People with blood disorders like sickle cell disorder and thalassemia, often need regular blood transfusions. However, transfused blood has excess iron which can build up in the heart, liver and other major organs. If this is not treated, organs can be seriously damaged.
Desferrioxamine is a medicine which removes the excess iron from the body. Desferrioxamine is also known as Desferal®. Desferrioxamine binds to the iron and leaves the body in pee and poo.
Desferrioxamine is given as a slow infusion in two ways:
- Under the skin (subcutaneously) – using a Neria™ Guard infusion device or a butterfly needle.
- Into a vein (intravenously) – it can be given through a thin tube, called a cannula, which is usually in for a short time. If you need treatment over a longer time, you may have it through a PICC line or Port-a-Cath®. Your doctor will explain how these work at your clinic appointment.
Your doctor will talk to you about the method that’s best for you. The dose you get will be tailored to your needs.
There are three types of infusion devices that can deliver desferrioxamine:
- A balloon infusor. You can have this done at home or at the hospital.
- A portable infusion pump. You can have this done at home or at the hospital.
- In bag of saline through a large pump. You can only have this at the hospital. You can have it when you have a transfusion.
A balloon infusor is often called the ‘Easyflow infusor’ or ‘Baxter pump’. These are the names of the companies who make them. It is a lightweight, disposable device containing diluted desferrioxamine. We use it to give a slow, continuous infusion under the skin, through a Neria™ Guard infusion device or sometimes through a vein. This means that you can have the treatment at home, usually over eight to 24 hours.
The desferrioxamine is inside in the balloon, which is inside a plastic case (see Figure 1). As the balloon deflates, it slowly pushes the desferrioxamine at a fixed rate through the Neria™ Guard infusion device. As this happens, the balloon gets smaller and its position moves down the scale on the infusor bag.
What are the parts of a balloon infusor?
Figure 1 shows a photo of a balloon infusor. The parts of the infusor are labeled on the photo and listed below.
- Luer connector – this connects the balloon infusor to the Neria™ Guard infusion line.
- Luer cap – this fits on the end of the connector to stop the medicine leaking out.
- Filter – this allows air bubbles to escape.
- Tube – the medicine goes through this tube from the balloon to the Neria™ Guard infusion line.
- Balloon – the medicine is inside this.
- Volume indicator – this scale shows you how much medicine has been infused.
- Fill port protector cap – the medicine goes through this port into the balloon infusor. The cap seals the port.
- Code number - this is used to identify your balloon infusor.
We will teach you how to use the infusor. We can also teach your relative or carer to use it. We will give you all the equipment you need.
You can have your treatment at home, so you can still do your daily activities. The infusor does not need any machinery or batteries, so it is quiet.
Sciensus, the home delivery company, deliver the Neria™ Guard infusion devices and infusors to you.
Keep your spare infusors sealed in their outer wrappings and store them in the fridge. Do not store the infusors in the freezer.
Keep the infusors you’re using, or about to use, in a clean place, away from direct sunlight, radiators and fires. Make sure children cannot reach them.
You can keep the infusor in your trouser pocket or in a small across-body bag. Some people sew pockets in their clothing to keep the infusor in.
You should discuss this with your doctor. There might be places we recommend you avoid if medical care is hard to access there.
Sciensus usually need at least six weeks’ notice to change or pause your deliveries. If you give less notice, the infusors may already have been prepared. If this happens, the hospital will still be charged, even if you don’t get them.
When you travel, pack the infusors in your checked luggage because it stays cooler there. If possible, keep the infusors with cool packs to help them stay at the right temperature.
Seal the empty infusor with the cap to stop any medicine left inside from leaking out. Don’t put the infusor in your bin at home. Sciensus will collect your empty infusors when they deliver your new ones. They will normally collect them every 2 weeks.
Put ALL needles in your sharps bin. They cannot go in your general waste.
Sciensus will deliver and collect your sharps bins along with your infusors.
To make sure that it’s working correctly:
- Check the position of the top of the balloon against the scale on the side of the infusor (see figure 2). It might not be in line with number ‘1’ on the scale when you start.
Figure 1. A photo of the parts of a balloon infusor
- A few hours after you start using the infusor, check that the balloon has moved down the scale.
- After the medicine finishes infusing, check that the balloon is empty. There may still be a small amount of medicine in it so the balloon might not be at ‘0’.
- Your infusor might have yellow, blue, red, or green on it. The colour shows how long it takes for the medicine to infuse.
Neria™ Guard infusion device is a device which inserts a cannula into your body by the touch of a button (see figure 3). It connects to your infusor to deliver the medicine.
Figure 3. Neria™ Guard infusion device
Please do not change your infusor without a nurse training you first. To change your infusor, follow the steps below.
Equipment
- Infusor
- Neria™
- Alcohol swabs. Use these to clean your skin. You can also use these to clean the access port of an indwelling line such as a PICC line. If you are using Neria™ Guard infusion devices, Sciensus will send you the alcohol swabs. Please contact them if you need more.
- Sharps bin – to put used needles in
- Cleaning solution – for your hands
- Cleaning solution –to clean the area you will put the equipment on
- Clear plastic dressing, such as Tegaderm® (if needed)
- Saline flushes (sodium chloride 0.9%) if you are giving the medicine through an indwelling line.
If you need any extra equipment, ask a Haematology Day Care nurse or your clinical nurse specialist (CNS).
