Dose calculation: Mg iron = [0.3 x wt (lbs) x 100 (14.8 - Hb)]/14.8
Note: in this calculation, 14.8 is the desired final hemoglobin value. The "Hb" in the equation is the patient's current hemoglobin value.
NOTE: Potential for anaphylactic reaction requires the administration of test dose.
2. Prepare full dose of Fe Dextran as ordered in 10cc syringe - use single-dose ampoules.
NOTE: Multi-dose vials of Fe dextran should not be used for IV administration due to their phenol content.
3. Transfer 25 mg of dose into 1cc syringe and inject into the 50cc bag of 0.9 NS (or as ordered by M.D.)
4. Place IV access, hang bag 500cc 0.9 NS using an IMED cassette tubing and regulate IV to KVO.
5. With the M.D. present, hook the 50 ml bag with Fe dextran 25mg test dose into a side-port of the main IV tubing set, and run the test dose in over 10-15 minutes, carefully observing the patient's vital signs.
NOTE: M.D. to stay in attendance.
6. Monitor patient for 15-20 minutes for signs of adverse reaction.
7. Only after the completion of the IV test dose should the remainder of the iron dextran be added to the 500 cc 0.9 NS bag. Administer full dose of Fe dextran via IMED pump over 2-6 hours as ordered by M.D.
8. Flush medication through tubing, using 0.9 NS 50cc bag.
9. D/C IV per institutional procedure.
10. Document on appropriate patient forms.
Large IV does of iron dextran can produce delayed adverse reactions (1-2 days) which usually subside within 3-4 days. These include: arthralgias, myalgias, moderate to high fever, backache, chills, dizziness, headache, malaise, nausea and/or vomiting. Nonsteroidal anti-inflammatory agents usually give good relief of these symptoms.
To provide prophylaxis against these problems, physicians can premedicate
patients with 60 mg of methylprednisolone. Premedication is particularly
helpful to patients with inflammatory conditions, such as rheumatoid arthritis.
These flairs may be caused by the inflammatory cytokines from reticuloendothelial
cells, which are "activated" when they engulf the circulating iron dextran
complexes in the circulation.