Download Pediatric Intensive Care Unit (PICU) Nurse`s Guide Intravenous Drip

Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Alprostadil
(Prostin VR,
PGE1)
THERAPEUTIC
CATEGORY
Prostaglandin
TYPICAL CHILD DOSE
0.01-0.4 mcg/kg/min
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
20 mcg/mL
Page 1 of 22
MAXIMUM RATE
OF
ADMINISTRATION
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Apnea occurs in 1012% of neonates,
usually within the
first hour of therapy.
Infusion rate should
be slowed if fever or
hypotension
develops.
Once therapeutic
response is attained,
gradually decrease
infusion rate to
lowest effective
dose
Monitoring Parameters:
Arterial pressure, respiratory
rate, heart rate, temperature,
pO2, monitor for gastric
obstruction in pts on drip > 120
hrs
Adverse Effects:
Hypotension, flushing,
bradycardia, tachycardia, fever,
cortical proliferation of long
bones, respiratory depression,
apnea
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
Alteplase (TPA,
Cathflo)
Antithrombotic
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
0.6
Occluded catheters:
<10 kg: 0.5 mg in NS in a
mg/kg/hour
volume required to fill lumen
10-29 kg: 1 mg/mL, dose equal
to 110% of catheter lumen
volume, max of 2 mL, instilled
into occluded catheter, up to 2
doses may be used, separated by
120 min
>30 kg: 2 mg/2 mL instilled
into occluded catheter, up to 2
doses may be used, separated by
120 min
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
1 mg/mL
Systemic thromboses:
0.1-0.6 mg/kg/hour for 6 hours
(some pts may require longer or
shorter duration of therapy);
initiate at 0.1 mg/kg/hour if no
response after 6 hours, increase
infusion by 0.1 mg/kg/hr to
maximum of 0.5 mg/kg/hr;
maintain fibrinogen > 100 mg/dl
Aminocaproic
Acid
Antifibrinolytic; Intermittent dose:
Hemostatic agent 50-100mg/kg/dose every 6
hours
30g/day
or
18g/m2/day
20 mg/mL
Continuous Infusion:
33.3 mg/kg/hr (1g/m2/hr)
Single doses over
at least 15-60
minutes
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Administer via
infusion pump;
extravasation may
cause bruising or
inflammation
Monitoring Parameters:
systemic use: blood pressure,
temp, CBC, reticulocyte,
platelet count, fibrinogen,
plasminogen, signs of bleeding
catheter clearance:
attempt to aspirate
blood after 30 min
of dwell time; if
successful, aspirate
4-5 mL of blood and
flush gently with
NS; if unsuccessful,
allow to dwell 90
more min and repeat
procedure. If still
unsuccessful after
120 minutes, a
second dose may be
instilled
Adverse Effects with systemic
use: sepsis, GI bleed, venous
thrombosis, hypotension, fever,
intracranial or cerebral
hemorrhage, bleeding, bruising
Do not administer
undiluted drug.
Monitoring Parameters:
Serum CK, fibrinogen
concentrations, BMP
Adverse Effects:
Hypotension, bradycardia,
arrhythmia with rapid IV
infusion
Page 2 of 22
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Aminophylline
THERAPEUTIC
CATEGORY
Antiasthmatic,
bronchodilator,
respiratory
stimulant,
theophyline
derivative
TYPICAL CHILD DOSE
Loading dose:
5.7 mg/kg
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
Antiarrhythmic
Bolus: 0.36
Do not extravasate.
