Download Pediatric Guidelines for IV Medication Administration

Pediatric Guidelines for IV Medication Administration
Approved For
Drug
Acetazolamide
(Diamox®)
Acetylcysteine
(Acetadote®)
Acyclovir
Adenosine
(Adenocard®)
ICU
ED
Telemetry
Required
Acute
Care
IVP
X
X
X
X
X
Infusion
only
X
X
X
Bolus
+
infusion
X
X
X
X
IV
Infusion
X
See
restriction
Concentration
Usual Dosing and
Administration
Dilute to
MAX of
100 mg/mL
30 gm/1000
mL
(30 mg/mL)
5-10 mg/kg/dose MR q 8 or 6 hrs.
MAX dose: 25 mg/kg/dose up to 500 mg/dose
MAX Rate: IVP over 1 minute.
Requires toxicology approval.
Bolus: 150mg/kg over 1 hr.
Maintenance: 15-7.5mg/kg/hr. See dosing protocol or
contact pharmacy for weight-based protocol.
Diluted to
<5 mg/mL
Infusion over 60-90 minutes. Dose: 5-20 mg/kg/dose q
8hrs.
6 mg/2 mL.
(3mg/ml)
DOSE:0.05-0.1 mg/kg up to 6 mg over 1-2 seconds
followed by rapid NS flush. May increase dose by 0.10.2 mg/kg q2 minutes up to 12 mg/dose every 1-2 mins
till termination of arrhythmia to a MAX CUM dose of
0.3 mg/kg/dose upto 30 mg.
> 50kg: 6mg, 12mg, 12mg
0.5-1 gm/kg/dose (10-20 mLs/kg/dose). Infusion over 3060 minutes. In emergencies, may administer over 15
minutes.
Adult MAX: 600mls/hr
.
Comments
Monitor serum electrolytes
When used in acetaminophen overdose,
monitor serum acetaminophen concentrations;
monitor LFTs. Bolus doses, monitor for
hypotension, flushing, anaphylaxis
Bolus doses must be completed in critical care
areas only. Maintenance IV infusions may be
continued or initiated in acute care areas.
Patient should be well hydrated to prevent
nephrotoxicity. Monitor urine output, Scr.
Restriction: In acute care areas, doses must
be administered by a physician. .
Communication with the ICU team prior to
adenosine administration is required. An
attending Hospitalist, Cardiologist, or ICU
physician must be at the bedside.
A continuous ECG rhythm strip must be
obtained during dosing to monitor and
document drug effects
Rapid infusion may cause hypertension and
pulmonary edema. Monitor vital signs and
fluid balance. Use within 4 hours of opening
vial.
60 micron filter/tubing supplied by pharmacy
Albumin 5%
(forhypovolemia,
hypoalbuminemia
X
X
X
5%
(50 mg/mL)
Albumin 25%
X
X
X
25%
(250 mg/mL)
0.25-1 gm/kg/dose (1-4 ms/kg/dose)
Infusion as tolerated over 30-120 minutes.
Adult MAX :180ml/hr
Rapid infusion may cause hypertension &
pulmonary edema. Monitor vital signs and
fluid balance. Use within 4 hrs of opening.
60 micron filter/tubing supplied by pharmacy
X
Dilute 500
mcg in
50mls NS
(10 mcg/ml)
Initial: 0.05- 0.1 mcg/kg/min.
Range: 0.01 up to MAX 0.4mcg/kg/minute
Infuse via large vein.
Monitor arterial pressure, RR, HR, oxygen
saturation, temp.
Diluted to
< 5 mg/mL
5-10mg/kg/dose q8hrs with NL renal function.
Infusion: Over 30 minutes.
Urine output, Serum creatinine,
Peak and trough concentrations.
(forhypoproteinemia
w/ generalized edema)
Alprostadil, PGE1
Prostin VR
Pediatric®)
X
Amikacin
(Amikin®)
X
X
Continuous
infusion
X
X
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
1
Pediatric Guidelines for IV Medication Administration
Approved For
DrugDrD
Amiodarone
(Cordarone®)
Ampicillin
ICU
ED
Telemetry
Required
X
X
Acute
Care
IVP
IV
Infusion
X
X
X
Bolus in
code only
No
infusion
X
X
X
X
Atropine
X
X
X
X
Azithromycin
(Zithromax®)
X
X
Aztreonam
(Azactam®)
X
X
Central line preferred for concentrations
exceeding 2 mg/mL. Dedicated filtered
(0.22 micron) line required.
Infusion 450
mg/ 250 mL in
D5W
For perfusing VF/VT 5 mg/kg over 20-60 min, MR X
3
Continuous BP/cardiac monitoring, thyroid
function, LFTs, and pulmonary function
should be monitored frequently.
X
slow
Dilute to
<30 mg/mL
=(amp 20 mg/
sulb 10 mg)
X
0.1 mg/mL;
1 mg/mL
MD
available
X
Comments
BOLUS: PALS for pulseless VF/VT5 mg/kg (MAX
300 mg/dose) given over 5-10 minutes. - 0.22 micron
filter preferred . Flush post dose.
Dilute to <20
mg/mL
X
Usual Dosing and
Administration
Bolus diluted to
1.5-3 mg/mLin
D5W
X
slow
Ampicillin/
Sulbactam
(Unasyn®)
Concentration
X
Dilute to 2
mg/mL
X
Dilute to
< 20 mg/mL
Infusion: Initial dose of 5 mcg/kg/min, increase to
desired effect to a MAX of 15 mcg/kg/min
IVP: not to exceed 10 mg/kg/minute.
Infusion: over 15-30 minutes
Dosing: 100-400 mg/kg/day divided every 6 hrs.
MAX 12 gm/day
IVP: not to exceed 15 mg/kg/minute (amp/sulb)
Infusion: Over 15-30 minutes
>1 month: 150-225 mg/kg/day (amp/sulb) divided
every 6 hrs
Children: 150-300 mg/kg/day (amp/sulb) divided
every 6 hrs. (non-meningitic doses)
(MAX dose: 12 gm ampisulb/day)
IV Push: given over 1 minute
Dosing: 0.01-0.2 mg/kg (MIN 0.1 mg)
Child: up to 0.5 mg, MRx1
Adolescent: up to 1 mg, MRx 1
Please see reference for dosing for specific
indications.
Infusion:MAX concentration of 2 mg/mL
over 1 hr
Dosing: 5-10 mg/kg/day as q 24 h
(MAX 500 mg)
Single dose regimen: 30mg/kg X 1 (MAX 1500mg)
For specific indications, please consult
pedi reference for recommendations.
IVP: over 3-5 min
Infusion: Over 20 minutes
Dosing: >1 month-90-120 mg/kg/day div q 8h or q 6
h. CF: 50 mg/kg/dose q 6 hrs MAX 8 gm/day
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Adjust with renal dysfunction.
Unsayn: Each 1.5mg unasyn=1mg apicillin
+0.5mg sulbactam.
With prolonged therapy, monitor
hematologic, renal and hepatic function.
Observe for change in bowel frequency.
Monitor vital signs and EKG; monitor for
side effects including dry mouth, dizziness
and palpitations.
Monitor for pain at infusion site, LFTs,
WBC and infection.
Adjust dosing with renal dysfunction.
2
Pediatric Guidelines for IV Medication Administration
Approved For
Drug
ICU
ED
Telemetry
Required
Concentration
Usual Dosing and
Administration
Acute
Care
IVP
IV
Infusion
X
X
0.25 mg/mL
Dosing:0.015-0.1 mg/kg/dose up to 4 mg q 6-24 hrs (MAX
dose is 10 mg/day, 20 mg/day w/ RF))
IV Push: over 1-2 minutes MAX 1mg/min
Monitor blood pressure, serum
electrolytes and renal function.
Clarify if dosing is as citrate salt or
caffeine base. Must be specified on
medication order.
May dilute in D5W
Monitor heart rate, number and
severity of apnea spells, and serum
caffeine levels
Not to be administered in
neonates(benzoates). Monitor heart
rate.
Bumetanide
(Bumex®)
X
X
Caffeine Citrate
(Cafcit)
For apnea
X
X
X
20 mg/mL
citrate salt
(=10 mg/mL
caffeine base)
Loading: 10-20 mg/kg citrate salt infused over
30 minutes
Maintenance: 5 mg/kg/day as citrate salt once daily starting
24 hours after bolus doseinfused over ≥ 10 minutes
Caffeine sodium
benzoate
For spinal
headache
X
X
X
Dilute to 0.5
mg/mL
Adults: 500 mgs as a single dosediluted with 1000 mL NS
and infused over 1 hour, followed by 1000 mL NS over 1
hour.
X
1 gm/
10 mL vial
Calcium Chloride
X
X
Slow IVP
Calcium Gluconate
Cefazolin (Kefzol)
X
X
Slow IVP
Slow IVP
only.
X
Comments
IVP In
code only
w/MD
present.
No
infusion.
Slow IVP
in code
w/ MD
present.
Infusion
OK
X
X
Slow
IVP
Recommend use only in symptomatic hypocalcemia
Bolus: 10-20 mg/kg/dose up to 1gm over a minimum of 10
minutes.
Infusion: Do not exceed 45-90 mg/kg given over 1 hour
X
X
1 gm/50 mL
=20 mg/mL
200-500 mg/kg/DAY as continuous infusion or in 4 divided
doses
Acute::Usual 100mg/kg or 1gm MAX 3gm over 10 minutes
Non-Acute: Usual 50-100mg/kg not to exceed 2gm over no
less than 60 minutes.
MAX: 200mg/kg up to 3gm
X
Dilute to
< 20mg/ml
IVP: Over 3-5 minutes
Infusion: Over 10-15 minutes
Dosing:Neonates>2 kg, + 7 days-60 mg/kg/day div q 8h.
