Venofer infusion complications

[mandykal, ADN, RN]

Hello all,

An anemic pt of ours is an elderly lady who had received Venofer Q daily x5 days via midline after Iron studies were reviewed that she wasn't obsorbing ferrous sulfate 325mg bid.

On the 3rd day after infused she c/o of UE discomfort (Midline site). The Venofer was then d/c'd secondary to complications to site, redness, warmth, tenderness during range of motion, her hgb was check and within normal >12.

Venofer was then changed to once a month via peripheral line. Last month we infused her via perip line without any difficulty... But many nurses including our IV Pharmacy disagreed to infusing via peripheral line. Venofer is mixed to 50mL of N/S over a 30 minutes...

So, I checking on the PH level on this venofer....And hopfully maybe questioning the pharm if this med can be infused at a slower rate greater than 30 minutes. Any suggestions?

KAL

[nitengale166]

our pharm says you can infuse over 30 mins as well but being an old stone age nurse and having seen the complications from a rapid iron infusion... I know better.... We most always do our outpts by peripheral and have used canula's as small as a 24G and I run it no less than 1 hr. Some of the nurses in our unit fuss at me for being so cautious but I know none of them will be sitting on a court room bench with me if ever sued!!!

[mandykal, ADN, RN]

our pharm says you can infuse over 30 mins as well but being an old stone age nurse and having seen the complications from a rapid iron infusion... I know better.... We most always do our outpts by peripheral and have used canula's as small as a 24G and I run it no less than 1 hr. Some of the nurses in our unit fuss at me for being so cautious but I know none of them will be sitting on a court room bench with me if ever sued!!!

Thanks for the response.....Yes, smaller GA cath is definitely safer as preventive measures

[kc319]

I would ask the pharm. if they would mix it in 100 ml of N/S instead of 50 ml. That is the way we infuse it at the HH Agency I work for.

[iluvivt, BSN, RN]

The venofer should not have been given via the midline. Anything with a ph of less than 5 (some references say 6) or greater than 9 should not be infused through a midline. The tip of the midline should have been in the upper arm just before the axillary vein in this location severe damage can occur with extravastions. The ph of venofer is 10.5-11 so way to alkalotic to be infused through a midline. A peripheral line is acceptable as well as any central line . 20mg a min is the recommended rate of infusion and monitor closely for hypersensitivity reactions

[marygfullerton]

we use peripheral lines all the time, mixed in 100cc's by pharm, and give it over one hour

[mandykal, ADN, RN]

I have been infusing it every other month with no complications since last year. I'm atleast satisfied because I don't have to infuse this daily for x amount of days.

[jnette, ASN, EMT-I]

We had a few outpatient soon-to be-dialysis-pts. who received monthly IV iron...... and we always ran it well over an hour. Always. Never less than 1 hour. :)