A nurse is preparing to administer IV iron dextran. Which pr… | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A nurse is preparing to administer IV iron dextran. Which preparation step most reflects safe practice given the FDA boxed warning?
1Administer the full dose without test dose
2Administer a small test dose first and monitor for 30-60 minutes with anaphylaxis emergency supplies (epinephrine, diphenhydramine, O2) at bedside✓ Correct answer
3Push the dose over 30 seconds
4Mix with KCl in the same line
Explanation
Correct (2): Iron dextran carries an FDA boxed warning for anaphylaxis. A test dose is required, with 30-60 min monitoring and anaphylaxis kit at bedside. Newer formulations (iron sucrose, ferric carboxymaltose, ferumoxytol) have lower risk but still need monitoring. (1,3,4) Dangerous.
In-depth explanation
Memory Tip Iron dextran IV = "Dextran-Danger" — test dose mandatory. Lower-risk: iron sucrose, ferric carboxymaltose. Always have epi at bedside.
Clinical scenario
Scenario 52-year-old female with severe IDA refractory to oral iron; ordered iron dextran IV. Pre-infusion preparation.
Key concepts
IV iron — Used when PO iron fails or absorption impaired (e.g., CKD, IBD, GI surgery).
Iron dextran anaphylaxis — FDA boxed warning; test dose + 30-60 min observation required.
Newer IV iron formulations — Iron sucrose, ferric carboxymaltose, ferumoxytol; lower anaphylaxis risk than iron dextran.