Intravenous Iron Administration: Methods, Solutions, and IV Line Placement
Intravenous iron can be administered as an undiluted slow bolus injection or as an infusion diluted in normal saline, with placement options including peripheral or central venous access depending on the specific iron formulation and dose. 1
Iron Formulations and Dilution Requirements
Different IV iron formulations have specific administration requirements:
Ferric Carboxymaltose (FCM)
- Dilution: Can be given undiluted as slow bolus injection or diluted in normal saline 1
- Maximum dilution: Should not be over-diluted as it affects drug stability 1
- Specific dilution guidelines:
- 500 mg dose: Dilute in maximum 100 mL of 0.9% sodium chloride
- 1000 mg dose: Dilute in maximum 250 mL of 0.9% sodium chloride 1
- Administration time:
- 500 mg: Minimum 6 minutes
- 1000 mg: Minimum 15 minutes 1
Iron Dextran
- Dilution: Dilute in normal saline or dextrose in water 1
- For CKD/home hemodialysis/PD patients: 500-1000 mg diluted in 250 mL normal saline 1
- Administration time: Infuse over 1 hour 1
- Pediatric dosing: Weight-based dilution in saline (see tables below) 1
Iron Sucrose
- Dosing: 200 mg can be given as bolus over 10 minutes 1
- Alternative administration: 200-500 mg over 30-210 minutes 2
Ferric Sodium Gluconate
- Dilution: 62.5 mg in 50 mL saline or 125 mg in 100 mL saline 1
- Administration time: 30-60 minutes 1
- Maximum dose: 125 mg per infusion 1
IV Line Placement Options
IV iron can be administered through:
- Peripheral venous access: Most common for routine administration
- Central venous access: Can be used when peripheral access is difficult
- For iron dextran only: Deep gluteal intramuscular injection is possible but can be painful and requires multiple injections 1
Administration Technique and Monitoring
- Pre-administration: Ensure secure IV placement before starting infusion 2
- Observation period: Patients should be observed for adverse effects for at least 30 minutes following each IV injection 1
- Maximum weekly dose: For FCM, maximum recommended cumulative dose is 1000 mg iron/week 1
- Setting: IV iron can be administered in hospital or community settings where staff are trained and equipped to manage hypersensitivity reactions 1
Potential Complications and Management
Local Reactions
- If bruising or tenderness develops during administration, stop infusion and monitor for 15 minutes 2
- Cold compresses and elevation of affected limb can help reduce inflammation 2
- Consider slower infusion rate (50% of initial rate) if symptoms resolve 2
Systemic Reactions
- Serious reactions can occur (0.6-0.7%) with iron dextran 1
- Anaphylaxis risk exists; resuscitation facilities should be available 1
- Different formulations have varying side effect profiles:
Special Considerations for Pediatric Patients
Iron Dextran Dosing for Pediatric Hemodialysis Patients
| Patient Weight | Dose per administration |
|---|---|
| <10 kg | 0.5 mL (25 mg) |
| 10-20 kg | 1.0 mL (50 mg) |
| >20 kg | 2.0 mL (100 mg) |
Iron Dextran for Pediatric Predialysis and PD Patients
| Patient Weight | Iron dose | Volume of saline for infusion |
|---|---|---|
| <10 kg | 125 mg | 75 mL |
| 10-20 kg | 250 mg | 125 mL |
| >20 kg | 500 mg | 250 mL |
Follow-up Monitoring
- Re-evaluate iron status 3 months after administration 1
- Avoid early re-evaluation (within 4 weeks) as ferritin levels increase markedly following IV iron administration 1
By following these guidelines for IV iron administration, healthcare providers can safely and effectively deliver iron therapy while minimizing the risk of adverse reactions.