Infants/Children: 50-100 mg/kg/day div q 8h
Adolescent/Adult: 1-2 gm IV q 8h
MAX ADULT DOSE: 12 gm/day
Slow
IVP
X
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Central Line preferred unless
emergency administration.
Do not administer I.M. or S.C. or use
scalp, small hand or foot veins for IV
administration since severe necrosis
may occur. Monitor serum calcium
(ionized calcium is recommended),
heart rate and EKG. Do not infuse
calcium chloride in same IV line as
phosphate-containing solutions.
Do not infuse calcium gluconate in
same IV line as phosphate-containing
solutions.
Monitor serum calcium (ionized
calcium is recommended), heart rate
and EKG.
See label comments on Pedi IV
Calcium Gluconate Bags
Adjust dosing with renal dysfunction.
3
Pediatric Guidelines for IV Medication Administration
Approved For
Drug
ICU
ED
Telemetry
Required
Acute
Care
IVP
IV
Infusion
Concentration
Usual Dosing and
Administration
Cefepime
(Maxipime)
X
X
X
X
Dilute to
< 20 mg/mL
IVP over 5 minutes.
Infusion over 30 minutes
Dosing 2 mo-16yo: 100-150 mg/kg/day div q 12 or 8 hrs.
CF 50 mg/kg/dose q 8hr MAX 6 gm/day
Cefotaxime
(Claforan®)
X
X
X
X
Dilute to
< 40 mg/mL
IVP over 3-5 minutes
Infusion: Over 10-30 minutes
<7 days:+>2000 g:100-150 mg/kg/day div every 8-12 hrs
> 7 days: >2000 g: 150-200 mg/kg/day divided every 6-8
hrs
1 month- 12 years: <50 kg: 100-200 mg/kg/day divided
every 6-8 hoursMeningitis: 200-300 mg/kg/day divided
every 4 or 6 hours (MAX 12 gm/day)
> 50 kg: Moderate infection 1-2 gms q 6-8hrs, Severe 2 gms
every 4 to6 hrs (MAX 12 g/day)
Cefoxitin
(Mefoxin®)
Ceftazidime
(Fortaz)
X
X
X
X
Dilute to
< 40mg/ml
IVP over 5 minutes
Infusion over 10-30 minutes
X
X
X
X
Dilute to
<40 mg/mL
Ceftriaxone
(Rocephin®)
X
X
X
X
Dilute to
< 20 mg/mL
IVP over 3-5 minutes
Infusion over 20-60 minutes
< 7days >2 kg: 100-150 mg/kg/day div q 8-12 hrs
>7 days >2 kg: 150 mg/kg/day div q 8h
Infant/child: 100-150 mg/kg/day div q 8h
CF: 150-300 mg/kg/day usual MAX 12 gm/day
IVP over 5 minutes
Infusion over 10-30 minutes
Infants and Children: 50-75 mg/kg/day divided every 1224 hours
Meningitis: 80-100 mg/kg/day divided every 12-24 hrs
(MAX: 4 gm/day)
Chlorothiazide
(Diuril®)
X
X
X
X
500 mg vial
diluted with 18
mL SWI for a
final
concentration
of 27.8 mg/mL
IVPover 3-5
Infusionover 30 minutes in dextrose or NS
<6 months: 2-8 mg/kg/day in 2 divided doses up to 20
mg/kg/day
>6 months: 4 mg/kg/day in 1-2 divided doses up to 20
mg/kg/day.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Comments
ID approval required for patients
outside the ICU. Pseudomonal
infections should be dosed at the
higher end of the dosing range.
Adjust dosing with renal dysfunction.
Indicated in neonate < 2 weeks or in
infants with clinically relevant
hyperbilirubinemia who may be at
risk for kernicturus.
With prolonged therapy, monitor
renal, hepatic, and hematologic
function periodically; number and
type of stools/day for diarrhea.
Adjust dosing with renal dysfunction.
Adjust dosing with renal dysfunction.
Monitor INR with prolonged use
CO2 is produced with reconstitution.
Remove pressure/air by venting vial
prior to drawing up dose—
Adjust dosing with renal
dysfunction..
*Do not use in any child <5kg,
unless short-term IV access is
unavailable. Avoid concurrent use in
all patients requiring IV calcium
supplementation.
Monitor CBC, platelet count, renal
and hepatic function tests
periodically, number and type of
stools/day for diarrhea.
Do not administer I.M. or S.C. since
extremely irritating to tissues. May
be further diluted. Monitor serum
electrolytes and blood pressure.
4
Pediatric Guidelines for IV Medication Administration
Approved For
Drug
ICU
ED
Ciprofloxacin
(Cipro®)
X
Cisatricurium
(Nimbex®)
X
Telemetry
Required
Acute
Care
IVP
X
X
IV
Infusion
X
Dilute to
< 2 mg/mL
X
40 mg/100 mL
200mg/500ml
MAX: 200
mg/100 mL
HIGH RISK MED
Clindamycin
Concentration
Usual Dosing and
Administration
Infusion over 60 minutes
Children 20-30 mg/kg/day divided q 12 h
CF: 30 mg/kg/day divided q 8 or 12 hrs
Bolus:IVP: 0.1-0.2mg/kg over 5-10 seconds
Infusion: 1-4 mcg/kg/minMAX 10 mcg/kg/min
X
X
X
Dilute to
< 18 mg/mL
Cyclosporine
(Sandimmune®)
X
X
X
Dilute in D5W
to
< 2.5 mg/mL
D10W
X
X
X
X
100 mg/mL
Neonates: 100-200 mg/kg /dose (=1-2 mLs/kg) over 1
minute.
D25W
X
X
X
X
250 mg/ML
Bolus: MAX of 200 mg/kg (=0.8 mLs/kg) over 1 minute not
to exceed 6 mLs/minute if undiluted
Infants <6 month: 0.25-0.5 gm/kg/dose (=1-2 mLs/kg)
MAX of 25 g(50 mLs/dose)
Infants >6 months-40 kg: 0.5-1 g/kg/dose (=2-4 mLs/kg);
MAX of 25 g(50 mLs)/dose
Hyperkalemia<40kg D25W-2mls/kg(0.5gm/kg) over
15-30 minutes + insulin regular 0.1unit/kg IV (MAX 50ml
(=25gm) +5 units insulin/dose.
Bolus: >40 kg not to exceed 3 mls/minute if undiluted
Adolscent/Adult: 25-50 gms (50-100 mLs) over 5-30
minutes
Hyperkalemia:adolescent/adult 25-50 gm + 5-10 units
insulin (5gm (10ml) per 1 unit insulin) over 5-60 minutes.
(Cleocin®)
2.5GM/10ML
SYRINGE
D50W
X
X
X
500 mg/mL
25gm/50ml
syringe
Comments
May cause venous irritation
Monitor muscle twitch response to
peripheral nerve stimulation, heart
rate and blood pressure
Not renally orhepatically
metabolized
Infusion over 10-30 minutes, not to exceed 0.5
mg/kg/minute
Dose: 20-40 mg/kg/day divided q 6 or 8 hrs
Usual adult 600-900 mg IV q 8h
MAX 4.8 gm/day
Initial: 5-6 mg/kg/dose (1/3 of oral dose) administered 4-12
hours prior to transplant
Maintenance: 2-10 mg/kg/day in 2 divided doses.
May be administered over 2-6 hours or as a continuous
infusion.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Doses prepared in glass. Use Non
PVC tubing( ie// nitro tubing)
Patients should be monitored
continuously for ≥ the first 30
minutes of the infusion for signs of
anaphylaxis. Monitor serum drug
levels, serum creatinine and BP
Monitor blood and urine sugar, serum
electrolytes and I & O.
For peripheral venous administration,
dilute dextrose to MAX
concentration of 12.5%. (1:1 with
NS)preferred. Monitor blood and
urine sugar, serum electrolytes and I
& O.
Avoid in infants/ young children.
Dextrose 10-25% preferred.
Peripheral: Dilution to 12.5% (1:3
D50:NS) preferred.
5
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Dexamethasone
(Decadron)
X
Dexmedetomidine
(Precedex)
X
Diazepam (Valium)
X
Digoxin (Lanoxin)
X
Telemetry
Required
X
Concenration
Acute
Care
IV
P
X
X
X
IV
Infusion
4 mg/mL
X
200 mcg/50 mL
(4mcg/ml)
X
5 mg/mL
X
Dilute to < 100
mcg/mL w/NS
Moderate
sedation
service
+
moderate
sedation
RN
X
MD administration for
loading doses
only.
X
X
Maintenance
doses
Digoxin Immune
Fab
(DigiFAB)
X
X
X
X
Dilute to 1-10
mg/mL with NS
Diltiazem
(Cardizem)
X
X
X
X
5 mg/mL for IVP
Infusion 1
mg/mL
Diphenhydramine
(Benadryl)
X
X
X
Dilute to <50
mg/mL
Usual Dosing and
Administration
Comments
Please see reference for dosing for specific indications
(usual range 0.3-2 mg/kg/day as a generally up to 40
mg/day) divided q 6-24 hrs.
If dose <10 mg, administer IV push over 1-4 minutes.
If dose >10 mg, dilute with D5W or NS and infuse over 1530 mins
Requires pediatric ICU, moderate sedation service, or
anesthesiology attending approval
Bolus( attending present) 0.5-1 mcg/kg over 10 minutes
Infusion: Usual 0.2-0.7 mcg/kg/hr. Higher doses have
been used.
Monitor hemoglobin, occult blood
loss, serum potassium and glucose.
IVP: Peds< 40 kg not to exceed 1-2 mg/min, >40 kg 5
mg/min
Dose:0.04-0.3 mg/kg/dose (up to 10 mg/dose) every 2-4
hours to MAX of 0.6 mg/kg within an 8-hour period if
needed.
