Giving iron by IV infusion

Also see — Putting in IV cannula

Attention

  • Do not use in first 3 months of pregnancy
  • Procedure only applies to giving ferric carboxymaltose (eg Ferinject) which must be ordered by a doctor
  • Clinician trained in basic life support must stay with person during infusion
  • Have anaphylaxis kit and emergency equipment ready in case of reaction (rare)
  • If any signs of adverse reactions — stop infusion straight away
  • Monitor for risk of extravasation (fluid in the tissues) which causes permanent and disfiguring skin staining 
  • IV site must be carefully chosen and IV cannula patency must be absolutely secure to minimise risk of extravasation 
  • Can safely be administered by
    • Slow IV bolus injection
    • IV infusion using a gravity feed giving set
    • IV infusion using an IV infusion pump

What you need

  • Ferric carboxymaltose (eg Ferinject)
    • Ferric carboxymaltose available in 2mL (100mg iron) and 10mL (500mg iron) vials
  • IV cannula — 18G–20G for adult, 22G–24G infants and children
  • Required volume of normal saline 
    • 10mL normal saline ampoule OR 50mL normal saline
  • Drawing up equipment — 10mL syringe, 18G needles x 2
  • IV giving set OR gravity feed giving set OR 20mL syringe
    • IV infusion pump (if needed)
    • Additive labels/IV bag sticker
  • Chlorhexidine 2% in isopropyl alcohol 70% wipes
  • Tape
  • Bluey
  • Tourniquet
  • See-through dressing

What you do

  • Check Temp, pulse, BP, RR, cannula site
    • Before starting infusion
    • 5 minutes after starting infusion
    • When infusion complete
  • Discuss risks of infusion with person (eg extravasation) and gain consent
  • Select IV cannula site to avoid flexion — antecubital fossa, wrist or back of hand. Distal forearm is preferable
    • Choose largest possible cannula — 18-20G for adult, 22-24G for infants and children
    • Put in IV cannula, check and secure with tape
    • Flush with saline to make sure you are in a vein. If patency is uncertain, iron infusion cannot be given
    • Put see-through dressing over cannula
  • Work out dose of ferric carboxymaltose, amount of normal saline needed — Table 6.1

Table 6.1 Dilution for ferric carboxymaltose (Ferinject)
  • Work out infusion rate of ferric carboxymaltose — Table 6.2

Table 6.2   Maximum infusion time
  • Ask another practitioner to check
    • Dose, infusion rate
    • That you have correct form of iron solution — do not use iron polymaltose
    • Check vials have no sediment
  • Wash hands and put on gloves
  • Draw up dose of ferric carboxymaltose and add to correct sized normal saline infusion bag 
    • Tip bag up and down (invert) several times to make sure the contents are well mixed
    • Fill out additive label and stick onto infusion bag
    • Put together IV giving set, prime line with fluid, let out any air bubbles
    • Attach giving set to IV infusion pump OR hang gravity feed bag
    • Connect and run iron infusion
  • If any signs of irritation around cannula or adverse reaction, stop infusion — medical consult
  • Person should stay at clinic for at least 30 minutes after end of infusion
  • Check temp, pulse, BP, RR before they leave clinic