Iron Sucrose Infusion Adult Only



Canberra Hospital & Health ServicesStandard Operating ProcedureIron Sucrose Infusion – Adult OnlyPurposeTo ensure the safe prescribing and administration of iron sucrose infusion in the Canberra Hospital and Health Services.ScopeAll approved ACT Health staff working within their scope of practise that prescribe, administer or advise on the use of iron sucrose in the Canberra Hospital & Health Services.Procedure1. SynonymsVenofer?2. ActionIron is an essential component of haemoglobin and therefore plays an important role in the production of red blood cells.3. IndicationFor the treatment of iron deficiency anaemia under one or more of the following circumstances AND where the patient has experienced a previous sensitivity to iron polymaltose:When oral therapy is contraindicated or inappropriate,When enteric absorption of iron is defective,When patient non-compliance or persistent gastrointestinal upset makes oral administration impractical.As an adjunct to erythropoietin therapy in patients with chronic renal impairment – reduces the erythropoietin requirements of these patients.4. ContraindicationsPrevious hypersensitivity to iron sucrose.Anaemia not caused by simple iron deficiency (e.g. haemolytic anaemia, megaloblastic anaemia caused by vitamin B12 deficiency, disturbances in erythropoiesis, hypoplasia of the marrow). Iron overload (e.g. haemochromatosis, haemosiderosis). Acute infectious renal complaints in acute phase.During the first trimester of pregnancy (should only be administered in the second and third trimester if the benefits of treatment outweigh the risk to the foetus).As elemental iron tends to accumulate in inflamed tissues parenteral iron should not be given to patients with severe inflammation or infection of the kidney or liver.5. PrecautionsUse with Caution (consult treating MO):Chronic polyarthritis Uncontrolled hyperparathyroidismInfectious hepatitisBronchial asthma (increased chance of hypersensitivity)Low iron binding capacity (increased chance of hypersensitivity) Folic acid deficiency (increased chance of hypersensitivity)6. RestrictionsIron sucrose infusions are prepared in the pharmacy department IV room. Orders need to be scanned down to the pharmacy department between the hours of 8:30am – 4pm.7. Presentation100mg/5mL ampoule8. Prescribing and AdministrationBefore administration of iron sucrose in a new patient, a test dose should be given. A dose of 20mg (1mL) of iron sucrose should be diluted in a maximum of 20mL sodium chloride 0.9% and infused IV over 15 minutes.An emergency tray and facilities for cardiopulmonary resuscitation must be readily accessible should a hypersensitivity reaction occur.Patients who are at increased risk of allergic reactions (see Precautions above) may require premedication 20 minutes prior to infusion:100mg IV hydrocortisone12.5 - 25mg IV promethazineTreatment in haemodialysis patients also receiving erythropoietin:100mg delivered IV into the venous limb of the dialysis line over 2-5 minutes OR,As an IV infusion diluted in a maximum of 100mL 0.9% NaCl over 15 minutes, during dialysis session. Should not be dosed more than 3 times per week. Most patients will require a minimum cumulative dose of 1000mg over 10 consecutive dialysis sessions to achieve desired haemoglobin or haematocrit response. May continue to administer at lowest dose necessary to maintain target haemoglobin, haematocrit, and iron storage parameters.Treatment in peritoneal dialysis, pre-dialysis or non-dialysis patients:300mg IV infusion in 250mL 0.9% NaCl over 1.5 hours every 14 days for 2 doses followed by, 400mg IV infusion in 250mL 0.9% NaCl over 2.5 hours 14 days later (total cumulative dose of 1000mg within a 28-day period). Dosage has also been administered as two infusions of 500mg in a maximum of 250mL 0.9% NaCl infused over 3.5-4 hours on day 1 and day 14 (limited experience).9. Timing of AdministrationDue to associated risk of anaphylaxis, iron infusions should, if possible, be commenced before 12 midday on weekdays so that medical staff are available for the majority of the infusion duration.10. Preparation Iron sucrose