Infusion:Slowly administer over 5-10 mins
Dosing: See age specific references
Loading Dose: range 10-30 mg/kg divided in 3 doses over
16-24 hrs (as 50%/25%/25%) not to exceed total 1 mg dose.
Maintenance: approx 1/3 of loading dose divided q 12 or
24 hrs. Rarely exceeds 10 mcg/kg/day up to 0.25 mg/day.
Requires toxicology consult! Dosing based on amount of
digoxin ingested. Each 40mg vial binds 0.5mg digoxin
IVP: If in Cardiac Arrest over3-5 minutes using. Infusion
preferred.
Infusion:Over 15-30 minutes through 0.22 micron filter.
Decrease rate or hold if infusion reaction occurs.
Bolus: 0.25 mg/kg over 2- 5 minutes; if inadequate
response, 0.35 mg/kg dose may be administered after 15
minutes
Infusioncontinuous(start after IV bolus doses)
< 50 kg (limited data) 0.05-0.15 mg/kg/hr up to 15 mg/hr
Adult: 5-15 mg/hr
IVP:0.5 mg/kg/min up to 25 mg/minute
Infusion: Over 10-15 minutes
Dosing: 0.5-2 mkg/dose(MAX 100 mg) up to 5
mg/kg/day(MAX 300 mg) divided q 6 hrs
May cause phlebitis
Monitor heart rate, respiratory rate,
blood pressure and mental status
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Ensure airway and respiratory support
measures in place, monitor level of
sedation, heart rate, respiration,
rhythm.
Bolus doses associated with
bradycardia and hypotension.
c
Loading dose requires telemetry. Not
for maintenance dose. Monitor heart
rate, rhythm, periodic EKGs, serum
electrolytes, renal function and serum
levels.
0.22 micron filter required
Monitor EKG, serum potassium and
digoxin serum levels.
Check for S/S of an acute allergic
reaction.
During administration monitor EKG,
heart rate, blood pressure and renal
function.
Monitor symptom relief and sedation
6
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
Acute
Care
Concentration
IV
P
ICU
ED
Telemetry
Required
Dobutamine
X
X
X
Dopamine
X
X
X
Doxycycline
(Vibramycin)
X
Droperidol
(Inapsine)
X
Enalaprilat
(Vasotec)
X
Enoxaparin
(Lovenox)
X
X
X
X
IV
Infusion
X
X
2.5 mg/mL
In pts w/
cardiac history
X
<10 kg 250 mg
/250 mls
> 10kg500 mg
/250 mls
MAX: 1000
mg/250 mL
<10 kg 200 mg
/250 mL
>10kg 400 mg
/250 mL
MAX: 800 mg/
250 mL
Dilute to <=1
mg/mL
MAX: 2.5
mg/mL
X
X
< 1.25 mg/mL
SC
100 mg/mL
For doses <10
mg, a special
dilution
of 20mg/ml will
be prepared by
pharmacy
MD
available
X
S
C
Usual Dosing and
Administration
Comments
Infusion: continuous at 2-20 mcg/kg/minute.
MAX 30 mcg/kg/min
Monitor EKG, blood pressure, heart rate,
CVP, MAP and urine output.
Infusion: continuous at 1-20 mcg/kg/min; titrate to
desired response; MAX dose 30 mcg/kg/min. Central
line preferred.
Monitor EKG, blood pressure, heart rate,
CVP, MAP and urine output.
Infusion: Doses < 100 mg over 1-2 hrs
Children: (rarely used) 2-5 mg/kg/day divided q 12 or
q 24 hrs not to exceed 100 mg/dose
Adolescents/Adults:Rarely exceeds 200 mg/day.
IVP: Slowly over 2-5 minutes
Postop nausea/vomiting prophylaxis 0.05-0.06
mg/kg/dose; MAX 0.1 mg/kg up to 2.5 mg
Postop nausea/vomiting treatment: 0.01-0.03
mg/kg/dose; MAX 0.1 mg/kg up to 2.5 mg
Adult: 0.625-2.5 mg/dose
May cause phlebitis, dizziness, N/V
I5-10 mcg/kg/dose administered every 8-24 hours (as
determined by blood pressure readings) over 5-15
minutes.
MAX: 60 mcg/kg/day, rarely to exceed 20 mg/day
Infants <2 months:
Prophylaxis: 0.75 mg/kg every 12 hrs
Treatment: 1.5 mg/kg every 12 hours
Infants >2 months and <18 years:
Prophylaxis: 0.5 mg/kg every 12 hours
Treatment: 1 mg/kg every 12 hours
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Monitor blood pressure, heart rate,
respiratory rate, temperature, serum
potassium and magnesium. Observe for
dystonias and extrapyramadial side effects.
EKG monitoring is recommended in
patients with a history of QT prolongation
or cardiac disease.
Clinical response seen within 15 minutes,
peak within 4 hrs. Monitor blood pressure,
renal function, WBC, serum potassium and
serum glucose.
Deep SC administration preferred(not im)
and allowed in all nursing units. Do not rub
injection site after administration. Monitor
CBC, platelets, stool occult blood tests. If
antifactorXa level are indicated, draw peak
levels 4 hrs post dose.
7
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
Concen
tration
Acute
Care
IV
P
IV
Infusion
X
X
X
ICU
ED
Telemetry
Required
Epinephrine
(Adrenalin®)
X
X
Ertapenem (Invanz®)
X
X
Erythropoetin
(EPO®, Procrit®)
X
X
Esmolol (Brevibloc®)
X
Esomeprazole
(Nexium®)
X
Etomidate
X
SC, IVP
For
anaphylaxis,
CPR
X
X
X
For IVP 1:10,000 
(0.1 mg/mL)
For ET/ SC /Drips
1:1,000 (1 mg/mL)
Drip Concentrations
< 10 kg 8mg /
250mls
10-50kg 16 mg/
250mls
>50 kg 4 mg/
250 mls
MAX:
16 mg/250 mLDilute to < 20
mg/mL in NS only.
Various, may be
given undiluted or
diluted 1:1 with NS
X
X
X
X
X
X
X
X
Per moderate
sedation
protocol
Moderate
sedation
service
+ sedation
RN
<10 mg/mLfor
IVP
20 mg/mL drip
< 4mg/ml
2mg/ml
20 and 40mg
vials
Usual Dosing and
Administration
Comments
IV Push: 0.01 mg/kg (=0.1 mL/kg) up to 1 mg (10
mLs) over 1 minute, every 3-5 minsprn.
Infusion: 0.1-1 mcg/kg/min; titrate dose to desired
effect. Central line preferred.
Do not use if pink in color. Monitor EKG,
heart rate, blood pressure, pulmonary
function and injection site monitoring for
extravasation.
Infusion: Over 30 minutes.
3 mths-12yrs: 15 mg/kg/dose q 12 h up to
1 gm/24 hrs
Adolescent/Adult: 1 gm q 24 hrs.
IVPush:Over no less than 1 minute, SC
preferred,
See pediatric dosing recommendations for disease
specific guidelines. Range 10-600units/kg
Bolus: 250-500 mcg/kg over 1-2 minutes
Infusion: 50-300 mcg/kg/min; titrate up every 20
mins to desired effect. Dosing may be higher with
SVT (up to 1000 mcg/kg/min in small children)
1-2 mg/kg/day administered in 1-2 divided doses.
Usual adult dose 20-40 mg/day MAX 80 mg
IVP: Dilute with 5 mLs NS per vial and push over
≥ 3 minutes.
Infusion: Add 40mg to 100ml
Moderate Sedation for Short Procedures: -.10.2mg/kg/dose
RSI/ induction of Anesthesia: 0.3mg/kg IV (-.20.6mg/kg)
IVP: Over 30-60 seconds
Do not infuse with dextrose containing
solutions.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Do not shake vial. Monitor Hgb/Hct, Iron
stores, BP
EKG, BP, HR, respiratory rate monitoring
mandatory during administration.
Gastric pH monitoring may be needed in
select patients.
Has no analgesic properties.
Requires moderate sedation monitoring
with procedure related use.
May result in transient myoclonus. Avoid
small vessels on the dorsum of the head or
hand. May cause discomfort at injection
site.
8
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Famotidine
(Pepcid®)
X
Fentanyl(Sublimaze®
)
X
Telemetry
Required
Concen
tration
Acute
Care
IV
P
X
X
X
X
IV
Infusion
Dilute to
>=4mg/ml
X
Filgastim
(G-CSF, Neupogen®)
X
X
Fluconazole
(Diflucan®
X
X
Flumazenil
(Romazicon®)
X
X
X
S
C
Gastric pH monitoring may be needed I
select patients
X
10 mg/mL vial
STD infusion
10mg/250NS
(40mcg/ml)
MAX Infusion
10 mg/100 mL NS
(100 mcg/mL)
Dilute with D5W
only to a
concentration greater
than or
=15 mcg/mL (ie//300
mcg/
20-50 mLs).
Usual dosing: 0.1-0.8 mcg/kg/minute
Recommended MAX 1.6
mcg/kg/min
Titrate: 0.05-0.1 mcg/kg/minute q 10-20 minutes
Do not bolus or flush line.
Monitor HR, BP, EKG, renal function
Infusion over 15-30 minutes. Incompatible with
NS. Dosing: 5-10 mcg/kg/day
Do not administer 12 hrs before or after
radiotherapy.
Dilute to <2
mg/mL
Infusion: <6 mg/kg up to 400 mg over 1 hr
> 6 mg/kg over 2 hrs
Dosing: 3-12 mg/kg/day
0.01 mg/kg (MAX dose: 0.2 mg) given over 15-30
seconds. May repeat after 45 seconds and then
every min to MAX total cumulative dose 0.05
mg/kg or 1 mg, whichever is lower. See dosing
table.
Monitor level of consciousness and
resedation, airway, BP, HR and RR.
