Case study 30.2

What could be the cause of Pete’s increased frequency of infection?

Pete requires regular, three weekly, immunoglobulin infusions to maintain his trough IgG level. This prevents infections. If he has not attended his infusions regularly, his trough level will drop to a sub-therapeutic level and he will be at higher risk of infection

How could you support the local day unit in caring for this patient?

It is important to establish why Pete is missing infusions. This can be assisted by discussion with Pete and with the staff of the local hospital. Are the appointment times difficult to attend because of his work or travel? Often day units can only offer treatment during the normal working week, which is difficult for working patients to attend. If this is a problem, it is worth asking if alternative treatment times are available. Education and training for patients and staff can increase knowledge about treatment with immunoglobulin and subsequently optimise care. Pete can be informed about the need to have regular infusions to prevent infection. The role of specialist nurse is often as much about supporting colleagues as it is about direct patient care.

Consider what other treatment options Pete has – what are the pros and cons of each, considering his current lifestyle?

Pete is struggling to find time out of his work schedule to attend hospital to have infusions. He may wish to consider the option of home therapy, which would allow greater flexibility in terms of when to infuse. If he chooses intravenous therapy, he will need to be able to self-cannulate, which is a difficult skill to master. If appropriate, his wife could be trained to cannulate or assist him with the procedure. This will allow him to continue to have three weekly infusions which would suit his travel requirements better than weekly subcutaneous infusion. Subcutaneous infusions can be easier to administer but require more frequent administration. With appropriate paperwork, Pete could take the treatment with him when he travels if required.

What role could patient education have in reducing the risk of infection and increasing adherence to treatment?

Pete’s current understanding is that stress is causing his infections. Whilst this may have an impact on his health, the infections are much more likely to be directly linked to his missed infusions. If he understands the connection, he is more likely to adhere to a treatment regime that will improve his health.