# Understanding and Managing Infusion Reactions and Hypophosphataemia With Intravenous Iron—A Nurses' Consensus Paper

## TL;DR

This paper provides nursing guidelines for safely administering intravenous iron, focusing on managing infusion reactions and hypophosphataemia.

## Contribution

It offers the first nursing-focused consensus on managing infusion reactions and hypophosphataemia during intravenous iron administration.

## Key findings

- Nurses should monitor patients during the first 5–10 minutes of infusion for immediate reactions.
- Hypophosphataemia symptoms like fatigue and muscle pain require vigilance after certain intravenous iron treatments.
- Patient preparation and clear communication are essential to reduce anxiety and ensure safety.

## Abstract

To provide evidence‐based guidance on practical aspects and potential safety concerns (infusion reactions and hypophosphataemia) related to the use of intravenous iron from a nursing perspective.

A modified Delphi consensus method.

Literature searches were conducted and used to support the development of 16 consensus statements. Six nurses with expertise in the field of gastroenterology and experience with the administration of intravenous iron participated in a modified Delphi process to develop a final set of statements.

Overall, 16 statements achieved consensus and covered the practicalities of administration, infusion reactions and hypophosphataemia. Patient preparation is a key step in the administration of intravenous iron, but information should be communicated carefully to prevent undue anxiety. Highlighting the nurse's confidence in the management of any reactions may help to reduce anxiety. The patient should be observed during the first 5–10 min of an infusion to allow prompt management of immediate infusion reactions, although severe hypersensitivity reactions are rare. Nurses should be vigilant for symptoms of hypophosphataemia (such as fatigue, weakness and muscle/bone pain), which can develop following treatment with ferric carboxymaltose, saccharated ferric oxide and iron polymaltose. Serum phosphate levels should be measured in patients receiving ferric carboxymaltose who are at risk of low phosphate.

Infusion reactions and hypophosphataemia with intravenous iron are documented in the literature, but existing publications do not approach these topics from a nursing perspective. This consensus paper highlights the importance of patient preparation, monitoring and prompt management when administering intravenous iron to ensure patient safety. Considering that nurses have a central role in the administration of intravenous iron, the availability of evidence‐based guidance is essential for both nurse confidence and patient safety.

No patient or public contribution was involved in the consensus process.