X
X
X
<3 months: 0.5 mg/kg/dose once daily
3 mths-1 yr: 0.5 mg/kg/dose twice daily
1-12 yrs: 0.5-1 mg/kg/day divided twice daily
IVP: Over > 2 minutes. MAX 10 mg/min
Infusion: Over 15-30 minutes
MAX DOSING: 2mg/kg/day
Younger infants: Bolus: 1-2 mcg/kg/dose over 35 mins; may repeat every 2-4 hrs. Doses >5
mcg/kg over 5-10 minutes.
Infusion: 1-2 mcg/kg bolus, then 0.5-1 mcg/kg/hr;
titrate to desired effect
Older infants and children 1-12 years: Bolus: 12 mcg/kg/dose over 3-5 mins; may repeat every
30-60 mins. Doses >5 mcg/kg over 5-10 minutes.
Infusion: 1-3 mcg/kg/hr; titrate to desired effect.
50 mcg/mL IVP
2000 mcg/100 mL
MAX:
2000 mcg/40 mL
5000 mcg/ 100 mL
Epidural
OK
Fenoldopam
(Corlopam®)
Comments
X
Moderate
sedation
service
Only
HIGH RISK MED
Usual Dosing and
Administration
0.1 mg/mL
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Titrate to patient response using age
appropriate pain scale.Peak response 5-10
minutes post dose. Monitor respiratory rate,
blood pressure, heart rate, oxygen
saturation, and bowel sounds.
Rapid IV push may cause apnea/ muscle
and chest wall rigidity.
9
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Telemetry
Required
Concen
tration
Acute
Care
IV
P
IV
Infusion
X
Folic Acid
(Folvite®)
X
X
X
Fosphenytoin
(Cerebyx®)
Note:preferred over
X
X
X
Furosemide (Lasix®)
X
X
X
Gentamicin
X
X
0.1 mg/mL
25 mg PE/mL
phenytoin, write all doses
as PE equivalents
X
10 mg/mL
100 mg/100 mL
X
Dilute to
2 mg/mL
40mg/ml for IM
use
Usual Dosing and
Administration
Infants: 15 mcg/kg/dose daily or 50 mcg daily
1-10 years: 1 mg/day initial; maintenance 0.1-0.4
mg/day
>11 years: Initially 1 mg/day; maintenance 0.5
mg/day
MAX rate: 5 mg/min
Loading dose: 10-20 mg PE/kg not to exceed 3mg
PE/kg/min up to 150 mg PE/.minute
Maintenance: 4-8 mg PE/kg/day in 2-3 divided
doses
IVP: MAX rate: 0.5 mg/kg/min up to 20
mg/minute
IVP; 0.5-2 mg/kg/dose every 6-12 hrs (MAX 6
mg/kg/day)
Infusion: 0.05-0.4 mg/kg/hr
Infusion:Administerover 30 minutes. Peak levels
drawn 30 minutes after infusion completed.
Trough levels just before dose.
Infants > 7 days and children <5yrs: 2.5
mg/kg/dose every 8 hours; once daily dosing: 5-7.5
mg/kg/dose every 24 hrs
Children >5 years: 2-2.5 mg/kg/dose every 8
hours; once-daily: 5-7.5 mg/kg/dose every 24
hours.
Cystic Fibrosis: 5 mg/kg/dose q 12 hr or based on
previous dosing history.
For other dosing, please see reference for dosing
for specific indications.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Comments
Monitor CBC with differential
Doses of fosphenytoin are expressed in
phenytoin equivalents (PEs). Monitor ECG,
BP and RR during loading dose q 5 minutes
and for ≥ 30 minutes thereafter. Monitor
serum phenytoin levels, CBC, platelets,
glucose and LFTs.
Monitor I & O, electrolytes, renal function,
BP; in high doses monitor hearing.
Monitor serum levels, urine output, and
serum creatinine, drug levels.
10
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Insulin Regular
(NovolinR®)
Telemetry
Required
X
Concentration
Acute
Care
IVP
IV
Infusion
X
X
X
< 50kg: 25
units/50
mlsMAX:
100 units/
100 mL
X
X
X
X
X
May give
undiluted, or
as an infusion
of <
2mg/ml
20mg/ml,
50mg/ml
Infusion 200
mg/100 mL
NS
500mg/250ml
In Code
HIGH RISK MED
Iron Sucrose
(Venofer)
X
Ketamine
(Ketalar®)
X
Ketorolac (Toradol®)
X
Labetalol
(Normodyne®,
Trandate®)
X
X
for
moderate
sedation,
MD
present
X
See
comments
X
Critical
care areas
only
X
X
X
MD
available
X
15 mg/mL
30 mg/mL
X
Critical
care areas
only
5 mg/mL
500 mg/250
mL
900 mg/250
mL
Usual Dosing and
Administration
Comments
IVP: Over 1 minute
Infusion: (regular insulin only)
DKA: Initial0.05-0.1 units/kg/hour up to 10 units/hr,
titrate to response.
> 50 kg: Normoglycemia in ICU..see adult protocol
Hyperkalemia: after calcium and bicarb administration,
infuse dextrose 0.5-1 gm/kg over 15-30 minutes followed
by insulin 0.1units/kg
Critical illness hyperglycemia: Review indications with
ICU attending. Usual starting dose 0.02-0.05 units/kg/hr
titrateto maintain blood glucose 80-140
Dosing: Refer to dosing references. Limited pediatric
dosing available.
IVP: Give each 100mg over 2-5 minutes (MAX 200mg)
Infusion: Each 100mg over 15-30 minutes
Monitor urine sugar, blood sugar and
electrolytes. Drug may adsorb to IV bag
and tubing, when using new tubing,
prime, wait 30 mins, then flush tubing
prior to starting infusion.
IVP: 0.25-2 mg/kg not to exceed 0.5 mg/kg/min.
Supplemental doses usually 1/3 to ½ of initial dose.
Infusion: Usual for analgesia/sedation or bronchospasm
5-20 mcg/kg/minute
Monitor RR, BP,HR, O2 sats.
Avoid in patients with increased ICP or
hypertension
Increases oral secretions.
Pretreatment with glycopyrrolate is
recommended if used for monitored
sedation.
Monitor for signs of pain relief, BUN,
creatinine, liver enzymes, blood loss and
urine output. Stop before surgery due to
prolonged bleeding
IVP: Over 1-2 minutes
Bolus: (optional): > 2yrs. MAX 1 mg/kg up to 60 mg x 1
Maintenance: > 6 months 0.25-0.5 mg/kg/dose (MAX 30
mg given every 6 hours as needed, not to exceed 20
doses/treatment course.
Bolus: 0.25-0.5 mg/kg/dose up to 1mg/kg
MAX rate: 0.25mg/kg over 3 minutes up to 10mg/minute.
Peak effect 5-15 minutes, duration 2-4 hrs.
Infusion: 0.4-3 mg/kg/hour
> 50kg: 2-6mg/minute
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
No test dose required.
May cause hypotension, esp w/ IVP.
.Hypotension may be rate related.
ECG monitoring ,HR, and BP
recommended during administration.
Monitor heart rate and blood pressure
every 5 mins until stabilized and every 15
mins during hypertensive episode up to
30 minutes post dose. Patient should
remain supine up to 3 hrs post dose.
Monitor blood pressure and heart rate
pre/post doseeInfusion allowed in ICU
only.
11
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Telemetry
Required
Concentration
Acute
Care
IVP
IV
Infusion
X
X
IVP Dilute
to
5 mg/mL.
Infusion:
100 mg/250
mL
Lepirudin (Refludan®)
X
X
Levetiracetam
Keppra®
X
X
X
Dilute to <
15mg/ml
w/NS
Levofloxacin
(Levaquin®)
X
X
X
Dilute to 5
mg/mL
Levothyroxine
(Synthroid®)
X
X
X
X
May dilute
w/NS to 40
mcg/mL
(5 mLs/200
mcg)
Lidocaine
X
X
Code
only
X
X
20 mg/mL
IVP
2 grams/250
mL
Linezolid (Zyvox®)
X
X
X
2 mg/mL
Usual Dosing and
Administration
Comments
Requires hematology/oncology approval!
May contact anticoagulation service for dosing
recommendations and monitoring. Dosing adjustment
with renal impairment required.
Bolus: 0.4 mg/kg not to exceed 44 mg over 15-20
seconds.
Infusion (continuous): Initially 0.15 mg/kg/hr not to
exceed 16.5 mg/hr, titrate based on an aPTT.
Dosing:20-60mg/kg/day divided q12hrs MAX 4GM/day
Infusion:Over 15 minutes
Monitor aPTT, renal function, and for
signs and symptoms of bleeding.
Infusion: Over 60-90 minutes
6 mths-5 yrs: 10 mg/kg/dose every 12 hours(limited
data).
Children> 5 yrs: 10 mg/kg/dose every 24 hrs (MAX
dose: 500 mg)
Adolescents/Adults: 250-750 mg IV q 24 hrs
IVP: Dilute vial with 5 mL NS, use immediately,
administer over 2-3 minutes. Discard remainder.
See age specific initial dosing, or per endocrine; IV
form is 50% of PO recommendation.
Too rapid infusion may cause
hypotension.
Monitor renal, hepatic, and
hematopoietic function periodically;
number and types of stools/day for
diarrhea.
IV dose usually 50% of oral dose.
Monitor T4, TSH, heart rate, clinical signs
of hypo- and hyperthyroidism.May be
used as a continuous infusion prior to
organ donation—
Monitor EKG, HR, BP.UO, LFT’s and
serum concentrations with continuous
infusion & IV site for thrombophlebitis if
via peripheral administration. Contraindicated with heart block. Lower dosing
may be required with severe CHF or
hepatic impairment.
