Q:

We are challenged with the decision of which pump to select for Hizentra administration on inpatient floors. It would be great to get an advice from a hands on immunologist, a nurse, or a pharmacist from a different institution to get their perspective. Does anyone have an expirience using Medfusion pump for Hizentra? How about CADD legacy plus? Thank you.

A:

Thank you for your recent inquiry.

I am forwarding your question to Dr. Richard Wasserman who has a great deal of experience in the administration of subcutaneous immunoglobulin. As soon as I receive his response, I will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We have received a response from Dr. Wasserman. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Richard Wasserman:
The simple and most direct answer for inpatient administration of subcutaneous IgG (Hizentra 20%, Gammagard 10% Liquid or Gamunex-C [10%]) is to use the standard intravenous infusion pumps used on the inpatient units. We have used IV pumps for subcutaneous IgG (IGSC) infusions, including 20% products, for at least ten years without problems. For inpatient use, I don't see a reason to purchase a different pump.

Because most IGSC infusions are done in the home setting, I offer a few additional comments. There are a variety of pumps used for IGSC infusions ranging from wind up mechanical pumps to battery operated pumps specifically designed for subcutaneous infusion. I can only comment on the pumps we have used clinically or during IGSC clinical trials.

Disclosure: I have no commercial interest in any infusion pump.

FREEDOM60
Positives
Inexpensive, easy to use, light weight, winds up like a toy (mechanical)

Negatives
No alarms, whistle or bells to signal pump failure or occlusion Operates at a single rate. Rates can be changed by changing the diameter of the tubing. If the patient ramps up their rate, different tubing will be needed for each change.

Uses a 60ml syringe only. If a large volume is infused, multiple syringes will be needed.
Connecting the syringe to the pump can be difficult for the elderly or someone with joint disease.

Cadd Prizm pump VIP Model 6101
Wt 1.0 lbs
Positives
Very easy for the patient to use.
Infusate is contained in an IV bag with essentially unlimited capacity.
Alarms for occlusion, too much back pressure, low volume and the end of the infusion.
Has a lock out system so patients can't change their rate independently.

Negatives
Patients and nurses have complained of hand pain when preparing for the infusion. (Spiking of the IV bag and priming). 
Priming is difficult and not intuitive.
The pump cassette is difficult to lock in place.
The pump may signal the end of the infusion when there is drug left in the IV bag (up to 100ml in our experience).
The pump cannot be pre-set to change rates during the infusion. 

BodyGuard 323
0.8lbs
Positives
Very easy for the patient to use, easy on the hands, light weight.
Infusate is contained in an IV bag with essentially unlimited capacity.
Alarms for occlusion, too much back pressure, low volume and the end of the infusion.
Has a lock out system so patients can't change their rate independently.
Has it's own charger.
Accommodates programmed rate changes.

Negative
The pump may signal the end of the infusion when there is a small amount of drug left in the IV bag.

Curlin Medical 4000 CMS
Wt 1.4lbs
Positives
Very easy for the patient to use, easy on the hands.
Infusate is contained in an IV bag with essentially unlimited capacity.
Alarms for occlusion, too much back pressure, low volume and the end of the infusion.
Has a lock out system so patients can't change their rate independently.
Has it's own charger.
Accommodates programmed rate changes.

Negatives
The pump may signal the end of the infusion when there is a small amount of drug left in the IV bag.
Somewhat heavy for an ambulatory pump.
I hope these comments are helpful.

Richard L. Wasserman, MD,PhD
Clinical Professor of Pediatrics
University of Texas Southwestern Medical School

I have one more question regarding this subject. What are the brand names of the IV pumps that were used for SCIG infusions? Were those large volume pumps or syringe pumps? Thank you again,

Response from Dr. Lieberman:
Thank you for your follow-up question.

Actually, the names given to you do have brand names included. For further information, because I note that you might need other details, I would suggest that you go to the websites that I have, for your convenience, copied below. These websites will lead you to detailed information regarding all of the pumps mentioned in Dr. Wasserman's response to you, and then you can research them further at your discretion. They will not only give you written information, but should also give you contact phone numbers to call suppliers regarding any further questions that may turn up in your decision-making process to choose a pump.

http://www.smiths-medical.com/education-resources/downloads/pain-management/cadd-prizm-vip-system.html

http://www.rmsmedicalproducts.com/?node=products&item=f60

http://www.google.com/search?sourceid=navclient&aq=hts&oq=&ie=UTF-8&rlz=1T4ADRA_enUS446US447&q=BodyGuard+323

http://www.imed95.com/catalogo/pdf/Bomba%20Curlin.pdf

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology