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Administration of intravenous iron dextran


  1. 2 50cc bags .9 NS
  2. 1 500cc bag 0.9 NS
  3. 1 IMED cassette tubing
  4. 1 10cc syringe with needle
  5. 1 1cc syringe with needle
  6. Fe Dextran in 2ml or 5ml ampoules
  7. Alcohol wipes
  8. 1 Buretrol


1. Obtain MD orders and ensure her/his ability to be in attendance, to administer test dose, and to be available during the infusion of full dose.

 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.)

NOTE: The use of 5% dextrose as diluent is associated with increased incidence of local pain and phlebitis. 250 to 1000 ml of 0.9 NS diluent is recommended for the full dose of iron dextran.

 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.

NOTE: M.D. should be available during the infusion, but not necessarily at bedside. Administration rate should not exceed 500 mg/hr.

 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.