An increasingly popular method of treating general practice patients with iron deficiency involves intravenous iron infusions with Ferinject ®.
Many general practices now provide this treatment service, which is popular with patients because of its convenience, efficacy and tolerability compared to traditional oral iron supplements or attending hospitals for iron infusions.
However, an uncommon but known complication from iron infusion treatment is permanent skin staining as a result of perivenous leakage from the intravenous administration site.
The Medical Council is concerned about a recent increase in complaints about large and unsightly permanent skin stains in patients who have had this treatment. The common themes in these complaints relate to practitioner failure to obtain the patient’s informed consent, lack of training, and nursing supervision protocols in place to prevent skin staining through leakage.
Importance of informed consent
The Council’s President, Associate Professor Richard Walsh, says it is essential that doctors give patients clear information so they understand the risks and benefits of treatment options and make an informed decision.
“Be absolutely sure that your patient has given you their informed consent to iron infusion treatment and that you have documented this. This means discussing known complications, such as skin staining, and ensuring that the patient understands these potential complications before asking for their consent.”
“Patients rely on doctors to fully disclose known risks so they can weigh these up and make an informed decision about their medical care.”
5 things you can do
- Make sure you have your patients’ informed consent prior to the procedure, ensuring that they understand the complications that can arise from iron infusions and the alternative treatments options.
- Specifically discuss the risk of permanent skin staining and how this could occur. This may involve showing them pictures of staining from the internet.
- Make sure the patient is aware of the symptoms that the cannula is out of position (pain and swelling) and the importance of notifying the supervising doctor or nurse immediately so the infusion can be stopped.
- Clearly document your discussion with the patient and their decision in your patient records.
- Ensure whoever is performing and monitoring the iron infusion (doctor or nurse):
- is adequately trained in IV insertion
- follows a set protocol
- ensures the infusion never runs in less than 15 minutes
- is vigilant in their observation and communication with the patient about symptoms of possible leakage.
Want more information?
- Iron infusion treatment information for practitioners – NPS Medicine Wise website
- Informed Consent: See the Medical Board of Australia’s Good Practice – A Code of Conduct for Doctors in Australia (Working with Patients section 3).