Intravenous Iron Orders - HUMCMD.net
Intravenous Iron Orders - HUMCMD.net
Intravenous Iron Orders - HUMCMD.net
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AUTOMATIC<br />
STOP ORDERS<br />
Requires renewal every 24<br />
hours:<br />
• Oral Anticoagulants<br />
• Albumin<br />
• Large Volume IV Solutions<br />
Requires renewal every 5<br />
days:<br />
• Injectable Anticoagulants(sc)<br />
• Controlled Substances<br />
• Cortisone Products<br />
UNACCEPTABLE<br />
ABBREVIATIONS<br />
DO<br />
NOT<br />
USE<br />
<br />
SAFE PRESCRIBING<br />
Always write the order as follows<br />
1.0 MG - Express as whole number only – 1 mg<br />
.5 MG - Always use zero before decimal – 0.5 mg<br />
U - Always write out the word – “unit”<br />
MSO4 - Always write out the word – “morphine”<br />
MgSO4 - Always write out the words – “magnesium sulfate”<br />
IU - Always write out the words – “international unit”<br />
QD - Always write out the word – “daily”<br />
QOD - Always write out the words – “every other day”<br />
AFFIX PATIENT INFO LABEL HERE<br />
Patient Name ________________________ MR# ___________<br />
ALLERGIES:<br />
Date<br />
of<br />
Order<br />
Hour<br />
of<br />
Order<br />
Nurse’s Signature<br />
PHYSICIAN MUST ENTER DATE, HOUR, AND SIGN EACH SET OF ORDERS.<br />
INTRAVENOUS IRON ORDER FOR ADULT PATIENTS<br />
(IRON DEXTRAN and FERRIC GLUCONATE-FERRLECIT)<br />
1. Baseline Hgb, Hct, Fe, TIBC, transferrin saturation, and ferritin must be available<br />
prior to ordering IV iron<br />
2. Use pediatric tubes for all blood draws.<br />
3. PRE-MEDICATIONS (only if needed )- include name, dosages, route and frequency:<br />
___________________________________________________________________<br />
___________________________________________________________________<br />
4. IV IRON ORDERS (see back page for dosing information)<br />
♣ PATIENT’S HGB= _________g/dL HGB GOAL = _________g/dL<br />
♣ WEIGHT (use IBW unless actual weight is less) = ______kg (see back of order)<br />
♣ ESTIMATED IV IRON REQUIREMENT = __________mg (see back of order for<br />
estimation of iron requirement). Choose ONE of the following iron products:<br />
A. IRON DEXTRAN IV:<br />
Test dose <strong>Iron</strong> Dextran: 25mg IV in 50mL NS over 15 minutes X 1<br />
If adverse reactions do not occur after one hour, initiate dose below.<br />
Total dose <strong>Iron</strong> Dextran (recommend maximum 1000mg per day - see back of order)♦:<br />
Day #1: Give _______ mg <strong>Iron</strong> Dextran IV in 250mL NS over _____hrs (4-6hrs)<br />
Day #2: Give ________mg <strong>Iron</strong> Dextran IV in 250mL NS over _____hrs (4-6hrs)<br />
Other or maintenance dose ___________________________________<br />
Have the following medications available prior to infusing <strong>Iron</strong> Dextran:<br />
Epinephrine 1:1000 (1mg/1mL) injectable<br />
Diphenhydramine 50mg injectable<br />
Hydrocortisone 100mg injectable<br />
Vital signs: baseline, then q 15 minutes X 1 h, then q 1 h during each infusion<br />
B. FERRIC GLUCONATE IV (FERRLECIT):<br />
IV infusion 125mg in 100mL NS over 1 hour (recommend maximum 125mg per day)<br />
once daily X ____ doses OR _____________________________________________<br />
IV push 125mg (10mL) undiluted over 10 minutes per dialysis session / patient visit X<br />
_____________doses (dialysis patients only)<br />
Vital signs: baseline, q 30 minutes during first infusion, then per unit policy<br />
Ferric Gluconate infusion must be used immediately after mixed by pharmacy<br />
RN to please call pharmacy prior to giving each infusion dose.<br />
Do NOT mix or infuse IV <strong>Iron</strong> with any other medications<br />
5. OTHER ORDERS:<br />