Requires ID approval. Avoid
foods/beverages high in tyramine to
avoid hypertension (consult nutrition)
Load: 1-1.5 mg/kg over 2-4 minutes up to MAX 0.7
mg/kg/min up to 50 mg/minute, MR 0.5-1 mg/kg Q 5-10
minutes X 2
Infusion: 20-50 mcg/kg/min MAX up to 6 mg/min in
adults (usual 1-4 mg/min).
Infusion: Over 30-120 minutes
< 12yo: 10 mg/kg/dose q 8-12 hrs up to 600 mg/dose
>12yo/adult: 400-600 mg q 12 hrs
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
12
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Lorazepam (Ativan®)
X
Telemetry
Required
Concentration
Acute
Care
IVP
X
X
IV
Infusion
X
ICU only
IVP: May be
diluted to 1
mg/mL w/ NS
MAX 4 mg/mL
Infusion
50 mg/50 mL
250 mg/250 mL
Magnesium Sulfate
X
X
Mannitol (Osmitrol®)
X
X
X
X
X
Low
dose
Meperidine
(Demerol®)
X
X
X
50 grams /250
mLs (20%)
X
Dilute to <
10 mg/mL
X
Dilute to 20
mg/mL
slow
HIGH RISK MED
Meropenem
(Merrem®)
X
X
X
PEDI STD:
1 GM/25 mLS
(40 mg/mL)
ADULT:
1 gram/50 mL
2 grams/50 mLs
12.5 grams/ 50
mL (25%)
Usual Dosing and
Administration
Comments
IVP: Not to exceed 0.05 mg/kg over 2-5 minutes up to 2
mg/minute
Dosing:0.02-0.1 mg/kg/dose (given every 4-8 hours as
needed). Initial MAX 2 mg for sedation, 4 mg for
seizures.
Infusion:0.05-0.15 mg/kg/hr up to 2 mg/kg/day or 100
mg/DAY whichever is less. (see comments)
Usual adult initial dosing 0.5-2mg/hr
Monitor respiratory rate, blood pressure,
heart rate and symptoms of anxiety.
Monitor for phlebitis/ infiltration with
peripheral access.
With normal renal function, doses
approaching 3 mg/kg/day( up to 170
mg/24 hrs should be monitored for
propylene glycol toxicity
(hyperosmolarity, lactic acidosis, renal
toxicity) . Other adult studies have
recommended doses not to exceed
1mg/kg/day .Patients with renal
compromise should switch to oral
lorazepam, seek alternative agents, or
monitor for toxicity using lower dosing.
Infusion ICU only.
Can cause hypotension with too rapid
infusion.Monitor serum magnesium, deep
tendon reflexes, respiratory rate and
blood pressure.
1 gm=8.12 mEq=98.6 mg Magnesium
Asthma: 25-75 mg/kg over 20 minutes
Torsades/PALS: 25-50 mg/kg over 10-20 minutes
Repletion(non-acute): 25-50 mg/kg/dose infused over 2-4
hrs
IVP: 0.2gm/kg over 3-5 minutes
Infusion: 0.25-1 gm/kg over 15 -60 minutes.
Requires inline filter.
Central line preferred. Monitor for extravasation.
IVP slow: 1 mg/kg/dose over 3-5 minutes every 3-4
hours as needed; administer over ≥ 5 mins (do not exceed
25 mg/min) MAX 100 mg/dose, up to 6 mg/kg/day.
Avoid repeated doses with renal dysfunction.
IVP: Over 3-5 minutes
Infusion: Over 15-30 minutes
Dosing: 20-40 mg/kg/dose q 8hrs up to
2 Gm/dose
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Evaluate dose for crystal formation prior
to administration. In-line <5 micron
filter should always be used with
concentrations >20%. . Central line
preferred. Extravasation may cause
edema and necrosis. Monitor renal
function, daily I & Os, serum
electrolytes, serum and urine osmolality.
Restricted use to post-anesthesia
shivering and rigors. Monitor
respiratory and cardiovascular status and
level of sedation, and pain.
Requires ID approval.
13
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Methadone
(Dolophine®)
Telemetry
Required
X
Acute
Care
Concentration
IVP
X
IV
Infusion
X
Methylprednisoloneso
dium succinate
(Solu-Medrol®)
X
X
X
10 mg/mL
Dilute w/ NS
to volume
needed to
infuse over 15
minutes
Infusion: Over 5-15 minutes
Initial Dose in narcotic naïve patients: 0.05-1
mg/kg/dose up to 10 mg/dose q 6-12 hrs(1st 24 hrs) , as
drug accumulates over 24-96 hrs, , dosing frequency may
need to be reduced to q 12-24 hrs.
Monitor RR, HR, BP, sedation and pain
levels. Abstinence scoring is used for
withdrawal. Monitor for QT
prolongation in patients with risk factors.
X
Dilute with
D5W to <
10 mg/mL
Initial: 2-10 mg/kg/dose every 6-8 hours. MAXdose 1
gm, Daily dose: 65 mg/kg or 3 grams, whichever is less.
Infusion:Administer slowly over 30-60 mins
X
40 mg, 125
mg,
500 mg & 1
g vial
Dosing: 0.5-2 mg/kg/day as high as 30 mg/kg depending
on indication.
IVP: <1.8 mg/kg up to 125 mg over 3-15 minutes
Infusion:May dilute each 1gm dose in a minimum of 100
mls NS (10mg/ml) (exception: spinal cord injury protocol
Onset: 4-6 hrs
Duration: 10-16 hrs
Monitor blood pressure, CBC with
differential, hemoglobin, hematocrit, and
liver enzymes.
Caution: Methylprednisoloneacetate is
for IM use only. Monitor blood pressure,
serum glucose and electrolytes.
<1.8
mg/
kg
Metoclopramide
(Reglan®)
X
Metronidazole
(Flagyl® )
X
Midazolam
(Versed®)
X
X
X
X
5 mg/mL
X
5 mg/mL
X
<50kg:
50mg/100ml
MAX:
100 mg/100
mL
1 mg/mL,
5 mg/mL
Low
dose
X
X
X
Per
monitored
sedation
protocol
for
moderate
sedation,
MD
present
X
Comments
X
HIGH RISK MED
Methyldopa
(Aldomet®)
Usual Dosing and
Administration
< 2mg/kg: administer over 1-3 minutes
>2 mg/kg: administer over 15-30 mins
15 mg/kg up to 500mg: Administer over >+30 minutes
>15 mg/kg up to 1 Gm: Administer over 1 hour
Dosing: 0.1-1 mg/kg/dose q 4-6 hrs
IVP: Low dose 0.1 mg/kg up to 10 mg over 1-2 minutes
Infusion over 15-30 mins
(MAX rate: 5 mg/min)
Dosing: 20-45 mg/kg/day up to 4 gms/day divided every
6 or 8 hrs
Infusion: Over 60minutes
6 months-5 years: Initial 0.05-0.15 mg/kg
(MAX total dose: up to 0.6 mg/kg up to 6 mg)
6-12 years: 0.025-0.05 mg/kg
(MAX total dose: up to 0.4 mg/kg up to 10 mg in nonintubated patients)
IVP: over 2-5 mins, longer for higher doses
Infusion: 0.06-0.4 mg/kg/hour MAX 0.4 mg/kg/hr
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Consider pretreatment with
diphenhydramine for doses > 0.25
mg/kg. Monitor for EPS. Too rapid
administration may cause anxiety
Administer diphenydramine for patients
Do not refrigerate. Doses other than 500
mg will be found in the Pyxis drop-off
box.
Monitor level of sedation, respiratory
rate, blood pressure, heart rate and
oxygen saturation
14
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Telemetry
Required
Milrinone lactate
(Primacor)
X
X
Morphine Sulfate
X
Acute
Care
X
Concentration
IVP
X
IV
Infusion
1 mg/mL 10
mLs
Infusion:
20 mg/100
mL
Load: 25-100mcg/kg over 15 mins
Infusion: 0.2-1.2 mcg/kg/min
Monitor EKG, BP, HR, UO platelet
count, potassium, renal function, signs
and symptoms of HF
X
2, 4, 10
mg/ml
PCA 1, 5
mg/mL
INF: 1mg/ml
100 or 250ml
MAX: 500
mg/ 100 mL
Bolus: 0.05-0.1 mg/kg/dose up to initial MAX 10 mg
over 5-30 mins
Infusion: Initial 0.005-0.15 mg/kg/hr; titrate to patient
pain response and tolerance.
Monitor HR, RR, BP, oxygen saturation,
pain relief and level of sedation.
X
20 mg/mL
1-1.5 gm/
50 mLs
1.6-2
gm/100 mLs
Dosing: 50-200 mg/kg/day divided q 4 or q 6 hrs
MAX 12 gms/day
IVP: Over 5-10 minutes
Infusion: Over 30-60 minutes
Monitor for burning, extravasation,
phlebitis
X
10 mg/mL
20 mg/mL
Premed: 0.1-0.2 mg/kg MAX 20gm
Analgesia: 0.05-0.15 mg/kg every 3-6 hours as needed.
Initial MAX 10 mg
MAX: 20 mg/dose up to 160 mg/day
IVP: Administer over 3-5 mins
Infusion:Over 15 mins
Monitor relief of pain, respiratory and
mental status, and blood pressure.