Step-by-step guide
1. Prepare the equipment
- Clean the surface you put the equipment on and let it dry.
- Collect the equipment and place it on the dry surface.
- Check that the infusor label has your name and hospital number on it.
- Check that the expiry date on the label hasn’t passed.
- Do not use your infusor if:
- The name or hospital number on the label is not yours.
- It has passed the expiry date on the label.
- The balloon has burst.
- There is any sign that the medicine has leaked from the infusor or tube.
- The cap is missing.
- The bubble does not appear.
- Wash and dry your hands.
- Open the infusor on the clean surface.
- Remove the cap from the infusor.
2. Inserting the cannula (inside the Neria™ Guard insertion device)
- Select the site where you want to insert the cannula. The best places to insert the cannula are in your abdomen, thighs and upper arms. The diagram below shows you exactly where these places are. Change the spot where you insert the cannula each time. Doing this helps your body absorb the medicine properly. It can also prevent skin irritation and scar tissue.
Figure 4. Places to insert the cannula
- Clean the skin where you will insert the cannula. Using an alcohol wipe, clean the skin in a circular motion. Start in the middle and move outward. Wait until your skin is dry before doing the next step.
- Remove the paper cover from the Neria™ Guard insertion device, by gently pulling the paper from the sticky pad. Be careful not to touch the sticky pad.
- Remove the safeguard by gently squeezing and pulling
- Position the insertion device on your skin and press the red activation button. The cannula automatically releases from the Neria™ Guard insertion device. You will hear a ‘click’ once the cannula releases. You don't need to pinch the skin in the area, but you can gently hold it with your other hand to keep it steady.
- Secure the cannula in place by pressing the sticky pad on your skin. You might need to keep the cannula in place by putting an extra dressing over it. If the cannula doesn’t stay in place, please contact your CNS to discuss what else can be done (see the contact details section).
3. Connect the cannula to the Neria™ guard tubing and allow the desferrioxamine to flow down the line.
- You should see a small drop appear at the needle end of the infusion device before you connect it to the cannula.
- Ignore small air bubbles within the infusor tube. They are not harmful.
- If you need to disconnect the infusor before it is completely empty, place the cap on the end of the tube. This will stop it leaking.
- Place a finger on the cannula cover while pushing the site connector straight in until you hear a ‘click’
4. Check the area where you inserted the cannula. From time to time check the area for redness, fluid leaks and to make sure the needle has not come out.
5. Remove the needle and tube. When the infusion is complete, remove the sticky pad and take the cannula out. Put the cannula and tubing in the sharps bin.
6. If you're using ‘back-to-back’ infusors, your cannula can stay in place for 1 or 2 days, as long as the skin around it looks healthy. There's no need to cover the cannula, as it won't leak any fluid. If you're unsure or have any questions, please contact your CNS.
7. When the sharps bin is full, return it to Sciensus who will provide you with a new one at the same time.
Detailed instructions on how to use the Neria™ Guard infusion device come with it. You can also watch a short video on how to use the device. For more details about the Neria™ Guard infusion device, please visit convatec.co.uk. ™ and ® refer to trademarks of the Convatec group of companies.
Convatec produced the above images and gave us permission to use them.
You will need four to seven infusions a week. The number of infusions you need will depend on the amount of iron in your blood. You can arrange to have the infusions at times that suit you. Some people find it works well to have night-time infusions, while they sleep. The infusion usually lasts eight to 12 hours.
Let your doctor know as soon as possible if you have any of the side effects listed below.
Most common side effects
- Pain
- Swelling
- Reddening and itching of the skin where the cannula was.
Sometimes you will get the symptoms listed above along with others such as:
- Fever
- Watery eyes
- Sneezing
- Aching joints
- Aching muscles
- Headaches
- Nausea.
Less common side effects
- Dizziness
- Sight problems
- Hearing problems.
For this reason, patients having desferrioxamine have hearing and vision tests each year.
Very rare side effects
- Shortness of breath
- Skin rash
- Weakness of the muscles
- Loss of sensation (for example numbness).
- Stomach pain, being sick and diarrhoea. This may be due to an infection called yersinia. If this happens, stop your desferrioxamine infusion and contact your hospital team right away using the details below.
Haematology admin team:
Haematology clinical nurse specialists (CNSs):
Haematology advice line (office hours, adults and children):
Adult haematology advice line (out of hours):
Paediatric helpline (out of hours):
- nurse in charge 07950 869 745
- ward T11 south 020 3456 7890 ext. 71103 or 71143
Apheresis:
Address:
Department of Haematology, 3rd Floor West, 250 Euston Rd, London, NW1 2PG
Website: uclh.nhs.uk/
Red Cell Network: uclh.nhs.uk/
Consultants:
Dr Ana Cabrero-Ortuno
Dr Emma Drasar
Dr Perla Eleftheriou
Dr Andrea Leigh
Dr Ryan Mullally
Dr Sara Trompeter
Dr Ethan Troy-Barnes
Matron:
Bernadette Hylton
Specialist nurses:
Christopher Dean
Enitan Roberts
Alexandra Saville
Sickle Cell Society
Tel: 020 8961 7795
Website: sicklecellsociety.org
UK Thalassaemia Society
Tel: 020 8882 0011
Email: office
Website: ukts.org
University College London Hospitals NHS Foundation Trust cannot accept responsibility for information provided by external organisations.
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Page last updated: 20 May 2025
Review due: 01 November 2026