IV iron protocol??

[JennyinLD]

Hi Everyone,

Can someone tell me if their L/D (or other unit) has a protocol for the nursing responsibilities while administering Ferrlecit? Our L&D has several antepartum moms receiving Ferrlecit and we do not have a cut and dry "cheat sheet", guideline, policy, call it what you will, of what we need to do to keep patients safe while giving this med. For example, how many blood pressures are taken during the initial dose, subsequent or multiple doses, what measures are taken to prevent hypersensitivity and what to do if it occurs, etc...

ANY help would be immensely appreciated!!!!

Thank you,

Jenny in L/D

[babyktchr, BSN, RN]

In all my years, have never given it.

[Arduy]

Hello JennyinLD,

in our general surgery unit we occasionally administer Ferric gluconate intravenously.

This drug is known to be compatible with normal saline only. We don't have a protocol for it, but:

We always administer this drug diluted in 100/250 ml of NS with very low flow rate (we haven't had any adverse reactions from patients).

The patients shouldn't go walking around the ward, but stay at their bed during the infusion (hypotension...).

As with every important situation (high alert drugs, patient returning from OR, etc.) I'd have a basal blood pressure taken, before initiating the therapy, and the patient should be informed about symptoms that can occur with this therapy , and to call if something's strange; the most important to watch out about are difficulty breathing, rash, classical anaphylaxis symptoms.

Iron IV is a classical vein irritant because of it's alkalinity, a slow rate of infusion helps with hemodilution, where a CVC is not present.

If there is hypotension a physician could decide to reduce the rate or temporarily stop the infusion, or use blood volume expanders if he wants to elevate the BP.

If there's an anaphylaxis reaction the therapy has to be discontinued and hypersensitivity treated.

Hope these few points are of help to you.

[Elvish, BSN, DNP, RN, NP]

I have personally never given it. I took care of a pt that had received some during her stay and OB was questioning whether to do another course. She had opted out of blood products for religious reasons after coming to the ED bleeding severely about a week postpartum. 34 pads (no, that's not a typo) in about 8 hours. Her lowest H/H was 2.8/10.

We gave it really slowly and stayed w/ the patient the whole time.

[RNLaborNurse4U]

I have never given IV iron. However, knowing my hospital, there is a policy somewhere on how to give it!! LOL