infusions are prepared in the pharmacy department IV room. StabilityProtect from light (need black bag to hang),Dilute immediately before administration.11. Line RequirementsIron sucrose should be infused intravenously through a peripheral line or as per haemodialysis instructions above.12. IncompatibilitiesLimited information – considered incompatible with other drugs and all fluids EXCEPT sodium chloride 0.9%.Refer to the Australian Injectable Drugs Handbook for up-to-date information.13. MonitoringMonitor heart rate, blood pressure, oxygen saturation and temperature at:Baseline,Then every 15 minutes for 1 hour,Then every hour until 1 hour post infusion.14. Adverse EffectsAnaphylactic reactions occur most frequently within the first several minutes of administration.If signs of allergic reaction or intolerance occur at ANYTIME during the infusion, the infusion MUST be stopped and a medical officer contacted immediately. Immediate adverse effects may include: Anaphylaxis, Bronchospasm with dyspnoea,Faintness, syncope, tachycardia, hypotension, circulatory collapse,Loss of consciousness.If any adverse reactions fall into the MET criteria, a MET must be called.Mild allergic reactions (mild rash, itching, no respiratory symptoms, no facial swelling) can be treated with an antihistamine such as promethazine. They may include:Cardiovascular: hypotension and collapse, tachycardia and palpitations. Central Nervous System: transient taste disturbances (metallic taste), headache, dizziness. Gastrointestinal: nausea & vomiting (may indicate excessive infusion rate), abdominal pain, diarrhoea.Musculoskeletal: joint and muscle pain.Dermatological: rash, urticaria.General: flushing, sweating, fever, shivering, chest tightness.Delayed Adverse Effects:Patients with rheumatoid arthritis and other inflammatory diseases (e.g. ankylosing spondylitis, lupus erythematosus) may be at particular risk of delayed reactions, including fever and exacerbation or reactivation of joint pain. They may include:Central Nervous System: dizziness.Musculoskeletal: arthralgia, myalgia, sensation of stiffening of arms, legs or face.Haematological: generalised lymphadenopathy. Dermatological: angioneurotic oedema, rash, urticaria.General: chills, fever, chest & back pain.15. InteractionsOral iron supplements should not be given concomitantly with parenteral iron. Stop oral iron supplements before iron infusion and do not restart for one week.Concomitant administration of ACE inhibitors may increase the incidence of adverse effects associated with parenteral iron preparations e.g. erythema, abdominal cramps, nausea, vomiting and hypotension.Refer to an up-to-date interactions resource or Medicines Information (ext. 43333) for comprehensive information.EvaluationOutcome MeasuresPatients who require an iron sucrose infusion are safely and appropriately managed.MethodAll incidents related to this procedure are reported via the Clinical Incident Reporting System Riskman & Staff Accident Incident Reporting (SAIR). Incidents are reviewed and corrective actions are reported via relevant departments in line with continuous quality improvement processes.Related Legislation, Policies and StandardsPoliciesThe Canberra Hospital Medication Prescribing standard operating procedure TCH09:070The Canberra Hospital Intravenous Admixture Preparation and Administration TCH11:107ReferencesVenofer (Iron Sucrose) Injection Product Information: Sigma Pharmaceutical (Australia) Pty Ltd. Available at MIMS Online.The Society of Hospital Pharmacists of Australia (2008) Australian Injectable Handbook 4th Edition. The Society of Hospital Pharmacists of Australia, Collingwood.Venofer Practice Guidelines. Drug Information Unit Westmead Hospital Pharmacy Department, Sydney.Policies and procedures: Iron Sucrose (Venofer) (2002) Royal Melbourne Hospital.DrugDex Evaluation: Iron. (2009). Available at Micromedex Online.Iron Sucrose: Drug Information (2009). Available at UpToDate Online.Disclaimer: This document has been developed by Health Directorate, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever. ................
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