The risk manager of my wife’s center is uncomfortable with home administration of IV iron. Her nephrologist asked us to try and identify centers which permit giving iron at home.
I would appreciate anyone whose center (or knows of a center) which permits this practice letting me know the center names to help us put our case together.
Thanks in advance for your help.
Mel
Rubin Dialysis Center
Mine does, but I’m in Canada, so it’s probably of no use to you. There are a few very specific instructions though. It must be after the first 30 minutes of treatment, and it can’t be more than 100mg. More has to be done in a hospital setting. It can’t be the very first time it’s used, either, due to the possibility of an allergic reaction. It can’t be administered if there is a temperature or if on antibiotics.
I can understand your centre’s caution though, because it’s possible to have an allergic reaction or hypotension any time.
Pierre
Pierre, could I have the name and location of your center? Many, if not most, nocturnal dialysis practices originated in Canada so it it is a useful precedent. I note the restrictions you described.
Mel
Sure, if you want it, Mel. It’s the Ottawa Hospital (Riverside Campus) Home Dialysis Unit, in Ottawa. They handle both PD and home hemo there.
By the way, in addition to the SOPs I already mentioned, the Venofer has to be administered 4ml per minute over a period of 5 minutes. The 4ml is from the syringe in which the 100mg of Venofer has already been mixed with 15ml of saline. I have to measure my BP both before and after.
Good luck.
Pierre
Ours does, but it isn’t going to help because we are in different country.
you might however be interested in how we administer the iron infusion.
Using a fresenius machine. In the last hour before dialysis finishes. I draw 8 mls of saline from the bag and 2 mls of iron from the ampule. Then, lower the blood pump to 180. clamp off the heparin line, remove it from the pump. Then, unclamp the line and withdraw into the heparin syringe 1 ml of blood ( this is to just clean out the line of heparin). Then, clamp the heparin line again, remove the heparin syringe and attach the syringe that is filled with the iron/saline. Attach this to the heparin pump and unclamp the line.
Then, set the heparin clock for 1 hour, and rate 10mls.
turn the heparin pump back on, turn the blood pump back up and administer 1.oml bolus, then thats it. the rest does it on its own.
hope this wasn’t to confusing, but it is a good way to do the heparin without having to do it manually.
Queenie – thanks, very interesting procedure. I infer you run OK without heparin during the last hour when the heparin system is being used to infuse iron. How many mg of iron are in the two mls? Is this a weekly procedure?
Mel
Hi, Mel,
he always runs the last hour and a half without heparin anyway, he does eight hours and the heparin is turned of at 6.30.
The iron is 100mg in 2ml. and at the moment he is doing so well he isn’t using any iron. But before he was doing administering once a fortnight ( when he was on interferon for hep C), then he was doing it once a month.
Queenie.
Does the NxStage or PHD have a port that IV Iron can be administered through.
one issue with iron is reimbursement. the only esrd related medicine that is covered for self administration by Medicare is epo. iron is not.
Some supplemental insurances cover the iron, we happen to have one of them so my questions is about the machines; do they have the port to administer the iron through.
I’m on the nx stage machine too and get IV iron. The procedure is the same as at pierre’s unit and there is indeed a port for meds on the nxstage machine. My unit is Barnsh-Jewish Dialysis Unit is St. Louis.
Lizzie
I have had some patients tell me they do very well with oral iron. If particular machine companies do not permit home patients to administer IV iron, perhaps oral could be used.
Yay for oral iron, Nay for injectable iron… :oops:
I’ve been using oral iron for almost a year now!! I want to try liquid based iron and see which is better…maybe sometime in the next few weeks…
Which brand of oral iron do you use?
I switched from IV iron (Venofir?) to oral iron (Proferrin ES) after I switched from in-center to home hemo. It’s been almost 6 months now on Proferrin and my iron stores are still really good. So, I guess that means that the oral iron is being absorbed pretty well.
When I first started home hemo, my neph did not feel that oral iron would be absorbed well enough to meet my body’s needs. He wanted me to get a 15 minute treatment of IV iron once a month, each time I came into the clinic for my monthly visit.
I was pretty opposed to that when he told me that is what he wanted - I get stuck too much already doing short daily home hemo; I didn’t want to have to get stuck again for a seperate iron dose and have to sit in the clinic for 15 minutes while I was getting it. The head nurse of my home hemo unit at my clinic suggested I try oral doses of Proferrin because she had heard that because Proferrin was derived from bovine iron, instead of synthetically created like the other oral iron options, that it tended to be absorbed by the body pretty well.
Luckily, my nephrologist decided that I could try it out to see how well my body absorbed it. When my next set of monthly labs came back there was no noticeable decrease in my iron stores. So he agreed to let me keep using it. Since then, all of my labs have reflected good iron stores.
So, I am going to keep taking Proferrin ES orally, until (and if) my labs show that my body is not absorbing it well enough anymore.
So far, so good. One extra pill a day sure beats having to get stuck once a month just to receive an IV iron treatment. I’m just going to keep my fingers crossed and hope that the Proferrins ES keeps working for me.
Oh yeah - my clinic will not let me administer IV iron by myself at home, even though I have never had an allergic reaction to it in the past. They told me that IV iron is regulated in the sense that patients are not permitted to give it to themselves at home. I don’t know if the regulation is due to a company rule (DaVita), a federal rule, or a state rule (Texas).
Glad you are doing well on the Proferrin ES. the same brand was suggested to me for the reasons you mentioned. Like you, I would not want to have to go in the unit and get an extra stick to get iron.
What time a day do you take your pill? What are the directions for how it should be taken? If it should turn out that it does not work well enough, I’ve heard that liquid iron is very affective.
Would you or anyone else know, does the doc/unit stand to profit from giving iron IV or is the profit inconsequential?
Jane -
I take my Proferrin ES in the evening, when I take most of my other meds (I probably have about 12 total that I have to take PO in the evenings). I just take 1 pill of Proferrin at night; it doesn’t matter if it is with or without food.
I’m not 100% sure on this, but I think that there isn’t a profit for the clinics when they give IV iron - I think that it’s sort of like EPO. I could be wrong, since I don’t pay their bills, but even if they did get a profit I’m sure it is inconsequential, like you mentioned.
Eston Burciaga
Eston,
Do you have any side effects from the oral iron? I mentioned it to a staff person and he said that oral iron is constipating and can cause stomach problems. You don’t seem to say you have any problems at all with this variety.