Counseling for patients with hemophilia A should include medication storage requirements, the importance of maintaining sterile injections, and administration considerations, such as how to use blunt fill needles.
Kimberly Epps, PharmD, CSP: When I’m counseling a patient with hemophilia A on their prescribed therapy, [advice] is going to be product specific. Each product has its nuances. I make sure I have the demonstration kit in front of me [in case] they have any questions. Most of these patients have been on these medications for so long, they could probably run circles around me. But I make sure I know the exact steps of the infusion process. I let them know the amount of time the product can be out of the refrigerated temperature and the consequences if it’s out the of refrigerated temperature for longer than that. They need to know the room temperature expiration. Let’s say they’re getting ready to infuse. They haven’t opened the box, but it’s been sitting on the counter and an emergency comes up—they’ve got to go get their child from school. Do they leave it out? Do they draw it up? Do they fuse or put it back in the refrigerator? They need to know their options at that point.
Once it’s drawn up in that syringe, they usually don’t have a huge time frame to use it. It’s between 1 and 3 hours, and I make sure that they’re aware of that. Especially in an area of natural disaster—whether it be fire, hurricane, tornado, earthquake, whatever—I need to make sure these patients know what to do if they lose power. If they lose electricity and can no longer refrigerate their medication, [I let them know] how long that medication is good for. We make sure to go over all those scenarios. We make sure they have a backup plan, like a cooler, in place. Finally, I encourage patients to be vocal about their preferences. If I’m going to stick a needle in my vein multiple times a week, I’m going to use the needle I like. I’m going to use the needle I’m comfortable with and make sure they understand that they need to have a sterile area to infuse. We usually make sure they have an infusion mat that’s their sterile area, and that they wipe it down thoroughly prior to infusion. Some patients like gloves. Some patients prefer to do bare hands. Make sure their hands are clean, and make sure the infusion site is thoroughly cleaned with prep alcohol or their preferred agent.
The special considerations for patients who infuse factor medications at home include having a safe, clean, designated space to infuse. That’s number 1 in importance. A lot of our Medicaid plans require that we put a clinician in the home upon starting the initiation of care so we can make sure the patient has a proper factor storage room. They need a clean, safe area to infuse their medications and a safe area where they store their infusion medications. [We want to ensure that] small children don’t have access to the sharp [objects] and that sort of thing. Beyond a safe area to infuse and store, make sure they’re comfortable with their therapy and with infusing and accessing their veins properly.
You’d think that a subcutaneous product would be a lot easier to manage and explain, but there are some considerations. Once they reconstitute the drug, they have to use a filter needle. They get multiple needles in their package. They need to know the different the needles, specifically the blunt fill needle. There’s a needle that goes into the drug for them to pull up, and it’s not the needle they use to infuse or inject the medication subcutaneously. They need to know the red cap—that’s the one you use to drop the drug. It’s so you don’t blunt the needle before injecting it into your arm so it doesn’t hurt so bad. You’re going to get two needles. You inject only one of those needles into your arm. Beyond that, it’s straightforward. You have to make sure that the patient understands subcutaneous vs intravenous. For medical professionals, that’s normal language. These patients have been accessing their veins for years. But one of the counseling points is that this goes subcutaneously, just under the skin.
Transcript edited for clarity.