___________________________________________________________________<br />
___________________________________________________________________<br />
Physician Signature: ____________________________________________________<br />
PLEASE DO NOT RETURN CHARTS WITH NEW ORDERS TO RACK-FLAG CHART<br />
HACKENSACK UNIVERSITY MEDICAL CENTER<br />
PHYSICIANS ORDERS AND TREATMENTS Page 1 of 1<br />
<strong>Intravenous</strong> <strong>Iron</strong> Order Medical Record HUMC NS#5031599 Rev.7/24/06
ESTIMATION OF IV IRON REQUIREMENT IN ADULT PATIENTS - <strong>Iron</strong> Dextran or Ferric Gluconate (Ferrlecit)<br />
DIRECTION:<br />
1. Use TABLE 1 to obtain IBW (use actual weight if it is less than IBW).<br />
2. Choose your Hemoglobin goal and use TABLE 2 to find the estimated dose of IV IRON (iron dextran or ferric gluconate (Ferrlecit)) in MG based on the<br />
patient’s current Hemoglobin.<br />
TABLE 1: IDEAL BODY WEIGHT (IBW) IN KG - Round weight down to the nearest 5kg<br />
HEIGHT 5ft 1 5ft 2 5ft 3 5ft 4 5ft 5 5ft 6 5ft 7 5ft 8 5ft 9 5ft 10 5ft 11 6ft 6ft 1 6ft 2 6ft 3 6ft 4 6ft 5 6ft 6 6ft 7 6ft 8 6ft 9<br />
MALE 52kg 55kg 57kg 59kg 62kg 64kg 66kg 68kg 71kg 73kg 75kg 78kg 80kg 82kg 85kg 87kg 89kg 91kg 94kg 96kg 98kg<br />
FEMALE 48kg 50kg 52kg 55kg 57kg 59kg 62kg 64kg 66kg 69kg 71kg 73kg 75kg 78kg 80kg 82kg 85kg 87kg 89kg 92kg 94kg<br />
• IBW in kg (male)= 50kg + 2.3kg/inch over 60 inches<br />
• IBW in kg (female)= 45.5kg + 2.3kg/inch over 60 inches (These equations are use to calculated IBW in TABLE 1 above)<br />
TABLE 2: HEMOGLOBIN GOALS - Round dose to the nearest 50 or 100mg<br />
HEMOGLOBIN GOAL = 12 g/dL WEIGHT WEIGHT HEMOGLOBIN GOAL = 13 g/dL HEMOGLOBIN GOAL = 14.8 g/dL<br />
WEIGHT MG of IV IRON based on patient Hgb MG of IV IRON based on patient Hgb MG of IV IRON based on patient Hgb<br />
(kg) 6g/dL 7g/dL 8g/dL 9g/dL 10g/dL (kg) 6g/dL 7g/dL 8g/dL 9g/dL 10g/dL (kg) 6g/dL 7g/dL 8g/dL 9g/dL 10g/dL<br />
40 1320 1100 880 660 440 40 1422 1218 1015 812 609 40 1570 1391 1213 1035 856<br />
45 1485 1238 990 743 495 45 1599 1371 1142 914 685 45 1766 1565 1365 1164 963<br />
50 1650 1375 1100 825 550 50 1777 1523 1269 1015 762 50 1962<br />
55 1815 1513 1210 908 605 55 1955 1675 1396 1117 838 55 2158<br />
60 1980 1650 1320 990 660 60 2132 1828 1523 1218 914 60 2355<br />
65 2145 1788 1430 1073 715 65 2310 1980 1650 1320 990 65 2551<br />
70 2310 1925 1540 1155 770 70 2488 2132 1777 1422 1066 70 2747<br />
75 2475 2063 1650 1238 825 75 2665 2285 1904 1523 1142 75 2943<br />
80 2640 2200 1760 1320 880 80 2843 2437 2031 1625 1218 80 3139<br />
85 2805 2338 1870 1403 935 85 3021 2589 2158 1726 1295 85 3336<br />
90 2970 2475 1980 1485 990 90 3198 2742 2285 1828 1371 90 3532<br />
1739 1516 1293 1070<br />
1913 1668 1423 1177<br />
2087 1819 1552 1284<br />
2261 1971 1681 1391<br />
2435 2123 1811 1498<br />
2609 2274 1940 1605<br />
2783 2426 2069 1712<br />
2957 2578 2199 1819<br />
3131 2729 2328 1926<br />
MG of <strong>Iron</strong> = 0.66 X IBW in kg X [ 100 − (Observed Hgb X 100) ] (This equation is used to estimate the dosages in TABLE 2 above.<br />
Desired Hgb Use this equation if your Hgb goal is different from the above)<br />
FERRIC GLUCONATE (FERRLECIT):<br />
‣ Recommend no more than 125mg per day at 125mg/h per manufacturer and HUMC guidelines.<br />
IRON DEXTRAN:<br />
‣ Recommend no more than 1000mg per day per HUMC guidelines.<br />
‣ Doses higher than 1000mg per day can be prescribed at the discretion of the prescribing physician with staff hematology consultation.<br />
‣ Suggested infusion time is 4-6 hours (shorter infusion time may be appropriate at the discretion of the prescriber and should not be faster than 500mg/h)<br />
JBui\071506<br />
<strong>Intravenous</strong> <strong>Iron</strong> Order Medical Record HUMC NS#5031599 Rev.7/24/06