mg/kg/min (not to Do not administer
exceed 25
IM
mg/min)
Monitor
theophylline levels
15
mcg/kg/min
(21.6
mg/kg/day)
Peripheral line:
3mg/mL
Rapid IVP if
pulseless
Central line:
6 mg/mL
0.25 mg/kg/min
for perfusing
tachycardias
Continuous infusion:
6 wks-1 year: 0.3-0.8 mg/kg/hr
(age dependent)
1-9 yrs: 1 mg/kg/hr
9-12 yrs: 0.9 mg/kg/hr
> 12 yrs: 0.63 mg/kg/hr
Loading dose: 5 mg/kg
Continuous Infusion:
5 mcg/kg/min
(7.2 mg/kg/day)
Increase incrementally until
desired effect or
15 mcg/kg/min
Argatroban
Anticoagulant
Initial: 0.75 mcg/kg/min; titrate
0.1 – 0.25 mcg/kg/min per
aPTT levels
ADMINISTRATION
CONSIDERATIONS
900 mg/day
25 mg/mL
(unless levels
dictate higher)
Dosage should be adjusted to
serum level measurements
during the first 12-24 hrs
Amiodarone/
Cordarone
Updated: 12/2013
1 mg/mL
Page 3 of 22
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Monitoring Parameters:
Respiratory rate, heart rate,
serum theophyline levels,
arterial or capillary blood gases
(if applicable); number and
severity of apnea spells (apnea
of prematurity)
Adverse Effects: may cause
Asthma levels: 5dysrhythmias; GI upset, GE
15mcg/ml
reflux, diarrhea, n/v, abd pain,
Neonatal apnea: 6- nervousness, agitation,
dizziness, muscle cramp,
12 mcg/ml
tremor, tachycardia, PVC,
seizure
Administer via
Monitoring Parameters:
central venous
cardiac, liver, renal, pulmonary,
catheter, if possible and thyroid function. EKG
due to phlebitis with should be monitored.
peripheral infusions Ophthalmologic exams are
> 3 mg/ml in D5W recommended.
Adverse Effects: bradycardia,
(but conc <= 2.5
mg/ml may be less corneal deposit, hypotension,
irritating). Use of thyroid dysfunction,
photosensitivity, tremor and
glass bottles for
infusion > 2 hours; involuntary disturbances.
polyvinyl tubing is
recommended.
Infused via infusion
pump.
Do not mix with
Monitoring Parameters:
other medications
aPTT, CBC, s/s bleeding
Adverse Effects: bleeding,
chest pain, dyspnea,
tachycardia, hypotension, fever
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Arginine
Bumetanide
(Bumex)
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
Urea Cycle
Disorder (UCD)
treatment;
Metabolic
Alkalosis
treatment
Loop diuretic
UCD: 200-600 mg/kg load over
90 minutes, followed by 8
mg/kg/hr
MAXIMUM
CHILD DOSE
Alkalosis:
0.5 x [HCO3 – 24] x weight (kg)
Initial dose:
Maximum of
0.01 – 0.1 mg/kg/dose
10mg/day
MAXIMUM
CONCENTRATION
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
100 mg/mL
1 g/kg/hr (up to 60 Central line
g/hr)
recommended
Do not extravasate
0.25 mg/mL
IVP over 1-2
minutes
Monitoring Parameters:
Blood gas, BMP, ammonia and
amino acid
Adverse Effects: hypotension,
flushing, hyperkalemia, GI
upset
Monitoring Parameters:
serum potassium, serum
sodium, blood pressure, blood
glucose, hepatic and renal
function.
Adverse Effects: anorexia,
constipation, cramping,
diarrhea, blurred vision,
dizziness, parathesias, vertigo,
muscle spasms, purpura,
photosensitivity, pruritus,
urticaria, rash
Continuous infusion:
Initial dose of 5 mcg/kg/hr and
titrate to clinical effect to
maximum of 200 mcg/kg/hr
or
Adult-sized patients: 0.9-1mg/hr
Page 4 of 22
MAXIMUM RATE
OF
ADMINISTRATION
Updated: 12/2013
1 mg bumetanide
approximately
equivalent to 40 mg
furosemide
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Calcium chloride
THERAPEUTIC
CATEGORY
Antidote for
hydrofluoric
acid, electrolyte
supplement
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
2 grams per
(Dose expressed in mg of
dose
calcium chloride):
Cardiac arrest in presence of
hyperkalemia or hypocalcemia:
20 mg/kg; may repeat in 10 min
if necessary
Hypocalcemia: 10-20
mg/kg/dose repeated Q4-6H if
needed
Hypocalcemia secondary to
citrated blood transfusion: give
0.45meq elemental calcium for
each 100ml citrated blood
transfused
Tetany: 10mg/kg over 5-10
min; may repeat after 6-8 hours
or follow with an infusion with
a max dose of 200 mg/kg/day
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
Bolus IV: 100
mg/mL
IV push:
50-100 mg/min
Continuous
infusion: 20
mg/mL
IV infusion: 4590 mg/kg over 1
hour.