HIGH RISK MED
X
Nalbuphine (Nubain®)
X
X
X
slow
X
X
slow
Comments
X
slow
Nafcillin
(Nafcil®)
Usual Dosing and
Administration
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
15
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Naloxone (Narcan®)
Telemetry
Required
X
Concent
ration
Acute
Care
IVP
X
X
IV
X
0.4 mg/
mL
Infusion:
4 mg/100
mLs NS
(0.04 mg
=40 mcg/
mL)
X
X
Comments
Infusion
IVP dilution:
< 40 kg 0.1
mg in
9.75 mLs NS
=(0.01mg/mL)
> 40 kg 0.4 mg
in
9 mLs NS=
(0.04mg/mL)
Neostigmine
(Prostigmin®)
Usual Dosing and
Administration
X
0.5 mg/ml
slow
1 mg/mL
Nicardipine
(Cardene)
X
X
X
Standard/Periph
eral- Add 25
mg to 250 mLs
NS (0.1mg/mL)
MAX/Central:
Add 100 mg to
60 mLs NS (1
mg/mL)
Nitroglycerin
X
X
X
100 mg/250
mLs
Post anesthesia narcotic reversal:
Narcotic naïve: 0.005-0.01 mg/kgIVP q 2-3 mins as
needed
Opiate dependent: 0.001-0.002 mg/kg IVP q 2-3 mins as
needed(1/10th-1/5th usual dose to prevent acute
withdrawal)
IVP: Over 30 seconds
Narcotic-induced pruritis:
0.25-2 mcg/kg/hr; increase by0.25- 0.5 mcg/kg/hr every
few hours as needed
Monitor respiratory rate, heart rate, and
blood pressure.
The duration of action of naloxone is
shorter than most opiates (20-30
minutes). Patients who receive naloxone
should be monitored for reoccurance of
respiratory depression.
Patients with acute pain will require
careful titration to maintain analgesia
while reversing respiratory depression.
Opiate intoxication: (narcotic naïve)
<20 kg: 0.1 mg/kg every 2-3 minsprn
>20 kg: 2 mg/dose every 2-3 minsprn
Opiate dependent: (1/10th-1/5th usual dose to prevent
acute withdrawal)
Infusion: calculate initial dose/hour based on effective
intermittent dose used and titrate; range: 2.5-160
mcg/kg/hour
Non-depolarizing NMB reversal: with atropine or
glycopyrrolate
Infants: 0.025-0.1 mg/kg/dose
Children: 0.025-0.08 mg/kg/doseMAX/DOSE (see adult)
Myasthenia gravis treatment:
0.01-0.04 mg/kg every 2-4 hoursMAX/DOSE (see adult)
Adult: 0.5-2.5 mg, MAX 5 mg
IVP: Administer over several minutes up to 0.5mg/min
Infusion: IF< 50 kg Initial 0.5-5 mcg/kg/minute
If >50 kg: 2.5-15 mg MAX: 15 mg/HOUR.
Titrate q 5-30 minutes
Infusion: If < 50 kg 0.25-1 mcg/kg/min titrate by 0.5-1
mcg/kg/min every 3-5 mins as needed. MAX 20
mcg/kg/min
>50 kg:5 mcg/min, titrate by 5-10 mcg/minq 3-5 mins up
to 300 mcg/min
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Atropine or glycopyrrolate recommended
prior to neostigmine. Epinephrine should
be available. Monitor HR, BP,RR,
muscle strength.
Monitor blood pressure and heart rate
Monitor blood pressure and heart rate.
Protect the drugfrom light.
16
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
Acute
Care
Concentrati
on
IVP
ICU
ED
Telemetry
Required
Nitroprusside
(Nipride)
X
X
IV
Infusio
n
X
Norepinephrine
(Levophed)
X
X
X
Usual Dosing and
Administration
Comments
100 mg/
250 mL
Infusion: 0.3-5 mcg/kg/min Titrate by 0.1 mcg/kg/min q
2-3 minutes
MAX 10 mcg/kg/min
<10 kg 8
mg/250
mL
Infusion:Initial 0.05-0.1 mcg/kg/min.
Titrate by 0.1-0.2 mcg/kg/minute every 5 minutes till
desired effect or toxicity
Recommended MAX 2 mcg/kg/min
Protect the drugfrom light. Do not use
if blue-green in color. Monitor blood
pressure, heart rate, cyanide and
thiocyanate toxicity; monitor acid-base
status as acidosis can be early sign of
cyanide toxicity; monitor thiocyanate
levels if infusion needed for >3 days or
dose >4 mcg/kg/min or in renal
dysfunction; monitor cyanide levels in
hepatic dysfunction.
Monitor blood pressure, heat rate, urine
output, and peripheral perfusion. Central
line preferred.
10-50 kg +
MAX
16 mg/250 mL
Octreotide Acetate
(Somatostatin)
X
X
X
X
Note: not to be
confused with
Sandostatin LAR
Depot IM injection
>50 kg4
mg/250
mL
50, 100, 500
mcg vial for
SC/IV admin
Standard
infusion:
500 mcg in 100
mLs
NS/D5W (5
mcg/mL)
REFRIGERAT
ED
Ondansetron
(Zofran)
X
X
X
X
2 mg/mL
Hypoglycemia/Antisecretory: 2-10 mcg/kg/day divided
q 8 or 12 hours or as continuous infusion: titrate to patient
response by increasing dose or interval;
Monitor baseline and periodic ultrasound
evaluations for cholelithiasis, blood
sugar, thyroid function tests, fluid and
electrolyte balance.
GI bleed/esophageal varices:0.5-1 mcg/kg bolus, then 1
mcg/kg/hour continuous infusion; titrate to
response(usual adult 25-50 mCG/HR)
MAX DOSE: 1500 mcg/day
SC: usual bolus route
IV: infuse over 15-30 mins in NS
IVP: over 3 minutes
Chemo induced N/V:
Children: 0.15 mg/kg/dose MAX 0.45 mg/kg/day up to
32 mg
Nausea/Vomiting:
Children >2 yrs <40 kg: 0.1 mg/kg
Children >40 kg: 4 mg
IVP: undiluted over 1-5 minutes
Infusion: over 15 minutes in NS/ D5W
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Monitor blood pressure and heart rate.
May cause headache.
17
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Pamidronate
(Aredia)
X
Pentobarbital
(Nembutal)
X
Phenobarbital
(Luminal)
X
Phenylephrine
(Neo-synephrine)
X
Telemetry
Required
Acute
Care
Concentr
ation
IVP
X
X
X
X
Continuous
Infusion
Or per
moderate
sedation
protocol
for
moderate
sedation,
MD
present
slow
X
Prepared by
pharmacy.
Volume
varies by
dose.
Hypercalcemia/osteopenia:0.5-1 mg/kg (MAX dose of
90 mg). Do not redose within 7 days.
Infusion: Over 2-24 hrs. (Longer infusion times ↓ the
risk of nephrotoxicity.) Infuse in dedicated line.
X
50 mg/mL
Sedation:
Children >6–18 mths: 1-3 mg/kg
Children >18 mths: 2 mg/kg, then 1-2 mg/kg every 5-10
minsuntil adequate sedation
MAX: 100 mg/dose
*IVP: slowly (<1 mg/kg/min up to 50 mg/min) Used
only with conscious sedation monitoring or in ICU/ER.
IV: Over 10-30 minutes. May be further diluted to no
less than 5 mg/mL with NS. Do not use unless solution is
clear.
Pentobarbital Coma:
Load: 15-35 mg/kg over 1-2 hrs
Infusion: 1-5 mg/kg/hr viadedicated central line
preferred. MAX: 10 mg/kg/hr
Anticonvulsant:
Load: 15-18 mg/kg at 1-2 mg/kg/minute (MAX 60
mg/minute).
Maintenance:
IV: < 1 mg/kg/min up to 30 mg/minute
Infants: ≤ 5 mg/kg/day in 1-2 doses
1-5 yrs: 6-8 mg/kg/day in 1-2 doses
5-12 yrs: 4-6 mg/kg/day in 1-2 doses
>12 yrs: 1-3 mg/kg/day in 1-2 doses
Hypotension/Shock:
Usual 0.1-0.5 mcg/kg/min; titrate to desired effect
Infusion:
2500 mg/
50 mls
(50 mg/ml)
X
X
IV
Infusion
X
ICU/
ER
only
Usual Dosing and
Administration
X
65 mg/mL
130mg/ml
X
(for<10 kg)
5 mg/250
mL
(10-+kg)
10 mg/250
mL
MAX
CONCENTR
ATION
60 mg/250
mL
Comments
Thrombophlebitis. Monitor serum
creatinine prior to each dose, urine
output, serum electrolytes, phosphate,
magnesium, hemoglobin, hematocrit,
CBC with differential.
Monitor vital signs, blood pressure,
respiratory status, cardiovascular states,
CNS status.
Monitor for
thrombophlebitis/extravasation.
Central linr preferred and particulate
filter required with continuous infusions.
Check infusion regularly to monitor for
precipitation.
For pentobarbital coma, also monitor
EEG bursts..
Monitor CNS status, seizure activity,
LFTs, CBC, renal function, serum
concentrations, respiratory rate, heart
rate, blood pressure,
Monitor heart rate, BP/MAP, CVP.
Central line preferred
PSVT: 5-10 mcg/kg over 20-30 seconds
(Adult: 0.25-0.5 mg)
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
18
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Phenytoin sodium
(Dilantin®)
Note:Fosphenytoin should
Telemetry
Required
X
Acute
Care
X
Concent
ration
IVP
IV
Infusion
X
be used in children instead
phenytoin
Phosphate as
Sodium Phosphate
X
X
X
Each 1 Meq Na+ = 0.75mM
Phos, 1mMPhos =
1.33Meq Na+
Potassium Phosphate
Each mMPhos=
1..47 meq K+
1 meq K+ = 0.68mM Phos
Phytonadione (Vitamin
K, Mephyton®)
X
Piperacillin/Tazobactm
(Zosyn®)
X
Potassium Chloride
X
HIGH RISK MED
SC/IM
only
X
For IV doses
exceeding
0.3meq/kg/hr
up to
10meq/hr
X
(ICU/
OR/ER
only)
X
X
X
X
Usual Dosing and
Administration
50 mg/mL
(mustdilute to 1-5
mg/mL in
NS)
Acute Seizures
Load: 15-20 mg/kg in a single or divided doses
MAXinfusion rate:
Neonates: 0.5 mg/kg/min
Children: 1-3 mg/kg/min not to exceed 50 mg/min
All IV doses
prepared by
pharmacy.
