QUESTION: How do you do iron with a catheter? I know you mentioned a slow push or IM, but any idea with IV drip for a catheter? Or maybe I should do a slow push with it?
ANSWER:
Injectable iron is known to have a higher incidence of anaphylaxis and other high grade adverse events than most other nutrients. As such the clinician should have very specific and proper training before attempting injectable iron formulas, as well as available emergency medications and interventions should an adverse event occur. Iron Dextran is limited to Z-Track IM injection (due to the high rates of anaphylaxis when Dextran is infused) and the Gluconate and Sucrose forms of Iron are reserved for IV infusion. Used appropriately all forms can raise ferritin and iron status faster than any oral repletion ever can, and clinically are associated with faster positive outcomes in low ferritin patients.
Admin: I only use Venofer or Ferelecit in IV form. I do NOT subscribe to the “push” formulas that the manufacturer suggests as we have no cath problems or other issues when we dilute it. I do a 1 AMP test dose on all Fe patients with Venofer or Ferelecit in 100-250 ml solution (D5 or NS). Then Tx with 2 AMP’s per IV. As with all nutrient infusions (especially HDIVC) a larger post IV flush is required to keep the Hickman or Groshong clear so we normally do 20 mL NS flush and then heparinized saline or not depending on cath type. If giving Fe and Nutrient IV we often do the Fe first then run the nutrient bag then the flush. If concerned we will run a whole 100 mL NS bag after. After literally thousands we have no problems doing it this way.
Just remember after Tx to let the person have 3-4 weeks off then re test Ferritin / TIBC or it will be falsely elevated.