(0.6-1.2 mEq/kg
over 1 hour).
Page 5 of 22
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Infusion through
central line
preferred- avoid
infusion into small
veins in dorsum of
hand or foot and
scalp veins because
of risk of
extravasation.
Infusion should be
stopped if patient
complains of
discomfort.
Must flush well
between sodium
bicarbonate to
prevent
precipitation.
Do not infuse with
phosphate
containing solutions
Monitoring Parameters:
Heart rate, ECG during IV
administration, serum calcium,
phosphate, magnesium.
Adverse Effects:
Metallic taste, cardiac arrest
(with rapid IV injection),
hyperkalemia, hypertension,
hypomagnesemia,
hypophosphatemia, milk-alkali
syndrome, vasodilation,
arrhythmias
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Calcium
gluconate
Cisatracurium/
Nimbex
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
Antidote for
hydrofluoric
acid, electrolyte
supplement
3g per dose
(Dose expressed in mg of
calcium gluconate):
Cardiac arrest in presence of
hyperkalemia or hypocalcemia:
60-100 mg/kg; may repeat in 10
min if necessary
Hypocalcemia: 50-100
mg/kg/dose repeated Q4-6H if
needed
Hypocalcemia secondary to
citrated blood transfusion: give
0.45meq elemental calcium for
each 100ml citrated blood
transfused
Tetany: 100-200 mg/kg over 510 min; may repeat after 6 hours
or follow with an infusion with
a max dose of 500 mg/kg/day
IV bolus: 100
mg/mL
Neuromuscular
blocker; skeletal
muscle relaxant
Intermittent: 0.1 – 0.15 mg/kg
Continuous: 1-4 mcg/kg/min
IV Bolus:
10 mg/mL
(Precedex)
Alpha-2
adrenergic
agonist, sedative
Continuous: 0.2 to 1
mcg/kg/hour
10-20 seconds
Continuous
infusion: 50
mg/mL
Continuous
Infusion:
1.6 mg/mL
Dexmedetomidine
MAXIMUM RATE
OF
ADMINISTRATION
4 mcg/mL
Page 6 of 22
IVP over 7-12
seconds
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Infusion through
central line
preferred. Infusion
should be stopped if
patient complains of
discomfort.
Must flush well
between sodium
bicarbonate to
prevent
precipitation.
Do not infuse with
phosphate
containing solutions
Monitoring Parameters:
Heart rate, ECG during IV
administration, serum calcium,
phosphate, magnesium.
Adverse Effects:
Metallic taste, cardiac arrest
(with rapid IV injection),
hyperkalemia, hypertension,
hypomagnesemia,
hypophosphatemia, milk-alkali
syndrome, vasodilation,
arrhythmias
Monitoring Parameters:
muscle twitch response to
peripheral nerve stimulation,
heart rate, blood pressure
Adverse Effects: bradycardia,
hypotension, bronchospasm (all
rare)
Monitoring Parameters:
HR, BP, sedation level
Adverse Effects:
Hypertension, hypotension,
bradycardia, nausea, dizziness,
fatigue
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Diltiazem
(Cardizem)
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
Antianginal,
Antihypertensive
Calcium channel
blocker
Loading dose: 0.25mg/kg over
2-5 min; if response inadequate
after 15 min, a second 0.35
mg/kg may be given
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
1 mg/mL
MAXIMUM RATE
OF
ADMINISTRATION
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
IVP over 2
minutes
Monitoring Parameters:
Heart rate, blood pressure
Adverse Effects:
Bradycardia, hypotension,
tachycardia (rare), flushing,
peripheral edema, CHF,
headache, dizziness, insomnia
Continuous infusion: 0.050.15mg/kg/hr
Continuous infusions rates of 515mg/hr have been reported but
are not adjusted for weight or
age.