Volume
depends on
dose and
whether via
central or
peripheral
adminis
tration.
Dosing in MMols: Hypophosphatemia:
Phos> 2: 0.05-0.1 Mm/kg up to 15mM
Phos 1-2 mM/dl- 0.16-0.25mM/kg up to 30Mm
10 mg/mL
1 mg/mL
60 mg
piperacillin
and7.5 mg
tazobactam/
mL
2.25 g/50 ml
3.375 g/50
mL
4.5 g/50 mL
Pedi: 0.4
mEq/mL-25
mL vials for
central bolus
doses (10
mEq)
Maintenance: 4-8 mg/kg/day in 2-3 divided doses
Phos< 1mM/dl: 0.25-0.4mM/kg up to
0.6mM/kg to MAX 30mM/dose or 45mM/day
IV infusion: Doses < 0.5mM/kg or 30mM over 4 hrs.
Doses >=0.5mM/kg or 30Mm over 6 hrs
*SC, IM, or PO preferred.
Dose: 1-10 mg, Usual 1-2.5 mg
IV(restricted) : Dilute w/ NS to volume needed to
administer over 15-30 minutes. (see comments)
Infants <6 mths: 150-300 mg of piperacillin
component/kg/day in divided doses every 6-8 hours
>6 mths: 200-350 mg of piperacillin component/kg/day
in divided doses every 6-8 hours.
CF: 350-450 mg/kg/day divided q4h or q6 hrs MAX
4.5gm/dose
IV:Over ≥ 30 minutes
Maintenance: Usual daily dose 2-5mEq/kg/day
(Adult usual: 40-80 mEq/day.)
Hypokalemia: Dosing depends on severity, etiology, and
renal function. See comments on individual dosing
limitations.
20 mEq/50
ml bags
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Comments
Loading doses: Monitor HR/ BP and RR
during loading dose q 5 minutes and for
≥ 30 minutes thereafter. Telemetry
monitoring recommended if patient has
significant underlying cardiac disease.
Particulate filter required. Check for
extravasation.
Monitor serum levels, CBC, LFTs, and
blood pressure.
Maximum Concentration:
Peripheral 30mM Phos/L (1.5mM per
50mls
Central: 30mM Phos/250
mls=
6mM per 50 mls
INFUSION: Intermittent doses over 4-6
hrs. MAX: 0.06mM/kg/hr
**in pediatrics, order doses in 50, 100,
150, 250, 500, OR 1000 ml volumes.
**caution: for Kphos orders written in
mM
be aware of K+ dose pt will also be
recieving
Monitor for potential hypersensitivity
reactions, flushing. Monitor BP, HR,
RR.@ baseline then q 5 min during
infusion .
Monitor serum electrolytes, bleeding
time especially high dose or w/ renal
impairment. periodic tests of renal,
hepatic, and hematologic function.
MAX: Peripheral 0.06 mEq/mL (60
mEq/L)
Central 0.4mEq/mL
RATE: non-telemetry <0.3 mEq/kg/hr
up to 10 mEq/hr
Telemetry-0.6 mEq/kg/hr up to
20 mEq/hr
Monitor serum potassium, glucose,
chloride, pH, urine output if indicated
19
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Prochlorperazine
(Compazine®)
Promethazine
(Phenergan®)
Propofol
(Diprivan®)
Telemetry
Required
X
X
X
Acute
Care
IVP
IV
Infusion
X
X
X
X
X
Concen
tration
X
Moderate
sedation
service
+
moderate
sedation
RN
X
X
5 mg/mL
25 mg/mL
X
10 mg/mL
200 mg/20
mLs
500 mg/50
mLs
1000 mg/100
mLs
Do not dilute
to less than 2
mg/mL with
D5W (even
via y-site)
due to
emulsion
instability.
Usual Dosing and
Administration
Comments
Antiemetic: Children >10 kg:
Dose IV/IM: 0.1-0.15 mg/kg/dose every 6-12 hours
(MAX: 10mg/dose)
IV: May be further diluted in a sufficient volume with
NS and administered over 15-30 minutes
IVP: Administer at MAX rate of 0.1
mg/kg/minute(MAX 5 mg/min)
In children < 5yo, reserve this agent for
patients who are unresponsive to other
alternatives due to the higher risk of
extrapyramidal effects. Alternative
routes to IV preferred.
Not recommended in patients < 2yrs of age due to
significant respiratory depression.
For use in children >2 years. Oral/rectal routes
preferred.
Antiemetic: 0.25-1 mg/kg (MAX dose: 25 mg in
children, 50 mg in adolescents) 4-6 times/day as needed.
Begin with lowest dose.
Usual Adult Dose: 12.5-25 mg
Monitor for extrapyramidal reactions,
respiratory depression, hypotension, and
signs of pain and extravasation.
IV: Further diluted 1:10 (v/v) or greater in NS to
minimize extravasation injuryand administered over 1020 minutes.
ICU SEDATION: (> 24 hrs)
Infusion 5-50 mcg/kg/minute. Titrate upward by 5-10
mcg/kg/min q 5-10 minutes to desired level of sedation
and as hemodynamically tolerated.
PRN boluses w/ infusion: 0.25-1 mg/kg up to 50 mg/dose
MAX MAINTENANCE ICU sedation rate not to exceed
50 mcg/kg/minute.
MONITORED PROCEDURAL SEDATIONInitiation:
IVP: 0.5-3 mg/kg over 20-30 seconds
OR
0.25-0.5 mg/kg/dose MAX 40 mg/dose
q 10 seconds
OR
100-300 mcg/kg/min x 3-5 minutes, then
titrate to desired effect
Maintenance infusion: usual 50-300 mcg/kg/min
Monitor for extrapyramidal reactions,
hypotension, and signs of extravasation.
Avoid in patients with significant peanut/
soy/ or egg allergies.
Monitor respiratory rate, blood pressure,
heart rate, oxygen saturation, ABGs,
depth of sedation, serum lipids or
triglycerides if use is >24 hours.
To minimize pain at injection site,
administer through central line or large
peripheral veins.
Use filter with pore size > 5 microns.
Insure strict aseptic technique. Unused
drug and tubing must be discarded every
12 hrs to minimize risk of infection.
Drug transferred to syringes must be
discarded within 6 hrs.
In patients receiving parenteral nutrition,
consider amount of fat provided by
propofolemulsion in nutrition goal.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
20
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Telemetry
Required
Propranolol
(Inderal®)
X
X
Protamine Sulfate
X
Acute
Care
IVP
IV
Infusion
X
1 mg/mL
May dilute
each MG in
10-50 mLs
NS
X
Rasburicase
(Elitek®)
X
X
Rho(D) Immune
Globulin (WinRho®)
X
X
Rocuronium
X
HIGH RISK MED
Concen
tration
X
X
X
X
X
10
mg/mL*
* After vial
reconstitutio
n with
5 mLSWI.
May be
further
diluted with
NS or D5W.
1.5 mg/mL
Requires
oncology
attending
approval.
Prepared by
chemo
pharmacy in
10-50 mLs
NS.
Approx 230240
units/mL, as
0.5, 1.3, 2.2,
4.4, 13 mL
vials
Does not
require
further
dilution.
1 mg/mL
Usual Dosing and
Administration
Comments
0.01-0.025 mg/kg slow IV over 10 mins (MAX dose: 0.5
mg/dose for infants and 1 mg/dose for children)
Usual adult dose: 1-3 mg slow over 10 minutes, not to
exceed 1 mg/minute
Conversion from PO to IV unpredictable
due to first pass metabolism.
Recommend alternative IV
hypertensive’s (labetolol or metoprolol
for BP control)
Monitor blood pressure, CVP, and EKG
Dose determined by the most recent time and dosage of
heparin or low molecular weight heparin, (please see
dosing references)
MAX dose: 50 mg
MAX rate: IVP < 5 mg/minute
Use cautiously in pts with fish or
protamine allergies.
0.15-0.2 mg/kg/dose MAX: 0.4 mg/kg/day for up to 5-7
days.
Infuse over 30 minutes. Flush with NS pre- and post
infusion.
Monitor for potential anaphylaxis.
Dedicated line preferred. Do not shake
or filter.
Recommended as a single course of
therapy.
Dose for ITP: 25-75mcg/kg slow IV over 3-5 minutes
Hgb should be >8 gm/dl prior to
administration.
May be further diluted with NS.
Infants: 0.5 mg/kg/dose, repeat every 20-30 minutes as
needed
Children: Initial: 0.6 mg/kg/dose with repeat doses of
0.075-0.125 mg/kg every 20-30 mins to desired effect
Infusion: 10-12 mcg/kg/min
Monitor peripheral nerve stimulator
measuring twitch response, heart rate,
blood pressure and assisted ventilator
status.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Hypotension, bradycardia and flushing
may be infusion rate related reactions.
Continue to monitor coagulation, blood
pressure, and cardiac status.
21
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Sodium Bicarbonate
X
Sodium Chloride 3%
(hypertonic)
0.513meq Na+/ml
X
Sodium Chloride
23.4%(hypertonic)
4 meq Na+/ml
Succinylcholine
X
X
HIGH RISK MED
Sulfamethoxazole and
Trimethoprim
(Bactrim, Septra®)
Telemetry
Required
X
Concen
tration
Acute
Care
IVP
IV
Infusion
X
X
X
X
X
Preferred
Emergency
intubation
only
X
X
5 mEq/10
mL(4.2%)
(=0.5
mEq/mL)*
*Preferred
in infants
and small
children
50 mEq/50
mL(8.4%)
(=1
mEq/mL)
Please see reference for dosing for specific indications.
Code: 1 mEq/kgdose over 3-5 minutes
Concentrated
electrolyte
Symptomatic IsovolemicHyponatremia:
uptp4mls/kg/dose over 15 minutes. (equivalent to ~ 1215mls/kg NS).
