What is the recommended protocol for administering a test dose of intravenous (IV) medication?

Protocol for Administering a Test Dose of Intravenous (IV) Medication

The recommended protocol for administering a test dose of intravenous medication includes ensuring proper patient identification, appropriate vascular access, and having emergency medications and equipment readily available before administration. 1

General Preparation

• Ensure proper patient identification using at least two identifiers before administering any IV medication 1, 2
• Have emergency medications (such as epinephrine, antihistamines, or specific reversal agents) prepared and readily available before administering test doses of medications with potential for anaphylaxis or severe reactions 1
• Ensure continuous electrocardiographic monitoring during administration of medications with high risk of adverse reactions 3, 1
• Use proper infusion systems to ensure accurate dosing, as both therapeutic effectiveness and adverse events are dose and rate dependent 1

Specific Test Dose Protocols

• For iron dextran: Administer a one-time test dose of 25 mg IV for adults (10 mg for pediatric patients weighing <10 kg; 15 mg for those weighing 10-20 kg) 3
• For iron gluconate: Administer a one-time test dose of 25 mg IV diluted in 50 mL 0.9% sodium chloride over 60 minutes 3
• For medications with risk of anaphylaxis: Start with 10% of the therapeutic dose as a test dose 1
• For medications with cardiac effects (e.g., adenosine): Use a two-syringe technique with immediate flush following the test dose 3, 1

Administration Technique

• Administer most IV test doses slowly over 2-3 minutes while monitoring vital signs and observing for adverse reactions 1
• For iron dextran, administer by slow IV push at a rate not exceeding 1.0 mL (50 mg, if undiluted) per minute 3
• Wait 15 to 60 minutes after the initial test dose before administering the remainder of the therapeutic dose, assuming no initial adverse reaction occurred 3
• Use the most proximal IV site possible for medications requiring rapid distribution 3

Monitoring During Test Dose Administration

• Monitor vital signs before, during, and after test dose administration 1
• Observe for signs of adverse reactions specific to the medication being administered 1
• For medications with risk of anaphylaxis, monitor for signs of hypersensitivity including rash, urticaria, hypotension, and bronchospasm 1
• Document patient response to test dose before proceeding with full therapeutic dose 1

Managing Adverse Reactions

• Stop infusion immediately if adverse reactions occur 1
• For anaphylactic reactions: Administer epinephrine immediately and follow anaphylaxis protocol 3, 1
• For extravasation of vasoconstrictors: Infiltrate the site with phentolamine 1
• Be prepared to provide respiratory support if administering medications that may cause respiratory depression 1, 4

Common Pitfalls and Precautions

• Never administer test doses of vesicant medications through peripheral IV lines with questionable placement 1
• Ensure proper weight-based dosing calculations and appropriate dilution, especially for pediatric patients 1, 5
• Avoid rapid administration of test doses unless specifically indicated for the medication (e.g., adenosine) 1
• Test doses for different medications (e.g., iron dextran and iron gluconate) are not interchangeable; an uneventful response to one agent does not preclude an adverse reaction to another 3
• Ensure test doses are administered by personnel trained to provide emergency treatment with immediate access to medications needed for treatment of serious allergic reactions 3