Dobutamine/
Dobutrex
Adrenergic
agonist
Dopamine/
Adrenergic
Dopastat, Intropin agonist
Dose: 2-20 mcg/kg/min; titrate
2 – 2.5 mcg/kg/min every 5
minutes to desired response.
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
40
mcg/kg/min
8000 mcg/mL
Correct
hypovolemia prior
to initiation of
therapy.
Infiltration causes
local inflammatory
changes or
extravasation may
cause dermal
necrosis
Initial: 5-10 mcg/kg/min
50
Maintenance:
mcg/kg/min
2-10 mcg/kg/min; increase 2 –
2.5 mcg/kg/min every 5 minutes
to desired response
6400 mcg/mL
Do not infuse
Monitoring Parameters:
through an umbilical EKG, heart rate, CVP, MAP,
artery catheter.
urine output, if pulmonary
artery catheter is in place
Extravasation causes monitor CI, PECP, SVR, RAP,
tissue necrosis.
PVR
Adverse Effects: anxiety, HA,
injection site rxns, ectopic
heartbeats, widened QRS
complex, ventricular
arrhythmias
Page 7 of 22
Monitoring Parameters:
blood pressure, ECG, heart rate,
electrolytes (potassium),
cardiac output.
Adverse Effects: chest pain,
hypertension, HA,
hypokalemia, injection site
rxns, arrhythmias, eosinophilic
myocarditis
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
Doxapram
Respiratory
stimulant
Initial: 2.5-3 mg/kg load
Continuous: 1 mg/kg/hr
2.5 mg/kg/hr
2 mg/mL
Epinephrine/
Adrenalin
Adrenergic
agonist
Cardiac arrest- initial 0.01
mg/kg (10 mcg/kg) or 0.1 ml/kg
of 1:10,000; may be repeated
every 3-5 min.
Initial Endotracheal dose: 0.1
mg/kg, may repeat q3-5 min.
Continuous infusion:
Initial: 0.05-0.1 mcg/kg/min
Maintenance: 0.01 – 1
mcg/kg/min; titrate 0.05 – 0.1
mcg/kg/min every 5 minutes to
effect
0.03
mg/kg/dose
for neonates,
0.1
mg/kg/dose
for infants
and children
by IV push.
Continuous
infusion: 64
mcg/mL
Epoprostenol /
Flolan
Peripheral
vasodilator,
platelet
aggregation
inhibitor,
prostaglandin
MAXIMUM RATE
OF
ADMINISTRATION
Infuse bolus over
15-30 minutes
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Do not extravasate
Monitoring Parameters:
Pulse oximetry, ABG, blood
pressure, heart rate, apnea
epidoses (number, duration,
severity)
Adverse Effects: Flushing, GI
upset, hypertension, pruritis
Do not administer if Monitoring Parameters:
solution is brown or blood pressure, heart rate
otherwise discolored Adverse Effects: anxiety,
or if a precipitate is dizziness, sweating,
present.
arrhythmias, pulmonary edema
Extravasation causes
tissue necrosis.
