using the rapid push method, 3–20 ml of SCIg (Vivaglobin®, 16% solution) is administered typically into a single site as often as every day. Some patients may, however, prefer administration at two sites simultaneously, taking their infusions less frequently, such as three times a week."

I would not like to inject more often than once a week.
Although if I did want to I could do that now. The article says that the rapid push method takes 5-20 mins depending on the patient. At present I infuse 70mls once a week, I could infuse 10mls once a day which, would take about 3 mins.

I have only scanned the article so there may be other benefits; perhaps it is faster to setup.

Stay well

[liz2mac]

Hi both,

I don't know what this is, will enquire.
However, I am aware of a type of subcut which uses a chemical to enable the subcut to be absorbed and therefore administered faster. Research I have done on this makes me feel that this is somthing to be very carefully looked into and discussed at length with our treating immunologist about the pro's and cons before considering it as an option.
Liz

[barbfrombc]

Rapid push is like subq but you don't need a pump, just butterly needles and a syringe. That means you do a smaller amount at a time but you likely have to do it every day. I saw my immunologist yesterday. He says it is being really promoted in the big city (well, big for Canada) where there is a space crunch at the hospital and they need to get iv patients out of there and treating at home. For some reason though pumps seem to be a big issue here and hence the rapid push method.

My dr says I am unfortunately not a good candidate for this. Rapid push is very convenient and works really well for people who are on small(ish) doses. I currently get 40 grams ivig every 2 weeks so I would need to be doing rapid push several times a day, every day. No thank you!!! However, my dr thinks that in the future there might be even more concentrated formulations and this might become more feasible even for folks like me.

Barb

[bamber]

My nurse mentioned this was happening abroad due to the (she thought) expense of pumps. But as you say Barb mine is 50 grams subcutaneous every week would be too much for me. She also mentioned stronger concentration in future. But I would worry about reactions with faster stronger concentration. Especially as I have had reactions in the past and had to use an epipen - also in hospital.

[dianesistern]

Seems to me like this is going backward my dad was one of the first people to be diagnosed with cvid over 60 years ago and it was administered that way originally makes you wonder why it progressed to iv then back again i feel it is due to money saving measures. Diane

[bamber]

I agree. I was diagnosed 37 years ago and had injections into a muscle (buttocks), usually once a week awfully painful. Think its due to the pumps being expensive. but don't know why there is not much too them. Its clockwork almost and i can't see any reason - why they shouldn't be produced cheaply.

[willo]

I think that is called intra-muscular whereas rapid push is subcutaneous so should be almost pain free.

[s162216]

The injections that your referring to 37 years ago would have been intramuscular as at the time that was the best/only way to adminsiter IgG (it could also be given subcutaneously but it was not as effective), they did the job but patients would usually suffer massive reactions frequently and they were severely painful according to older patients at my infusion clinic who used to have them years ago. Not very much could be given as muscle can only absorb a small amount of fluid so frequent doses were needed.

Rapid push works on the idea that you can give a small amount daily (although 3 ml is quite an amount) so that a high level can be maintained over the course of the week. This eliminates the need for pumps which are expensive as they have to be produced to very exacting tolerances and even the clockwork style ones are more complex than you might think plus not many drugs are given as an SC infusion so theres low demand in comparison to IV pumps for instance.

I have a subcutaneous insulin pump which I have attached to me all the time and that costs £3200 for the pump alone but it is very advanced though with 2 processors (1 just to run safety checks constantly) and a lot of additional settings such as adjustable basal rates throughout the day. Not bad for something only about 1.5 cm thick and the size of a credit card (look up a picture of an 'Accu Chek Spirit Combo' to see what I mean). Plus the £3200 does not include the tubing, cannulas etc so the total bill to the NHS comes to about £8000 every 4 - 6 years!

Sam

[john]

hi all,
i'm back in the real world!! holiday was great, home is better!!
i started off 20 years ago using im, a massive syringeful of gloopy gamma globulin, one into each buttock, once a month and extremely painful.
the product was not as refined as iv or scig is these days, i don't think that a great deal of thought was given to that kind of thing, and also the treatment did not work very well either!
rapid push first came to my attention when i was at pia a few years ago, and as stated it is a comparatively small amount of product, injected just under the skin and done every day, or even more often. it was supposed to be such a small deal that we would all jump at it!! we didn't!!
then there was talk of pre-injecting an enzyme to make the sub cutaneous fat more fluid and able to absorb subcut more quickly and in bigger quantity, again something that has gone off the radar. there will be new methods of delivery, i'm sure, but what we have now seems to fit the bill for almost all of us, and i think i would rather have research directed at safety, efficacy of protection and lifestyle issues myself.
i do think as an ex-electronics engineer who worked in medical research, that the current pumps used for our product delivery are way over-complicated and therefor over expensive. the clockwork device was a breath of fresh air, simple, robust and foolproof, and i was really impressed by it. yes its a bit big, doesn't look very sexy and probably doesn't convey the desired image of high tech, but it's cheap and it works and it uses no batteries!! just one step away from rapid push when you think about it!
take care - nice to be back - john
ps i never use a pump for my ivig - what's wrong with gravity?? it's silent, green and doesn't need the nurse to be constantly at my side when it plays up!!

