Management of Intravenous Iron Extravasation

Immediate Actions

The American College of Cardiology recommends stopping the infusion immediately and switching to normal saline at KVO rate to maintain access while preventing further tissue damage 5
Monitoring of vital signs, including blood pressure, pulse, respiratory rate, oxygen saturation, and temperature, should be performed until stable 5
A physical assessment should be conducted to determine if the infiltration is isolated or associated with systemic symptoms, which might indicate a concurrent hypersensitivity reaction 5
Documentation of the event in the patient's medical record, including the medication infiltrated, estimated volume, location, and clinical findings, is essential 6

Yellow facial discoloration may occur and can persist for weeks to months but typically fades gradually 6

For mild symptoms, such as isolated headache or myalgias, NSAIDs are recommended as first-line treatment 5
For moderate reactions, consideration of hydrocortisone 100-500 mg IV, famotidine 20 mg IV, and second-generation antihistamines, such as loratadine 10 mg orally or cetirizine 10 mg IV/orally, is advised 5
Avoidance of first-generation antihistamines, such as diphenhydramine, and vasopressors is recommended, as they can convert minor reactions into hemodynamically significant events 5
For severe reactions, administration of epinephrine 0.3 mg IM and calling emergency services is necessary 5

Ensuring proper IV line placement and securing the catheter to prevent extravasation is crucial 6
Using slower infusion rates, as faster rates increase reaction risk, is recommended 5, 6
Considering alternative iron formulations if infiltration or reactions recur is advised 6

The European Society of Cardiology emphasizes that proper line placement is the primary prevention strategy, and overlooking this can lead to complications 6
Aggressive treatment of self-limited infusion reactions with antihistamines or vasopressors should be avoided, as most reactions are complement activation-related pseudo-allergy (CARPA), not true IgE-mediated hypersensitivity 7