There is only one brand of desferrioxamine (iron chelator) made. The company which manufactures it is Novartis. It comes in a powder form in 500mg vials. In Europe, Novartis has distributed a new "refined" version of Desferal. It has been said the refined version is supposed to decrease site reactions such as itching, swelling, and bumps. In the United States, the FDA needs to approve the refined version before Novartis can distribute it here.
- Sterile Water.
You need this to dilute the Desferal. Even though different companies make sterile water, it is all the same solution. The difference may be the size of the vials it comes in. It is available in anywhere from 10 ml to 20 ml size vials.
This is used to transfer the sterile water to the Desferal vials, as well as to hold the medication while it is being infused into your body. There are different size syringes ranging from 1 cc to 20 cc. The size you use will depend on the amount of Desferal you need as well as the amount of sterile water you use to dilute the Desferal. Standard use is 5 cc for younger patients to 10 cc for teenagers and young adults.
- Alcohol Pads.
This is very important because it helps to keep vials sterile. Different companies make alcohol pads and there are two sizes available (small and large). Alcohol pads can also be bought over the counter at a neighborhood drug store.
- Straight Needle or Filter Needle.
These needles are used to draw out the sterile water and Desferal from the vials into the syringe. They come in many different sizes. You don't want one too small because it becomes difficult to draw back the water and Desferal. On the other hand, you don't want one so big that it causes the sterile water and Desferal to leak out of the vials. The most commonly used size is a 27-inch gauge needle.
- Sub-cutaneous Needle Set.
There are a variety of choice of sizes and angles of the needle. You should try a few of them because the one you use is a matter of personal preference. Some choices include:
- Straight needle: This needle requires that you stick it in at an angle; often it is helpful to create a 'pillow' with some gauze and place it under the needle to cushion and brace it.
- 27 inch gauge straight butterfly needle: This requires you to stick it in at an angle and is placed under the skin.
- "Thumbtack" or "Button": This type has a 27 inch gauge and is already angled at 90 degrees which goes straight down into the skin. This type of sub-Q set is made by Baxter.
- Douglas needle: This needle is at a 90 degree angle as well and has a butterfly-like yellow handle. It is a little longer in length than the thumbtack but thinner in width.
- Chronimed: This needle is 27 gauge and resembles the button needle, but is shorter in length.
- MiniMed Sof-set Infusion Set: This needle has not been as widely used until recently. It has a 27 inch gauge; the handle is clear in color and is shaped like a butterfly for easier grasp. The needle is removed after insertion, leaving a tiny plastic catheter under the skin for infusion. Some children prefer this set because the needle does not remain in the skin.
- Clinipur ( also known as ThalaSet): This 90 degree infusion set is a 27 gauge
silicone-coated stainless steel needle available in 6, 8 and 10mm length needles.
It has a special flexible finger grab for virtually painless insertion, easy positioning,
and lies completely flat against your skin during use.
The hypoallergenic adhesive eliminates the need for an extra dressing and the cotton
backing has a see-through window for visual inspection of the site.
Gauze is handy for applying alcohol (if you aren't using pre-packaged wipes), cleaning off iodine scrubs, and cushioning your infusion needles, if desired, and cleaning up spills.
- Povidone-Iodine pads.
Iodine is scrubbed onto the area of infusion to kill germs and prevent infection. It is left on the skin for two minutes, then cleaned off with a new sterile alcohol pad.
You will need this to hold the sub-Q needle in place while the Desferal is being infused. Again, there are many different sizes and each patient has their personal preference for comfort. Some patients are allergic to certain kinds of tape so it is important you use tape that not only holds the needle in place well, but that is also easy on your skin. Some choices in tape include:
- Paper Tape: This kind of tape is thin and has a cloth-like feeling. It is not as sticky as regular tape and does not hold as well, especially in humid environments.
- "Hospital" tape: This tape is thicker and sticky, usually found in hospitals for I.V. use.
- Tegaderm: This tape is light without the sticky feeling, but holds very well.
Sometimes you need a little extra help in being able to stick yourself or your child with less pain. Anesthetics can be used before sticking yourself or your child to numb the site where the needle will be placed. Some types include:
- Emla cream. This is a cream which must be applied half hour to an hour before sticking yourself or your child with the sub-Q needle. You apply it to the area on your stomach, arm or leg where you will place the needle. You then need to place a Tegaderm patch over it so that it will not come off until the site is numb and ready to insert the needle.
- Spray. For this kind of anesthetic, you spray the area you will use immediately before
sticking yourself with the sub-Q needle. It numbs the area temporary and wears
This is the machine which is used to infuse the medicine from the syringe into your body. Which company you get your pump from and how your Desferal is infused determines the type of pump you will have. Some types include:
- Graseby: Graseby pumps are the most widely used pump in the United States when administering sub-Q Desferal.
- Marcal: This name brand pump is mostly found in Europe.
- Cad: The cad pump is loaned to patients from their health care company and is used more often with patients who have ports, pic-lines or those who use higher grams of Desferal.
- Elastomeric Home Pump "C": This new pump, available through I-Flow (www.i-flowcorp.com), delivers Desferal through a positive pressure system and does not require batteries.
- Crono Pump (IntraPump): This newest pump is extremely small, weighs 4 oz,
is quiet and very simple to program. It can be worn discreetly under your clothing or in
your pocket. You can infuse anytime, anywhere - it's very user friendly!
You will need a battery in order for your pump to run. Make sure your pump is working and always has one or two extra batteries just in case the current one dies. You can tell the battery is working by the light that flashes on your pump. If the light is blinking, it indicates the battery is working and the Desferal is being infused. The Graseby pump uses a standard 9-volt battery. Your health care company may supply the battery or you can buy it at any store which sells batteries. The CAD pump also uses a regular 9-volt battery. Finally, taking the battery out after use prolongs its life and prevents the pump from turning on when not in use.
- Sharps Container.
This is used to throw away used needles and syringes. The law dictates that we can not throw away used needles and syringes along with our regular trash. Do not leave used needles lying about. Always dispose of them properly. Sharps containers are red and come in many different sizes and shapes. They should be given to you with your Desferal supplies. You only need to throw away needles and syringes. Desferal and sterile water vials, alcohol, tape, and their packaging can all go into your regular garbage can.
The best way to find out about new supplies and different techniques is by talking to other patients. You can learn a lot from your peers to help you find a way that works for you and makes using your pump a little easier!