Protect from light
Dose: 2 ng/kg/min up to 20
20 ng/kg/min
ng/kg/min; may increase by 1-2
ng/kg/min increments every 15
minutes
70000 ng/mL
Page 8 of 22
Abrupt withdrawal,
interruptions in
delivery, or large
reductions in dosage
may cause
symptoms
associated with
rebound pulmonary
hypertension (ie,
dyspnea, dizziness,
and asthenia. Short
expiration (8 hrs)
without cool pack
Monitoring Parameters:
Pulmonary artery pressure, total
pulmonary vascular resistance,
systemic arterial pressure,
cardiac output, and heart rate
should be monitored during
acute infusion in patients with
primary pulmonary
hypertension
Adverse Effects:
Flushing, sweating, nausea,
hypotension, bradycardia,
tachycardia, hyperglycemia,
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
Esmolol/
Brevibloc
Antiarrhythmic,
beta-adrenergic
blocker
Bolus dose: 100-500 mcg/kg
infuse over 1 minute
Continuous infusion: 50-250
mcg/kg/min
1000
mcg/kg/min
20 mg/mL
Fentanyl citrate/
Sublimaze
Analgesic,
narcotic, general
anesthetic,
opioid
Dose: 0.5-4 mcg/kg followed
by continuous infusion of 1-5
mcg/kg/hr until desired effect
50-100
50 mcg/mL
mcg/kg/dose
for anesthesia
Furosemide/
Lasix
Antihypertensive Edema initial, 1 mg/kg/dose; up 200 mg
diuretic
to 2 mg/kg/dose every 6 hours
10 mg/mL
Continuous infusion: initial
0.05-0.1 mg/kg/hour; titrate
dosage to clinical effect up to
0.4 mg/kg/hr
Page 9 of 22
MAXIMUM RATE
OF
ADMINISTRATION
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
IVP over 1 minute Do not extravasate
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Monitoring Parameters:
blood pressure, EKG, heart rate,
respiratory rate, IV site
Adverse Effects: bradycardia,
chest pain, HA, pain at injection
site, bronchospasm (rare),
seizures (rare)
IVP over 1-5
Chest wall rigidity
Monitoring Parameters:
minutes
related to high doses Respiratory rate, blood
(>5mcg/kg, slow and rapid escalation pressure, heart rate, O2
IVP 5-10 minutes) to moderate doses- saturations, bowel sounds,
abdominal distention.
may be reversed
Adverse Effects: asthenia,
with naloxone
confusion, urinary retention,
arrhythmias, chest pain, apnea,
circulatory depression,
tachyphylaxis
0.5 mg/kg/min
Transient and
Monitoring Parameters:
(not to exceed 4
permanent
serum potassium, serum
mg/min)
ototoxicity has been sodium, blood pressure, blood
associated with
glucose, hepatic and renal
administration rates function.
Adverse Effects: anorexia,
> 4 mg/min or 0.5
constipation, cramping,
mg/kg/min
diarrhea, blurred vision,
dizziness, parathesias, vertigo,
muscle spasms, purpura,
photosensitivity, pruritus,
urticaria, rash
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Heparin
THERAPEUTIC
CATEGORY
Anticoagulant
TYPICAL CHILD DOSE
Neonates and children < 1 yr:
loading dose = 75 units/kg over
10 minutes with initial drip at
28 units/kg/hr; adjust to APTT
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
100 units/mL
Analgesic,
narcotic
Bolus: 0.01mg/kg/dose
4mg/mL
Continuous infusion:
0.003-0.005mg/kg/hr
Insulin, Regular
Isoproterenol/
Isuprel
Antidiabetic
agent
Adrenergic,
bronchodilator,
sympathomimetic
Diabetic ketoacidosis: 0.1
unit/kg/hour (range: 0.05-0.2
unit/kg/hour depending upon
rate of decrease in serum
glucose)
IV bolus: 100
units/mL
Continuous
infusion: 1
unit/mL
Dose: 0.05-2 mcg/kg/min;
2 mcg/kg/min 64 mcg/mL
titrate to response by increments
of 0.1 mcg/kg/min every 10-15
minutes
Page 10 of 22
ADMINISTRATION
CONSIDERATIONS
Adjust per Pediatric
Heparin Protocol
Children > 1 yr: loading dose =
75 units/kg with initial drip at
20 units/kg/hr; adjust APTT
Hydromorphone
Updated: 12/2013
IVP over 2-3
minutes
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Monitoring Parameters:
APTT, platelet count, signs of
bleeding, hemoglobin,
hematocrit
Adverse Effects:
Hemorrhage,
thrombocytopenia, fever,
headache, chills, n/v, elevated
liver enzymes
Monitoring Parameters:
Respiratory rate, blood
pressure, heart rate, O2
saturations, bowel sounds,
abdominal distention.