[s162216]

I don't use a pump for IVIG either at the QMC, nobody there does as far as I know (and the nurses all agree that for what we're having and it not being exactly very rate intolerant, their a bit of a waste of time) plus it lets us control the rate so if I start to get a headache etc then I can slow it a bit.

At Addenbrookes though they insist upon putting it on a pump and to be honest its just annoying, permanently beeping, me having to try to attract a member of staffs attention if I want the rate slowed (not that the guy there bothered listening to me the first time I had it there during the university holidays and put it on 30 ml/hr because I had 'never had it before' despite there being a copy of my infusion log from the QMC and me telling him that I had had it multiple times before. Eventually I persuaded him to increase it so he stuck it on 300 ml/hr! Knowing that it was too fast and not beginning to feel very well I tried asking him if I could have it at 60 drops per minute which is my usual rate but he had no idea how to convert that to ml/hr! Eventually I called my usual Immunology Clinic at the QMC and within 5 minutes they had given a rough conversion of what it should be. Whenever I have it there I always get a severe headache for some reason which I only get occasionally at the QMC).


My insulin pump on the other hand sort of has to be high tech as unlike SCIG, it could get very nasty quickly if something went wrong.

Sam

[bamber]

Yes mine was was intramuscular 37 years ago when I was 10 and stayed the same for 8/9 years. Then I had IV for a short time but had a reaction so back to intramuscular until I was about 24/25 then tried IV again and had to keep an epipen of adrenaline with me. But reactions only happened twice after that. I have had subcut for a number of years now and now use a pump that is a quite big called a freedom pump that is clockwork. But even that is said to be expensive to run. Not sure of cost exactly (probably better not to know). I know insulin you have to be exact with and IGG is more of a long term need.

[susand]

Hi,
I do use a pump for my subcuvia. Initially they were Graseby, which I disliked and caused endless problems becuase of extensive scar tissue. Then came the wonderful Freedom Pumps and I was an ambassador for their use in clinic. However, my infusions were taking hours due to the scar tissue. The wonder juice had to find it's own route and circumnavigate the adherence obstacles. I do need it slowly and with pre-meds, so now the pump serves perfectly. We can decide on the speed - I have 10ml over 90 minutes and repeat that in the legs and we are also able to regulate the pressure.
It all depends on what works best for us

Sue

[bamber]

I had Graseby first too and they did have problems with the needles. The Freedom pump has helped with that they are so small. (needles are small). Sue do you have another pump now as i can't change speed with my freedom pump? I have 50mls - it takes about 1 and 3/4 hours once a week. Unless there are different freedom pumps?

[willo]

On the Freedom 60 pump I have the speed is controlled by the tubes i.e. different diameters. Including changing syringes my infusion lasts about 1 and 3/4 hours delivering 70mls using 4 needles and the F2400 tube which, I've been told, is the fastest.

[bamber]

That makes sense actually think the nurse did mention that when I was put on it. Thank's. I have four sites - but don't know what the tube size is must be smaller than yours.

[s162216]

I actually asked one of the specialist immunology nurses when I went for my last infusion if she has heard of rapid push before and in her opinion it was a waste of time. Apparently Oxford tried several years ago it as did several other centres including one person where we were at the QMC but as she put it, it was great for the hospitals as it was quick and cheap but the patients hated it as it they who had have the massive injections daily, and all eventually went back to what they were using before.

Sam

[barbfrombc]

Hi Sam - that is very interesting. The rapid push method is being promoted here and I guess some people really like it but they were on fairly small doses of ivig and were having a lot of problems with it. I think I prefer to just go spend a day every two weeks getting "topped up" and then I forget about it for two weeks. In the summer, if I am well, my dr says its fine to even skip one treatment as I am stable enough now that he doesn't think my levels are going to drop so fast that one treatment is going to make a huge difference. I found that quite reassuring but I can't say I have any big travel plans in the works that can't be accommodated in my biweekly schedule.

Barb