A prospective study to evaluate the nursing management of initial rituximab infusions in outpatient settings

Amy L. Goodrich, Lan W. Flinn, Candis Morrison

Research output: Contribution to journalArticlepeer-review


Rituximab is a monoclonal antibody targeting CD20 expressing B-cells approved for use in refractory low-grade non-Hodgkins lymphoma. Infusion related side effects include: fever, chills, rigors, hypotension, and bronchospasm,with 80% of patients experiencing side effects during initial infusions. There is uncertainty regarding the optimal pre-treatment regimen and symptom management during infusions. Infusions are titrated based on the nurses perceptions of the severity of the patients side effects. It is uncertain as to how nurses perceptions correlate with those of patients. The objectives of this investigation were to describe nursing management of first infusion reactions and to document how first infusions are administered and tolerated in a busy out-patient department. Comparisons between the infusion nurses and the patients perceptions of the first infusion side-effects were assessed. The third objective was to conduct a pilot investigation to begin to determine if patient, disease, and/or infusion parameters could be used to predict adverse events in practice. Thirty patients receiving first infusions of Rituximab were enrolled with diagnoses including low, intermediate and high-grade lymphoma and CLL. Consistent with previous studies, tumor burden was associated with increased risk of adverse events. Also consistent with this pattern was our finding that some of the patients with low, or no, tumor burden also experienced significant side effects. Infusion times ranged from 2 to 12.5 hours. Dizziness and vomiting were the side effects most strongly related to prolonged infusion courses. Nurses and patients perceptions of side effects were correlated, both when side effects were absent and when they were severe; however there was a low-correlation of perceptions when side effects were in the moderate range. Correlation between patient and nurse perceptions were significant for the following symptoms: chills, flushing, throat swelling/ tightness, shortness of breath, itching and nausea. Patients who received pre-medications other than acetaminophen and diphenhydramine experienced more side effects and longer infusion courses.Other factors that were significant predictors of high side effects scores and prolonged infusion times in this sample were dehydration and a history of drug allergies. The sample size was too small to make any conclusions. Regarding these factors, further study with a larger sample size will answer questions regarding significance of these factors as predictors.

Original languageEnglish (US)
Pages (from-to)237b
Issue number11 PART II
StatePublished - Dec 1 2000

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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