Adverse Effects: asthenia,
confusion, urinary retention,
arrhythmias, chest pain, apnea,
circulatory depression
Optimal rate of
Monitoring Parameters:
decrease is 80-100
Urine sugar and acetone, blood
mg/dl/hour
sugar, serum electrolytes,
(decreasing serum
hemoglobin A1C
glucose too rapidly Adverse Effects:
may lead to cerebral Palpitations, tachycardia,
edema)
fatigue, hypoglycemia,
hypokalemia
Only Regular
Insulin can be given
intravenously
Do not use if
Monitoring Parameters:
solution is colored
cardiac rhythms, BP, HR, RR,
or precipitate is
EKG
Adverse Effects: confusion,
present.
syncope, tremor, myocardial
Incompatible with
ischemia (rare)
epinephrine
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Ketamine/
Ketalar
THERAPEUTIC
CATEGORY
Anesthetic
adjunct
TYPICAL CHILD DOSE
Dose: 0.5-1 mg/kg occur 2-3
minutes followed by 5-20
mcg/kg/min continuous
infusion, with or without
supplemental O2
Anesthesia maintenance: 0.010.03 mg/kg/min
Labetalol
Antihypertensive Bolus:
, beta-adrenergic 0.2-0.5mg/kg/dose (max of
20mg/dose)
blocker
MAXIMUM
CHILD DOSE
Not
established,
but large
doses prolong
recovery and
increase risk
of adverse
effects
MAXIMUM
CONCENTRATION
IV bolus: 50
mg/mL
MAXIMUM RATE
OF
ADMINISTRATION
2 mg/min or 0.5
mg/kg/min
Continuous
infusion:
2 mg/mL
Antiarrhythmic,
local anesthetic
Ventricular arrhythmia: 0.5-1
mg/kg q5-10 min
Loading dose: 1 mg/kg
Maintenance: 10-50
mcg/kg/min by infusion
3.6 mg/mL
2 mg/minute
IV bolus: 20
mg/mL
Not to exceed 0.7
mg/kg/min or 50
mg/min
whichever is less
3mg/kg/hr
3 mg/kg
intermittent
infusion
(although this
route is not
recommended)
88 mcg/kg/min
Continuous
infusion 8 mg/mL
by continuous
IV has been
proposed
Page 11 of 22
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Dilute to 50 mg/mL
for IV push
Monitoring Parameters:
monitor cardiac function in
patients with cardiac
decompensation or
hypertension, monitor for signs
of emergency symptoms
Adverse Effects: vivid
dreams, increased blood
pressure, tachycardia, muscle
hyperactivity
Laryngospasm or
apnea requiring
intubation may
occur
Continuous infusion:
0.25-1.5 mg/kg/hr
Lidocaine/
Xylocaine
Updated: 12/2013
Monitoring Parameters:
blood pressure, EKG, heart rate,
respiratory rate, IV site
Adverse Effects: bradycardia,
chest pain, HA, pain at injection
site, bronchospasm (rare),
seizures (rare)
Serum concentration Monitoring Parameters:
monitoring
continuous EKG monitoring,
suggested, cardiac
serum concentration, IV site
monitoring essential (thrombophlebitis may occur
with prolonged infusion).
Adverse Effects: hypotension,
paresthesias, tremor,
arrhythmias, cardiac arrest,
seizures
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Lorazepam/
Ativan
THERAPEUTIC
CATEGORY
Antianxiety,
benzodiazepine,
anticonvulsant,
antiemetic
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
Adjunct antiemetic: 0.05 mg/kg 4 mg/dose or
up to 2mg/dose effective in
0.25-0.4
controlling chemo-induced N/V. mg/kg/dose
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
2 mg/mL
2 mg/min
200 mg/mL
5-10 minutes
Status Epilepticus: 0.03-0.1
mg/kg and may repeat 0.05
mg/kg in 10-15 min if no
response
Magnesium
sulfate
Electrolyte
supplement,
Torsades de
Pointes
treatment,
bronchodilator
Agitation in the ICU pt
(unlabeled use):
0.01-0.1 mg/kg/hour
Hypomagnesium:
Neonates:
25-50 mg/kg/dose (0.2-0.4
meq/kg/dose) Q8-12H
Children:
25-50 mg/kg/dose (0.2-0.4
meq/kg/dose) Q4-6H
2000 mg
Management of seizures and
hypertension:
20-100 mg/kg/dose Q4-6H
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Protect from light
and refrigerate.
