Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

c. The patient will be counseled concerning the possibility for adverse reactions and of the
signs and symptoms preceding possible adverse reactions they may have after receiving their
immunotherapy. The patient/guardian will sign the informed consent.
d. The dosage schedule in the patient's prescribed course of AIT will be discussed.
e. The nurse/technician must physically examine the injection site prior to the patient
departing the clinic. The allotted time period for waiting after injection is a minimum of thirty
minutes. If the use of the toilet is necessary before the end of the 30 minute wait, the
nurse/technician must be informed, and only the handicapped (distress alarmed) toilet is to be
used. Failure to remain in the patient waiting area for the prescribed time after injection may
result in the termination of immunotherapy.
6. Immunotherapy Procedures:
a. Retrieve the patient's allergy record.
b. Retrieve the patient's extract from the refrigerated storage. Ensure that the extract pulled is
for the right patient, that the vial content agrees with what is ordered on the Allergen Extract
Prescription and is listed on the injection record.
c. Question the patient about any delayed local reaction or systemic symptoms. Make the
appropriate adjustment in the dosage according to the provided protocol for that patient. If the
patient states (s)he had a delayed systemic reaction, record this on the Immunotherapy
Administration Form. An appointment with the Physician-In-Charge is necessary before
proceeding with immunotherapy.
d. Check dosage advancement schedule for the amount of extract to be given. Document the
dosage in the appropriate column on the Immunotherapy Administration Form. The
nurse/technician administering the AIT will annotate the date and time of administration, the
injection site (R or L), and initial the form.
e. Gently shake the vial before using. Draw up the dosage required using a tuberculin/1cc
syringe and a 26 - 27 gage needle. Ensure that the pertinent information is checked; confirm this
information with the patient.
(1) Right patient
(2) Right extract
(3) Right interval
(4) Right dosage
(5) Right method, route, and technique
f. Administer the allergy injection. Give the injection subcutaneously into the posterolateral
surface of the middle third of the upper arm. Always pull back on the plunger before the allergy
extract is administered; if blood returns, withdraw the needle and use the other arm. Avoid
massaging the injection site to lessen unduly rapid absorption of the allergen.
g. Instruct the patient to wait 30 minutes in the clinic patient waiting area and to report any
problems immediately.
h. Check the injection site(s) and annotate the appearance of the injection site(s) prior to the
patient leaving the clinic.
i. Document all reactions in the patient's allergy record. Notify the Physician-In-Charge if
there are recurrent local reactions preventing advancement of the patient’s AIT, any systemic
reactions, or other problems affecting administration of immunotherapy.
j. Unless reactions dictate a change in dosage and/or the Physician-In-Charge (in consultation
with the prescribing Allergist) annotates otherwise, the nurse/technician will always follow the