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Renal: Administration of Intravenous Iron Polymaltose during haemodialysis – Doc
Guideline and
Procedure
Administration of Intravenous Iron Polymaltose during Haemodialysis in
Adults
Document Number:
Sites where Guideline and Procedure
applies:
All HNE facilities where a patient undergoes Haemodialysis
Target audience:
Nephrology clinical staff, who provide care to haemodialysis
patients.
This document comprises part of the clinical information
package for care for Haemodialysis patients within a
hospital facility or satellite dialysis unit.
Polymaltose, Iron,
Description:
Keywords:
Replaces Existing Guideline and
Procedure:
Yes
Registration Number(s) and/or name and JHH Nephrology SWP N 1.2
of Superseded Documents:
Relevant or related Documents, Australian Standards, Guidelines etc:
 NSW Health Policy Directive 2007_079 Correct patient, Correct procedure, correct site
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_079.pdf
 NSW Health Policy PD 2005_406 Consent to Medical Treatment
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf
 NSW Health Policy Directive PD 2007_036 Infection Control Policy
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf
 NSW Health 2007_007 Medication Handling in NSW Public Hospitals.
http://www.health.nsw.gov.au/policies/pd/2007/PD2007_077.html
 HNEH CG 10_03 Total Dose Iron Polymaltose Infusion
http://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0003/71823/HNEH_CG_10_03_Total_D
ose_Iron_Polymaltose_Infusion_CPG.pdf
Prerequisites (if required):
Registered or Endorsed Enrolled Nurses who have been deemed
competent in the performance of haemodialysis.
Procedure Summary:
This Guideline and Procedure sets out the steps to be followed when
administering IV Iron Polymaltose during haemodialysis. The procedural
components of the document such as, Preparation of patient, Preparation
of equipment, Technique, Cleaning up and Documentation are considered
mandatory.
Guideline Note :
This document reflects what is currently regarded as safe and appropriate
practice. However in any clinical situation there may be many factors that
cannot be covered by a single document and therefore does not replace
the need for the application of clinical judgment in respect to each
individual patient.
Date authorised:
05/08/2010
Authorised by:
HNEAHS Renal Clinical Stream Leadership Group
Contact Person:
Contact Details:
Kelly Adams
49048800
Review due date:
TRIM Number:
Version One
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Renal: Administration of Intravenous Iron Polymaltose during haemodialysis – Doc
OUTCOMES
1. Safe administration of IV Iron Polymaltose to patients.
2. Maintenance of infection control policies
3. Safe disposal of contaminated wastes.
4. Risks of blood exposure of needle stick injury significantly eliminated
5. Minimised risk of medication incidents.
ABBREVIATIONS & GLOSSARY
Abbreviation/Word
Definition
MO
Medical Officer
ESA
Erythropoietin Stimulating Agent
IV
Intravenous
Hb
Haemoglobin
GUIDELINE
The administration of IV Iron is a vital aspect of care for patients on haemodialysis as the average
haemodialysis patient can lose up to 3g of iron per year due to blood loss. Continued therapy with
IV iron represents a key opportunity to improve patient outcomes and increase the efficiency of
anemia treatment. Regular administration of low doses of IV iron prevents the recurrence of iron
deficiency, enhances response to recombinant human erythropoietin therapy, minimizes fluctuation
of hemoglobin levels, hematocrit levels, and iron stores, and may reduce overall costs of care
(Besarab, 2006).The patients are prescribed iron doses by their Nephrologist and nursing staff
require a valid medication order to administer the drug.
Method of Delivery
Iron Polymaltose is administered via the dialysis machine Heparin Pump, with a 100mg dose can
administered over the last 30 minutes of treatment. Maximum rate of administration should not
exceed 5mg/minute HNEH CG 10_03 Total Dose Iron Polymaltose Infusion
Dilution of Drug
It is also recommended that the 100mg in 2mL dose be diluted with sodium chloride 0.9% (normal
saline) into a final concentration of 100mg in 5mL. This dilution ensures minimal loss of the drug
within the heparin line.
Initial Dose
Due to the risk of a severe drug reaction the initial dose of IV Iron Polymaltose must be given in the
Hospital Dialysis Setting under medical supervision. The initial 100mg dose can be delivered via
the Heparin pump during dialysis treatment however it must be infused over 60 minutes.
Blood pressure and pulse must be checked prior to the commencement of the infusion, every 5
minutes for the first 15 minutes and then every 15 minutes thereafter (HNEH CG 10_03 Total Dose
Iron Polymaltose Infusion)
If drug reaction is suspected cease infusion immediately and contact MO (See Nursing Alert at the
end of this Procedure for further instructions.)
Nursing Alert: Patients with previous medication allergies at at higher risk of reactions
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Renal: Administration of Intravenous Iron Polymaltose during haemodialysis – Doc
IV Iron and Antibiotics
If a patient is on a course of antibiotic treatment (either IV or oral), administration of IV iron is not
recommended. In the infectious process serum levels of Ferritin will be high due to the infection,
which in turn renders any blood serum readings inaccurate. It is recommended that the infection
and/or inflammation be treated first, and then, IV Iron therapy recommenced when an accurate
reading of blood results can be determined.