HypovolemicHyponatremia:Use NS fluid bolus
ICP Management: 1-4 mls/kg undiluted over 15 minutes
May not be
stored at
bedside or in
pyxis.
Available for
STAT
Call
pharmacy.
20 mg/mL
Does not
require
futher
dilution.
REFRIGER
ATE
X
Usual Dosing and
Administration
16 mg/mL
TMP
80 mg/mL
SMZ
Note:dosin
g based on
TMP
component
Non-Code:Not to exceed 1 mEq/kg/hr up to 50 meq/hr
Prevention of tumor lysis: 120-200 mEq/m2/day
Comments
Monitor serum electrolytes, urinary pH
and arterial blood gases if indicated, pain
and phlebitis with peripheral
administration.
Hyperosmolar: Central line preferred, or
dilute 1 mEq to 2 or 3 mLs for peripheral
administration
Verify compatability before Y-site
administration with other drugs.
ICP Management Adults: 15-30mls undiluted over 15
minutes
Initial: 1-2 mg/kg (MAXtotal dose: 150 mg)
Administer over 30 seconds.
Maintenance: Avoid repeated dosing. 0.3-0.6 mg/kg
every 5-10 mins as needed. For short-term administration
due to risk of hyperkalemia.
Evaluate risk-benefit in infants<2 months:. Avoid use if
infant has hyperbilirubinemia or in patients with renal
failure.
Mild-Mod infections: 6-12 mg TMP/kg/day divided
every 12 hours
Serious infections: 15-20 mg TMP/kg/day divided every
6-8 hours.
Administer MAX concentration of 1:10 dilution (each 5
mL of drug added to no less than 50 mLsof D5W) over
60-90 minutes. Complete infusion within 2 hrs of
dilution due to limited stability.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Central line preferred. For correction of
acute hyponatremia, avoid rapid
increases in serum sodium. In
symptomatic patients or is serum sodium
< 120meq/L, target for an initial increase
of 4-6meq/L, not to correct beyond 1215meq/L per 24hrs
Central line required. Monitor serum
Na+ and osmolar gap.
Avoid in any patients with
neuromuscular disorder/acute burns
secondary to risk of hyperkalemia.
Avoid with increased ICP.
Because of the risk of malignant
hyperthermia, use of continuous
infusions is not recommended. Monitor
heart rate and rhythm, serum potassium,
assisted ventilator status, muscle
twitching.
Use a particulate filter. Monitor for
precipitates, especially in maximally
concentrated dilutions.
Monitor for rash, phlebitis, urine output,
CBC, renal function tests.
22
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Telemetry
Required
Terbutaline
(Brethine®)
X
X
Tobramycin (Nebcin®)
X
Tromethamine
(THAM®)
X
Vancomycin
(Vancocin®,
Vancoled®)
X
Acute
Care
X
X
X
Concentration
Usual Dosing and
Administration
Comments
IVP
IV
Infusion
X
X
1 mg/mLvials
Infusion: 20
mg/100 mLs
NS (200
mcg/mL)
Prepared by
pharmacy
unless
emergent.
See infusion chart
Bolus: 2-10 mcg/kg (administer from infusion bag0.010.05 mls/kg over 5-10 mins bag)
Infusion:0.1-6mcg/kg/minute (MAX 10
mcg/kg/minute).Titrate by increments of 0.1-0.2
mcg/kg/min every 30 mins to desired effect.
Monitor heart rate, blood pressure,
respiratory rate, serum potassium, CPK,
EKG, and blood gases if applicable.
X
Dilute to
< 5 mg/mL
Monitor serum levels, urine output, and
serum creatinine
X
18 gm/500
mLs
(0.3
mM/mL)
1 mEq=1
mm=
120 mg per
3.3 mLs
Infusion:Administerover 30 minutes. Peak levels drawn
30 minutes after infusion completed. Trough levels just
before dose.
Infants > 7 days and children <5yrs: 2.5 mg/kg/dose
every 8 hours; once daily dosing: 5-7.5 mg/kg/dose every
24 hrs
Children >5 years: 2-2.5 mg/kg/dose every 8 hours;
once-daily: 5-7.5 mg/kg/dose every 24 hours.
Cystic Fibrosis: 5 mg/kg/dose q 12 hr or based on
previous dosing history.
For other dosing, please see reference for dosing for
specific indications.
Neonates: 1 mL/kg for each pH unit below 7.4.
Infants/Children/Adults:
Dose (in mLs)= kg X base deficit (mEq/L) X 1.1
up to 13.9 mLs/kg/dose
Infusion:Over≥ 1 hr.
0.7-1 mL/kg/hr MAX 23 mls/kg/day.
Acute Acidosis: 25% of dose over 5-10 minutes followed
by remainder over 1 hr.
X
Dilute to <5
mg/mL
Central: <
10mg/ml per
request if fluid
restricted
Infusion:Over 60-90 minutes, slower if pt experiencing
red-man syndrome (histamine-like reaction).
< 7 days: 10-15 mg/kg every 12 hours
> 7 days: 10-15 mg/kg every 6-8 hrs
Infants> 1 month, children: 40-60 mg/kg/day divided
every 6-8 hours up to initial MAX 1.5 gm/dose up to 4
gm/day. Adjust for renal dysfunction.
NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.
Version 9/28/2008 Barb Maas Pharm. D.
Intended for short-term use.
Central line or large peripheral vein
(pH10.5) preferred. Monitor for
extravasation, tissue injury, thrombosis.
Monitor for respiratory depression,
hypoglycemia, hyperkalemia, renal
functiom, serum pH, ABG’s,
hyperosmolarity
Monitor periodic renal function tests,
urinalysis, serum vancomycintrough
levels, and WBC.
Use caution with concurrent NSAID use
and/or dehydration + high dose
vancomycin
secondary to risk of induced acute renal
failure
23
Pediatric Guidelines for IV Medication Administration
Drug
Approved For
ICU
ED
Telemetry
Required
Acute
Care
Concen
tration
IVP
IV
Infusion
Vasopressin
X
X
X
Vecuronium
(Norcuron®)
X
X
X
X
X
HIGH RISK MED
Verapamil (Isoptin®,
Calan®)
Voriconazole
(VFend®)
References
X
X
X
X
X
Usual Dosing and
Administration
Comments
PTS <50 kg:
DI: 5 units/
500 mlsNS
SHOCK: 50
units/
250 mLs NS
PTS>50
kg/adults
DI: 10
units/250
mls NS
SH0CK:
40units/
100 mLNS
IVP: Dilute to
1 mg/mL
Continuous
Infusion:
50 mg/100 mL
D5W
IVP: ACLS 40 units over 15-30 seconds
PTS <50 kg:
DI :0.0005 unit/kg/hr; double dose as needed every 30
mins to MAX 0.01 units/kg/hr
SHOCK:0.02-0.12 units/kg/hr up to 2.4 units total/hr
PTS>50 kg/adults:
DI :0.0005 unit/kg/hr; double dose as needed every 30
mins to MAX 0.01 units/kg/hr
Hypotension/Shock: 0.04-0.1 units/MINUTE
Central Vein Preferred. Monitor fluid
intake and output, urine specific gravity,
urine and serum osmolality, serum and
urine sodium.
Monitor BP, S/S ischemia( digital, gut,
coronary)
IVP: Over seconds
Pedi Dosing: Neonates: 0.05-0.2mg/kg/dose IV q1=2 hrs
or per hr as continuous infusion.
Monitor assisted ventilator status, heart
rate, blood pressure, peripheral nerve
stimulator measuring twitch response.
Patients must be intubated and properly
sedated.
IVP: 1-2.5
mg/mL
Infusion:
IVP: Over 2-5 minutes
Not recommended in infants. Monitor
EKG, blood pressure and heart rate. IV
calcium should be readily available.
50 mg/100 mL
D5W
Diluted by
pharmacy to
0.5-5 mg/mL
Lexi-Comp’s Pediatric Dosage Handbook- 14th Edition
Pediatric Injectable Drugs-8th Edition
2008 Intravenous Medications-24th Edition
Micromedex
UMMMC Adult Guidelines for IV Medication Administration 2007
VUMC IV Medication Administration Chart revised 09/21/04
University of Kentucky Chandler Medical Center Pediatric IVP/Infusion Drug Lists 2005
Children’s Hospital and Clinics of Minnesotta Pediatric IV Administration Guidelines
Revised 09/05
Children 1-16 years: 0.1-0.3 mg/kg/doseMAX initial
dose 5 mg, MR in 15-30 minutes x 1 with MAX of 0.3
mg/kg to 10 mg/dose
Infusion: Over 1-2 hrs not to exceed 3 mg/kg/hr
Dose:3-6 mg/kg/dose q 12 hr, esophageal candidiasis
doses may be lower
Patients may commonly experience
reversible visual changes. Monitor
electrolytes. Use cautiously in patients
with proarrythmic conditions. Infectious
disease approval required. Do not use
IV form in renal failure
Editor: Barbara Maas Pharm. D.
Primary Reviewers/Co-editors: Angela Gilchrist Pharm. D., Amy Hellinger Pharm. D.,
CharlesTurck Pharm. D.
Primary Nursing Reviewers: Carol Kronopolis, Charles Wheeler, Lynn D’Angelo,
Rosemary Cerquiera
Primary Physician Reviewers: Hospitalist- Tom Guggina ICU Attending- Scott Bateman
ER Attending-Mariann Manno
Appoved by Pharmacy and Therapeutics 09/14/08
Add formedication
future: Cosyntropin,
lopressor,
gancyclovir, immune globulin, sodium 24
NOTE: This is not a comprehensive medication list. For items not listed, review standard
resources oralteplase,
consult the
pharmacist.
chloride 3%, etomidate
Version 9/28/2008 Barb Maas Pharm. D.