What information should be included when writing outpatient daycare notes for iron sucrose infusion?

Documentation for Iron Sucrose Infusion in Outpatient Daycare

Outpatient daycare notes for iron sucrose infusion must include pre-infusion assessment, administration details with vital sign monitoring, adverse event documentation, and post-infusion instructions.

Pre-Infusion Documentation

Patient Assessment and Indication

• Document the indication for IV iron therapy: intolerance to oral iron, inadequate response to oral iron, or need for rapid iron repletion 1
• Record baseline laboratory values: hemoglobin, ferritin, transferrin saturation (TSAT), and mean corpuscular volume (MCV) 2, 3
• Document iron deficiency criteria: typically TSAT <20% and ferritin <300 ng/mL in dialysis patients, or lower thresholds in other populations 3

Risk Stratification

• Assess and document high-risk features for infusion reactions: history of severe asthma, eczema, mastocytosis, multiple drug allergies, or prior reaction to IV iron 1
• Note contraindications: document absence of active infection, iron overload, or hypersensitivity to iron sucrose 4
• Record concurrent medications, particularly ACE inhibitors (which do not contraindicate use but should be noted) 3

Administration Documentation

Dosing Details

• Document the prescribed dose: maximum single dose is 200 mg for iron sucrose 1
• Record the infusion method: iron sucrose can be given as a 2-5 minute IV push (FDA-approved) or diluted in 100-150 mL normal saline over 10-30 minutes 1, 4, 5, 6
• Note that no test dose is required for iron sucrose, unlike iron dextran 7, 3

Vital Signs Monitoring

• Document baseline vital signs: blood pressure, pulse, respiratory rate, oxygen saturation, and temperature 1
• Record vital signs during the first 10 minutes of infusion, as immediate reactions typically occur within the first minute 1
• Continue monitoring throughout infusion and for at least 15-30 minutes post-infusion 1, 5

Infusion Process

• Document IV access: peripheral IV site, gauge, and any difficulties with placement 8
• Record infusion start time and rate: slower infusion rates are associated with lower reaction rates 1
• Note patient tolerance: specifically document presence or absence of metallic taste (occurs in ~18% of patients but is benign) 5

Adverse Event Documentation

Immediate Reactions

• Document any symptoms during infusion: pruritus, flushing, urticaria, chest tightness, back pain, joint pain, shortness of breath, or hypotension 1
• Classify reaction severity if present:
  • Mild: pruritus, flushing, urticaria, chest tightness, back/joint pain 1
  • Moderate: transient cough, shortness of breath, tachycardia, hypotension (SBP drop ≥30 mmHg or SBP ≤90 mmHg) 1
  • Severe/anaphylaxis: loss of consciousness, angioedema, multi-organ involvement 1

Management of Reactions

• Document interventions if reaction occurs: stopping infusion, switching to normal saline, administering antihistamines, corticosteroids, or epinephrine 1
• Record response to interventions and time to symptom resolution 1
• Note any rechallenge attempts: if symptoms resolved, document restart at 50% infusion rate 1

Common Minor Events

• Document transient symptoms: metallic taste (most common, 17.9% of cases), mild nausea, injection site pain, or lightheadedness 5, 6, 8
• Note that serious adverse reactions are rare (<1%) with iron sucrose 5, 2, 3

Post-Infusion Documentation

Patient Education

• Document counseling on delayed reactions: flu-like symptoms, arthralgias, myalgias, fevers that may occur hours to days after infusion 1
• Record instructions for managing delayed symptoms: use of NSAIDs for symptomatic relief 1
• Note when to seek medical attention: persistent or worsening symptoms 1

Follow-Up Plan

• Document plan for repeat dosing if needed: iron sucrose can be given up to 500 mg weekly (maximum) 1
• Record timing of follow-up laboratory monitoring: typically hemoglobin and iron studies should be rechecked 2-4 weeks after completing iron therapy 2, 3
• Note target parameters: aim for hemoglobin normalization and ferritin >100 ng/mL to replenish stores 1

Safety Considerations

Resuscitation Readiness

• Document availability of resuscitation equipment: anaphylaxis may occur with any IV iron formulation, and resuscitation facilities must be immediately available 1
• Note staff preparedness: all personnel must be trained in recognition and management of infusion reactions 1

Iron Overload Prevention

• Document cumulative iron dose if patient receiving serial infusions 4
• Note monitoring plan to prevent iron overload: regular ferritin and TSAT monitoring in patients on long-term therapy 1, 4