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CSC SC Iron Dextran Monthly Ver 11-20-17 (HL 1857)

CSC SC Iron Dextran Monthly Ver 11-20-17 (HL 1857) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Supportive Care


CSC SC IRON DEXTRAN MONTHLY VER: 11-20-17 –  Properties
Cycle 1 –  11/21/2017 through 12/18/2017 (28 days), Planned
Day 1, Cycle 1 –  Planned for 11/21/2017
Treatment Conditions
Treatment Condition A
Clinical guidelines for administration:
Desired critical lab values for holding or administering iron dextran: ***
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to iron dextran can occur. For first and second dose, patient should be treated in a location to
optimize emergency care.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior to full treatment dose of iron dextran, but AFTER iron dextran test dose
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior to full treatment dose of iron dextran, but AFTER iron dextran test dose
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
iron dextran complex (INFED) 25 mg in sodium chloride 0.9 % 50 mL bag
25 mg, Intravenous, ONCE, 1 dose Starting when released
Indication = test dose
iron dextran complex (INFED) in sodium chloride 0.9 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Hypersensitivity risk. See emergency medications.
If no significant reaction experienced within 20-30 minutes of receiving test dose, administer full dose as ordered.
If total dose is less than 1000 mg, administer over 2-3 hours.
If total dose is greater than or equal to 1000 mg, administer over 3-4 hours.
Dose indicated here {includes/excludes:14821} test dose of 25 mg.
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Zztestonc,Fiona F [2462287]
11/21/2017 10:33:27 AM Page 1 of 6
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Cycle 2 –  12/19/2017 through 1/15/2018 (28 days), Planned
Day 1, Cycle 2 –  Planned for 12/19/2017
Treatment Conditions
Treatment Condition A
Clinical guidelines for administration:
Desired critical lab values for holding or administering iron dextran: ***
Treatment Condition B
Give if ferritin is less than 30 ng/mL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to iron dextran can occur. For first and second dose, patient should be treated in a location to
optimize emergency care.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
iron dextran complex (INFED) in sodium chloride 0.9 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Hypersensitivity risk. See emergency medications.
If total dose is less than 1000 mg, administer over 2-3 hours.
If total dose is greater than or equal to 1000 mg, administer over 3-4 hours.
Cycle 3 –  1/16/2018 through 2/12/2018 (28 days), Planned
Day 1, Cycle 3 –  Planned for 1/16/2018
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Zztestonc,Fiona F [2462287]
11/21/2017 10:33:27 AM Page 2 of 6
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Treatment Conditions
Treatment Condition A
Clinical guidelines for administration:
Desired critical lab values for holding or administering iron dextran: ***
Treatment Condition B
Give if ferritin is less than 30 ng/mL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to iron dextran can occur. For first and second dose, patient should be treated in a location to
optimize emergency care.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
iron dextran complex (INFED) in sodium chloride 0.9 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Hypersensitivity risk. See emergency medications.
If total dose is less than 1000 mg, administer over 2-3 hours.
If total dose is greater than or equal to 1000 mg, administer over 3-4 hours.
Cycle 4 –  2/13/2018 through 3/12/2018 (28 days), Planned
Day 1, Cycle 4 –  Planned for 2/13/2018
Treatment Conditions
Treatment Condition A
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Zztestonc,Fiona F [2462287]
11/21/2017 10:33:27 AM Page 3 of 6
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Clinical guidelines for administration:
Desired critical lab values for holding or administering iron dextran: ***
Treatment Condition B
Give if ferritin is less than 30 ng/mL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to iron dextran can occur. For first and second dose, patient should be treated in a location to
optimize emergency care.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
iron dextran complex (INFED) in sodium chloride 0.9 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Hypersensitivity risk. See emergency medications.
If total dose is less than 1000 mg, administer over 2-3 hours.
If total dose is greater than or equal to 1000 mg, administer over 3-4 hours.
Cycle 5 –  3/13/2018 through 4/9/2018 (28 days), Planned
Day 1, Cycle 5 –  Planned for 3/13/2018
Treatment Conditions
Treatment Condition A
Clinical guidelines for administration:
Desired critical lab values for holding or administering iron dextran: ***
Treatment Condition B
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Zztestonc,Fiona F [2462287]
11/21/2017 10:33:27 AM Page 4 of 6
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Give if ferritin is less than 30 ng/mL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to iron dextran can occur. For first and second dose, patient should be treated in a location to
optimize emergency care.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
iron dextran complex (INFED) in sodium chloride 0.9 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Hypersensitivity risk. See emergency medications.
If total dose is less than 1000 mg, administer over 2-3 hours.
If total dose is greater than or equal to 1000 mg, administer over 3-4 hours.
Cycle 6 –  4/10/2018 through 5/7/2018 (28 days), Planned
Day 1, Cycle 6 –  Planned for 4/10/2018
Treatment Conditions
Treatment Condition A
Clinical guidelines for administration:
Desired critical lab values for holding or administering iron dextran: ***
Treatment Condition B
Give if ferritin is less than 30 ng/mL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
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Zztestonc,Fiona F [2462287]
11/21/2017 10:33:27 AM Page 5 of 6
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Hypersensitivity reaction to iron dextran can occur. For first and second dose, patient should be treated
in a location to optimize emergency care.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Give 30 minutes prior iron dextran
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
iron dextran complex (INFED) in sodium chloride 0.9 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Hypersensitivity risk. See emergency medications.
If total dose is less than 1000 mg, administer over 2-3 hours.
If total dose is greater than or equal to 1000 mg, administer over 3-4 hours.
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Zztestonc,Fiona F [2462287]
11/21/2017 10:33:27 AM Page 6 of 6
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org