Monitoring of Ferritin levels
Patients commencing or having a dose change to there ESA and/or iron therapies require monthly
testing of Hb. Iron Studies and Nutritional markers should be attended 2 weeks post administration
of any Iron correction and from there determine the maintenance schedule of iron (Cari Level IV
evidence.) If after 3 months or until stabilised Hb then it is appropriate to move them to less
frequent dosing schedule.
If after three months of an uninterrupted maintenance dosing that demonstrates there is sufficient
iron stores and steady Hb , only then would three monthly iron testing be appropriate.
If there is any interruption to the dosing schedule of either the ESA or iron the monthly testing
should be re-instituted
PROCEDURE
The procedure requires mandatory compliance.
Patient Preparation
This Guideline & Procedure applies to maintenance doses of IV Iron Polymaltose. The initial dose
should be administered in a Hospital Dialysis setting with medical supervision available. The
clinician administering the Iron should check that an initial dose has been given, and that no
adverse reactions were experienced by the patient.
It is mandatory to ensure that the patient has received appropriate information to provide informed
consent and, that patient identification, correct procedure and correct site process is completed
prior to any procedure.
Staff Preparation
It is mandatory for staff to follow relevant: “Five moments of hand hygiene”, infection control,
moving safely/safe manual handling, and documentation practices.
Equipment Requirements








Alcohol hand gel
Personal Protective Equipment
20mLsyringe
Blunt drawing-up needle
10mL vial of sodium chloride 0.9% (normal saline)
Additive label
Sharps disposal bin
Legal medication order
Procedure Steps
1. Check Iron Polymaltose dose against prescription, check expiry date and Patient allergies
with an appropriate second person. Complete additive label
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Renal: Administration of Intravenous Iron Polymaltose during haemodialysis – Doc
2. Don personal protective equipment
3. Attach drawing up needle to 20mL syringe
4. Open the glass ampoule of Iron Polymaltose by “snapping” the top off. (Ensure that you
“snap” away from you, and also not in the direction of another person)
5. Draw the complete amount of Iron Polymaltose into the 20mL syringe. Expel any excess air
from the syringe after drawing up.
6. Draw up 3mL of sodium chloride 0.9% (normal saline) from the 10mL vial making a final
solution of 5mL.
7. In the last 30minutes of treatment, clamp the heparin line and remove the heparin syringe
from the dialysis machine heparin pump. Discard into contaminated waste bin.
8. Attach 20mL syringe to the heparin line and place syringe in dialysis machine heparin
pump. Open clamp on heparin line when syringe secure in pump.
9. Adjust rate and “stop time” in order to deliver prescribed amount in allotted time.
appropriate second person should check the rate and “stop time.”
An
10. Attach additive label to the barrel of the syringe.
11. Discard remnants of the glass ampoule and drawing up needle into sharps disposal bin.
12. Observe patient for any symptoms of an adverse reaction. (If giving Initial Dose follow
observation regime as stated in the above Guideline.)
13. Discard 20mL syringe along with blood lines into contaminated waste at the end of
treatment.
Nursing Alert: Symptoms of an adverse reaction include sudden onset of hypotension
and tachycardia. If adverse reaction is suspected STOP iron infusion immediately
-
Call the Rapid Response Team as per calling criteria or Ambulance if in the satellite
dialysis unit setting
-
Maintain airway and cardiovascular output.
APPENDICES
Five Moments for Hand Hygiene
REFERENCES
Besarab, A. (2006) Resolving the paradigm crisis in intravenous iron and erythropoietin
management. Kidney International 69, S13–S18
Hand Hygiene Australia 2008: Five Moments for Hand Hygiene
Hunter New England Total Dose Iron Polymaltose Infusion HNEH CG 10_03
http://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0003/71823/HNEH_CG_10_03_Total_
Dose_Iron_Polymaltose_Infusion_CPG.pdf
Salem L, Harvie B, and A King, (2006) The Health Management Plan for End Stage Kidney
Disease, Sydney;HNEHS
Sigma Pharmaceuticals, (2002) Product Information: Ferrosig Injection, Victoria Australia; Sigma
Pharmaceuticals (Australia) Pty Ltd
Singh, A.K., and Hertello, P. (2005) The Benefits of IV Iron Therapy in Treating Anemia in Patients
with renal disease and Comorbid cardiovascular Disease. Nephrology Nursing Journal; March-April
Vol 32(2)
Weiss, G., Goodnough, L.T. (2005) Anemia of Chronic Disease. The New England Journal of
Medicine; March 10, 2005 Vol 352, No.10
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Appendix 1
Adopted from the World Health Organization and Hand Hygiene Australia.
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