Education of patients with primary
hypogammaglobulinemia for S/C Ig self-administration
The Saint-Louis Hospital (Paris) Experience
R. Laumond, J. Baron Lysio, M-L Doizé
Aims of the approach
Allowing for autonomy of patients at home
Reducing the costs for the health system
Modifying the use of out-patient hospital
The educational booklet
Evaluation scaleHygiene and installation
Week 1, 2, …
Technical care
Hand washing, AsepsisWastePeremption of products…
Date, and validation:-Demonstration-Made « alone or with »-Acquired
Inclusion S/C administration of Ig is a medical decision
Eligibility Criteria : Voluntary contribution Cognitive capacity Subjective assessment of skilfulness Rule approval
Training period 3 steps for each patient
Demonstration (showing & handling by a
nurse)
Made « with » (handling with a nurse)
Made « alone » (validated by a nurse)
The step made « alone » can be carried on for
several weeks until autonomy is reached
Practical course
Hand washing Work surface organization Syringe manipulation
Programming and connecting the ambulatory infusion pump
Draining the tubulure after adjusting it on the syringe
Decontamination of the cutaneous surface
Installation and occupation of the patient during infusion as wished
Subcutaneous injection
Made alone
Following at home
Control session planned 3 months later in out-patient hospitalisation
Thereafter, hospitalisation or consultation every 6 months
Call center for questions or emergency
Quantitative Results
• 48/58 substituted patients included
• 159 out-patient sessions (Median = 3 per
patient)
• 1 failure (patient decision)
• Few side effects (only local reactions)
• Treatment could be resumed in all patients
Qualitative results
• Most patients (95%) were satisfied with Ig s/c administration :– More comfortable and painless than Ig IV– Less time consuming– Satisfied with the process
Conclusion