iron_infusion_wh

intravenous iron Rx (ferric carboxymaltose) at Western Health

Introduction

  • all patients MUST be informed that there is a risk of permanent skin staining from the infusion and consent for this should be documented

Ferric carboxymaltose infusion in ED

  • if out of hours, public holidays or weekends, refer patient to MADU for iron infusion as an outpatient as infusion will NOT be possible at these times when pharmacy is closed
  • if M-F 9am-4pm, then, if appropriate, and capacity within ED allows, arrange iron infusion in Fast Track via pharmacy as per:

step 1. ensure it is indicated and no C/Is

  • patient must be aged 14yrs or older
  • patient must not be on haemodialysis
  • patient must not have had an iron infusion within past 1 week (max. is 1000mg/wk)
  • no known allergic reaction to ferric carboxymaltose
  • patient is not pregnant (avoid in 1st TM, can be used with caution in 2nd and 3rd TMs)
  • patient must have documented iron deficiency
    • low serum ferritin < 15-30mcg/L in adults
    • high transferrin or total iron-binding capacity
    • low transferrin saturation (preferably on a fasting morning sample)
    • low serum iron
  • either not tolerating oral iron or oral iron is not appropriate as deficiency is severe and risk of decompensating or need for blood transfusion if not given
  • ED has capacity to manage the infusion safely

step 2. order the infusion

  • PBS triplicate prescription for:
    • ferric carboxymaltose 500mg/10mL x 2 ampoules, no repeats
  • IV infusion chart for:
    • ferric carboxymaltose 1g in 250mL 0.9% saline and rate over 15min
  • send both the above to pharmacy to prepare
  • patient will be billed PBS rates ($38.30 non-concessional, $6.30 for concession card holders)

step 3. administer infusion in Fast Track

  • confirm patient identification
  • iv cannula
  • vital signs documentation
  • commence infusion
  • observe for anaphylaxis during infusion and for 30 minutes after it ceases
  • other common adverse events:
    • nausea 3%
    • transient hypophosphataemia 2%
    • injection site reactions 1.6%
    • headache 1.4%
    • hypertension 1.3%
    • dizziness 1.2%

step 4. estimate amount of further iron Rx needed

Simplified method - Hb in g/L body weight 35-70kg body weight > 70kg
<100 g/L 500mg more 1,000mg more
>100 g/L nil 500mg more

step 5. discharge advice

  • determine need for further iron Rx:
    • if more iron is required, either on going oral iron is required or a subsequent iron infusion as an outpatient via MADU at least 1 week after this dose (referral for this can be made as above)
  • discharge home with discharge letter:
    • instructions to GP for future referrals to MADU
    • ensure GP has arranged or will arrange Ix of iron deficiency as indicated (eg. gastroscopy/colonoscopy)
    • request GP to arrange and follow up rpt bloods in 1-2 weeks
iron_infusion_wh.txt · Last modified: 2019/09/04 07:09 by wh