The Medical Advisory Team updates its recommendation regarding out-of-hospital infusion services to manage the risk of infusion reactions in patients treated with intravenous therapies for COVID-19 infection:

  1. Personnel providing infusion therapy for COVID-19 should follow the appropriate EUA guidance and any guidance provided by manufacturers regarding operationalizing their treatments (e.g. playbooks or treatment guides), including the recommended post-infusion direct observation period.
  2. Personnel involved in administering parenteral medications should have current Basic Life Support or higher certification, and be trained in the administration and monitoring of IV infusions and the initial management of infusion reactions.
  3. Infusion service locations should utilize either their existing trained infusion/parenteral therapy personnel, or have access to a licensed provider (physician, nurse practitioner, nurse, paramedic, pharmacist clinician or physician assistant) with Advanced Cardiac Life Support Certification who is immediately available and designated to address the life-threatening needs of a patient experiencing a reaction. Facilities without existing trained infusion/parenteral therapy personnel or access to an ACLS-certified provider who is willing and able to be designated to be immediately available to address life-threatening patient needs during infusion should refer eligible patients to another service location.
  4. Infusion service locations should ensure the ability to immediately activate Emergency Medical Service via phone or have access to direct emergency department admission.
  5. Medications, supplies, and equipment to manage an infusion reaction should be immediately available during each administration of a parenteral medication in a Reaction Management Kit, or standard Crash Cart.
  6. Reaction Management Kits should include, at a minimum:
    • Epinephrine, corticosteroids, antihistamines, and IV fluids
    • Resuscitation equipment including a barrier mask for CPR and a manual resuscitation pump or “self-inflating bag” that attaches to the CPR barrier mask, or a bag valve mask or manual resuscitator, capable of providing positive pressure ventilation.
    • Breathing support including oxygen and delivery system or device to provide up to 15 l/m
  7. Providers should consider premedication to prevent hypersensitivity reactions in patients with a history of multiple or severe drug allergies. There is no evidence for or against routine premedication for the currently available COVID-19 infusion therapies, and premedication should be considered on a case-by-case basis.
  8. Personnel involved in preparing and administering parenteral medications should follow appropriate sterile compounding guidance and state regulation.1,2

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