Date:
▲ ▼ IV Iron Iron Sucrose 300 mg IV sodium chloride 0.9% 250 mL. Give:
Administer over at least 90 minutes. INFUSION REACTIONS: If signs of hypersensitivity/anaphylaxis, STOP infusion immediately and notify physician Follow guideline for Anaphylaxis: Clinical Practice Guideline (Registered Nurse initiated Activity, 2009) Infusion reaction medications: Acetaminophen 650 mg PO x1 EPInephrine 1 mg/ml (1:1000) 0.5 ml IM for anaphylaxis diphenhydrAMINE 25-50 mg IV x1 for urticaria/pruritus
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Prescriber Signature Prescriber Phone CPSID
Subject:
Creative Commons License Burnaby Hospital Iron Infusion Referral eForm, created by Dr. John Yap, Mar7_2020. Licensed under a GPL. Please consider supporting OSCAR BC.