How to Plan for Successful Home SCIg Self-Administration for Primary Immunodeficiency

For people living with primary immunodeficiency, immunoglobulin replacement therapy is a cornerstone of treatment. These therapies help replace missing antibodies and lower the risk of serious infections. While some people receive immunoglobulin through an intravenous infusion (IVIg) at a clinic, infusion center, or at home, many eventually transition to subcutaneous immunoglobulin (SCIg), which can be self-administered at home.

Home SCIg offers more flexibility and steadier antibody levels, but since it is self-administered, it also comes with a learning curve. Before starting, patients or caregivers are trained by a nurse or other healthcare professional on proper technique, safety, and troubleshooting. That training is essential, and with the right preparation, most people become comfortable managing infusions on their own.

There are two main ways SCIg is given at home: with a small external pump or a rapid manual push method with syringes. Both approaches are well established and safe when taught correctly, and the goal with either method is the same: to make infusions routine, manageable, and as comfortable as possible.

This guide walks through the practical steps that can set you up for success.

One of the biggest predictors of a smooth infusion is preparation. Have a clean, organized space and all your supplies ready before you begin, to reduce stress and mistakes.

Choose a space where you can sit or recline comfortably for the duration of your infusion. Many people prefer a quiet room with good lighting and a flat surface, such as a table or counter, for setting up supplies. Before each infusion, clean your work surface with a disinfectant.

Your supplies may vary slightly depending on whether you use a pump or the manual push method, but most people will need:

• Immunoglobulin vials
• Infusion administration tubing
• Subcutaneous needle sets
• Pump-compatible syringes or standard syringes
• Transfer devices or needles
• Alcohol wipes and antiseptic skin prep
• Gauze and tape or transparent dressings
• An infusion pump and adapters, if applicable
• A sharps container

Gather everything before you begin so you are not searching for supplies mid-infusion.

For many people, inserting the needle is the most intimidating part of home SCIg. The good news is that SCIg uses small, short needles placed just under the skin, not into muscle or veins.

During training, nurses typically demonstrate proper technique and supervise several practice sessions.

“The first time you receive the infusion it can cause anxiety; it may be ideal for the first injection to be given in a provider’s office, so patients and caregivers can experience the injection with on-site help,” says Megan Ehret, PharmD, a professor in the department of practice, sciences, and health outcomes research at the University of Maryland School of Pharmacy in Baltimore.

The subsequent injections will get easier over time, says Ehret.

Reducing Pain or Discomfort

There are ways to make the needle insertion less painful. Ehret recommends:

• Pinch the skin using two fingers around the infusion site, and then insert the needle with a quick, dart-like motion straight into the skin.
• Numb your skin by placing an ice pack on the location for about 15 minutes prior to the injection. “This will temporarily reduce pain and serve as another distraction,” she says.
• Use numbing creams (ask your provider for recommendation or prescription) if sensitivity is an issue.
• For the first administration, start out with a slow infusion rate, and consider using an extra needle to avoid putting too much Ig in at one site — that can reduce irritation.

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Over time, many people report that needle insertion becomes routine and less stressful than they initially expected, says Ehret.

Choosing the right infusion site and rotating sites properly can keep your injections on track, reduce discomfort, and help your skin stay healthy.

Common infusion sites include:

• The abdomen
• Thighs
• Upper arms
• The sides of the hips or upper legs

“A different site should be used each time which is at least one inch from a previous injection site,” says Ehret.

Additionally, infusions should not take place in an area where the skin is tender, bruised, red, hard, or tattooed, she says.

Local reactions are common with SCIg and usually mild.

These may include:

• Swelling
• Redness at the infusion site
• Itching

• “Dry priming” the line means keeping a little bit of air in the line just before the needle starts; this keeps the Ig from making the end of the needle wet, which can cause irritation.
• Apply a cold or warm compress after the infusion.
• Slow the infusion rate if approved by your care team.
• Rotate sites consistently.

Swelling is more common early on and often becomes less noticeable as the body adjusts. Persistent pain, spreading redness, warmth, or signs of infection should be reported to your nurse or doctor, says Ehret.

Keeping good records helps both you and your healthcare team track how treatment is going and identify patterns if issues arise.

• Date and time of each infusion
• Dose and infusion rate
• Lot or serial numbers of vials
• Infusion sites used
• Any side effects or problems

“Many medications have an app associated with them which allows for easy recordkeeping,” says Ehret. A paper log or physical calendar works, too.

A visual calendar can help you keep track of injection sites as well dates and times, she says. “If you’re unsure what method might work best for you or how to make a calendar, your pharmacist may be able to help you create one,” she says.

Ehret recommends contacting your nurse or healthcare provider if you notice:

• Signs of infection, such as fever, increasing redness, warmth, or drainage
• Severe or worsening pain at infusion sites
• Equipment problems you cannot resolve
• Missed doses or uncertainty about how to proceed
• Feeling overwhelmed, anxious, or unsure about continuing infusions on your own

Many patients need extra support early on, and follow-up visits or check-ins are common. Over time, most people find that SCIg becomes a manageable part of their routine, says Ehret.

• Home SCIg can be a safe and effective way to manage primary immunodeficiency, but success depends on proper training, preparation, and following a consistent routine.
• Organizing supplies, rotating infusion sites, and using pain-reduction strategies can make infusions more comfortable and easier to manage over time.
• Mild swelling or redness at infusion sites is common and usually improves, but signs of infection, severe pain, or worsening reactions should be reported to your nurse or doctor.
• Keeping simple records and staying in contact with your care team can help catch problems early and support long-term success with home treatment.