What are the essential details to document for a patient with iron deficiency anemia undergoing intravenous (IV) iron infusion, considering their medical history, current symptoms, and laboratory results?

Documentation of IV Iron Infusion

Document the indication, pre-infusion assessment including iron studies and vital signs, infusion details (formulation, dose, rate, dilution), monitoring parameters during and post-infusion, any adverse events, and post-infusion vital signs with patient disposition. 1, 2

Pre-Infusion Documentation

Indication and Diagnosis

• Record the diagnosis of iron deficiency anemia with supporting laboratory values: hemoglobin <13 g/dL in men or <12 g/dL in non-pregnant women, AND ferritin <45 ng/mL (or <30 ng/mL in absence of inflammation), and/or transferrin saturation <20% 1, 3, 4
• Document the specific indication for IV iron rather than oral iron: oral iron intolerance or failure, malabsorption conditions (celiac disease, post-bariatric surgery), chronic inflammatory conditions (IBD, CKD, heart failure), ongoing blood loss exceeding absorption capacity, or pregnancy (second/third trimester) 1, 3, 4, 5
• Note any underlying etiology identified through GI evaluation, including results of H. pylori testing, celiac serology, or endoscopic findings 1

Pre-Infusion Assessment

• Record baseline vital signs including blood pressure, heart rate, respiratory rate, and oxygen saturation 2
• Document baseline iron studies: serum ferritin, transferrin saturation, hemoglobin, and hematocrit 1
• Screen for and document any history of prior reactions to parenteral iron products or multiple drug allergies 1, 2
• Confirm and document that emergency medications and personnel trained in anaphylaxis management are immediately available 1, 2

Infusion Documentation

Medication Details

• Document the specific IV iron formulation used (iron dextran, ferric gluconate, iron sucrose, or newer high-dose formulations) 1, 2
• Record the exact dose in mg of elemental iron: For ferric gluconate, typical adult dose is 125 mg (10 mL) per session; pediatric dose is 1.5 mg/kg (maximum 125 mg) 2
• Document dilution and infusion vehicle: ferric gluconate should be diluted in 100 mL of 0.9% sodium chloride for adults or 25 mL for pediatric patients 2
• Record infusion rate and duration: ferric gluconate is typically infused over 1 hour, or may be given undiluted as slow IV injection at rate up to 12.5 mg/min 2

Test Dose (if applicable)

• For iron dextran only, document administration of 25 mg test dose (10 mg for pediatric patients <10 kg, 15 mg for 10-20 kg) given IV over 1 minute 1
• Record 15-60 minute observation period after test dose before proceeding with therapeutic dose 1

Monitoring During Infusion

Vital Signs and Observation

• Document vital signs at regular intervals during infusion (typically every 15-30 minutes) and continuously observe for signs of hypersensitivity 2
• Record any symptoms or signs of hypersensitivity reactions: pruritus, facial flushing, chest pain, dyspnea, wheezing, back pain, hypotension, diaphoresis, nausea, or dizziness 2
• Note that hypotension may occur independent of allergic reactions and usually resolves within 1-2 hours; this may be augmented by concurrent dialysis 2

Adverse Events

• Document any adverse events immediately, including severity, time of onset, interventions provided, and resolution 2
• Common reactions to document include nausea, vomiting, injection site reactions, hypotension, cramps, hypertension, dizziness, dyspnea, chest pain, and leg cramps (occurring in ≥10% of adult patients) 2
• In pediatric patients (6-15 years), document hypotension, headache, hypertension, tachycardia, or vomiting if they occur 2

Post-Infusion Documentation

Immediate Post-Infusion

• Record vital signs immediately after infusion completion and document patient stability 2
• Document observation period of at least 30 minutes post-infusion until patient is clinically stable 2
• Note patient's tolerance of the infusion and any delayed symptoms 2

Treatment Plan

• Document the cumulative dose administered and remaining doses needed: most patients require cumulative dose of 1000 mg elemental iron over 8 dialysis sessions for repletion 1, 2
• Record plan for repeat dosing if indicated, noting that single-dose or two-dose high-dose formulations are preferred when available 1
• Schedule follow-up iron studies (ferritin, transferrin saturation, hemoglobin, hematocrit) to be checked 2-4 weeks after completion of iron repletion course 1, 2

Patient Education Documentation

• Document patient counseling regarding risks of hypersensitivity reactions, symptoms to report (chest pain, dizziness, lightheadedness, swelling, breathing problems), and that oral iron absorption may be reduced if taken concurrently 2
• For pregnant patients, document counseling about hypersensitivity risks that may have serious consequences for the fetus 2

Critical Safety Documentation

Contraindications and Warnings

• Document absence of known hypersensitivity to the specific iron formulation being used 2
• Note that Ferrlecit is not approved for use in neonates or infants due to benzyl alcohol content 2
• Document that doses exceeding 125 mg of ferric gluconate may be associated with higher incidence of adverse events 2

Monitoring for Iron Overload

• Document baseline and periodic monitoring of iron parameters to avoid iron overload: maintain ferritin <800 ng/mL and transferrin saturation <50% 1
• Withhold IV iron temporarily if ferritin or transferrin saturation become excessively elevated 1