From the Guidelines
If you notice hardness at the IV site after an iron infusion, apply warm compresses to the area for 15-20 minutes several times daily to help reduce inflammation and promote absorption of any extravasated iron. This hardness, known as phlebitis or chemical irritation, is a common reaction when iron preparations come into contact with surrounding tissues 1. Monitor the site for worsening symptoms such as increasing pain, redness, swelling, or warmth, which could indicate infection or more severe tissue damage. Elevating the affected limb may help reduce discomfort. Most cases resolve within a few days with these conservative measures. If you develop fever, pus, streaking redness, or if symptoms worsen despite home treatment, seek medical attention promptly as this could indicate a more serious complication requiring medical intervention. Some key points to consider when managing IV iron infusions include:
- The most common infusion reaction is complement activated related pseudo-allergy (CARPA), also known as a Fishbane reaction, which is physiologically different from an anaphylactic reaction 1.
- Anaphylaxis due to IV iron is exceedingly rare, occurring with <1:200000 administrations 1.
- Prior to discharge, patients should be informed of possible delayed infusion reactions, which can occur several hours to days after the infusion, and may include flu-like symptoms, arthralgias, myalgias, and fever 1.
- If subsequent IV iron therapy is required, consider the need for appropriate premedication or an alternative formulation 1.
From the Research
IV Iron Infusion Reactions
- IV iron infusion can cause adverse reactions, including complement-mediated infusion reactions, which may occur in up to 1 in every 200 patients 2.
- These reactions can be minor and resolve without therapy, but inappropriate intervention can convert them into hemodynamically significant adverse events 3.
- True anaphylaxis is very rare, and previous concerns about intravenous iron increasing the risk of infection or cardiovascular disease are unfounded 2.
Management of IV Site Hardness
- If the IV site becomes hard after infusion, it may be a sign of extravasation, which requires immediate attention 4.
- Nursing intervention, including stopping administration of IV fluids, disconnecting the IV tube, and aspirating any remaining drug, is recommended 4.
- Local thermal treatments, such as ice packs, can be used to decrease the site reaction and absorption of the infiltrate 4.
Prevention of Extravasation
- Health professionals should be familiar with extravasation management standard guidelines and regularly check the extravasation kit 4.
- Assessing patients' sensory changes and paying attention to their words can help prevent extravasation 4.
- Continuous education on extravasation is essential for the medical team to reduce the occurrence rate and contribute to patient care improvement 4.