Infliximab Infusion Practices in Irish Gastroenterology Departments
Egan C, Christopher B, Kennedy M, O’Sullivan M, Garry C, Kelly O, Smyth C, Farrell RJ.
Gastroenterology Department, Connolly Hospital Blanchardstown
Since its approval in 1997 Infliximab infusion therapy has become increasingly used in Irish hospitals for moderate to severe ulcerative colitis and Crohns disease. As gastroenterologists have gained experience in the use of Infliximab for IBD we have adapted and modified our practice in delivering the drug. However there are no national guidelines for infusion room practice to ensure consistent safe and efficient practice.
The aim of this study is to investigate current Infliximab infusion practices in Irish Gastroenterology Departments.
A questionnaire was developed in the Gastroenterology unit at Connolly Hospital and delivered to all IBD nurses who attended our unit for a national IBD study day.
IBD nurses from 10 hospitals took part; 80% public-hospital, 20% private-hospital. The number of Infliximab infusions ranged between 1 and 30 per week. Most infusion units are independent of the Gastroenterology unit with only 30% of infusion rooms located in the endoscopy department. All hospitals perform routine bloods prior to each infusion, 70% on the day of the infusion. In 60% of hospitals the blood results are not routinely checked prior to the infusion if the patient is clinically well. 30% of hospitals routinely check trough Infliximab levels. In 70% of units Infliximab is administered at higher doses in refractory patients. Intravenous hydrocortisone is routinely given pre-infusion in 50% of units. 50% of infusions are administered by an IBD nurse or infusion nurse. All units give the induction infusions over 2 hours with 70% reducing maintenance infusion duration to between 30 and 60 minutes. The duration of post-infusion observation also varies between 0- 120 minutes for the first infusion and 0 to 60 minutes following maintenance infusions with no consistency as to when observation time should be reduced.
Only half of units surveyed had dedicated IBD or infusion nurses. Centres with a higher volume of infusions have shorter infusion times and post-infusion observation times than centres providing smaller numbers of infusions. Our study highlights significant variability in Infliximab infusion practices for Irish IBD patients and underscores the need for national guidelines to standardise Infliximab infusion practices within Irish hospitals.