Monitoring Parameters:
Respiratory rate, BP, HR, CBC
w/ diff, and liver function tests
Expires in 60 days at w/ long term usage
room temp.
Adverse Effects: CNS and
respiratory depression,
drowsiness, GI symptoms,
propylene glycol toxicity,
nystagmus, hypertension or
hypotension
Monitoring Parameters:
Serum magnesium, deep tendon
reflexes, respiratory rate
Adverse Effects:
Hypotension, diarrhea,
hypermagnesia, abdominal
cramps, gas formation, muscle
weakness
Adverse effects are related to
serum concentration:
>3 mg/dl: depressed CNS,
blocked peripheral
neuromuscular transmission
leading to anticonvulsant
effects
>5 mg/dl: depressed deep
tendon reflexes, flushing,
somnolence
>12 mg/dl: respiratory
paralysis, complete heart block
Treatment of Torsades de
Pointes VT:
25-50 mg/kg/dose (not to
exceed 2gm/dose)
Bronchodilation (asthma):
25 mg/kg/dose (max 2gm) as a
single dose; 30-70 mg/kg over
20 minutes has been given
Page 12 of 22
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Midazolam/
Versed
Milrinone/
Primacor
THERAPEUTIC
CATEGORY
Anticonvulsant,
benzodiazepine,
hypnotic,
sedative
Phosphodiesterase
enzyme inhibitor
TYPICAL CHILD DOSE
Anesthesia: 0.15 mg/kg initially
followed by up to three doses of
0.05 mg/kg at 2 minute intervals
Continuous IV: neonates <=32
weeks gestational age: 1
mcg/kg/min, then decrease to
0.5 mcg/kg/min ASAP
Neonates >32 weeks: 1
mcg/kg/min
Infants/children: 0.05- 0.2
mg/kg as loading dose over 2-3
min. followed by 1-2
mcg/kg/min; titrate by 1
mcg/kg/min increments q 30
min until desired effect.
Dose: 0.2 -1 mcg/kg/min
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
Intravenous/intran 1-5 minutes
asal: 5mg/mL
Intramuscular: 1
mg/mL
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Respiratory
depression and
arrest requiring
mechanical
ventilation may
occur following
excessive dosing,
rapid administration,
or use with fentanyl
Monitoring Parameters: level
of sedation, respiratory rate,
heart rate, blood pressure,
oxygen saturation
Adverse effects: cardiac arrest,
hypotension, bradycardia,
drowsiness, sedation, amnesia,
muscle tremor
Do not extravasate
Max dose in 400 mcg/mL
adults is 1.13
mg/kg/day
(not
established in
children)
Page 13 of 22
Furosemide is
incompatible with
milrinone
Monitoring Parameters:
Blood pressure, heart rate,
cardiac output, CI, SVR, PVR,
CVP, EKG, platelet count,
serum potassium, renal
function, clinical signs and
symptoms of CHF
Adverse effects: ventricular
arrhythmias, chest pain, HA
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
Morphine/
Astramorph PF,
Duramorph,
Infumorph
Analgesic
narcotic, opioid
Naloxone /
Narcan
Antidote for
Opiate intoxification:
2 mg
narcotic agonists 0.01 - 0.1 mg/kg, repeat every
2-3 min if needed
If continuous infusion is
required, calculate the initial
dosage/hour based on the
effective intermittent dose used
and duration of adequate
response seen; titrate dose; a
range of 2.5-160mcg/kg/hr has
been reported.
Narcotic induced pruritis: initial
2 mcg/kg/hour; may increase by
0.5 mcg/kg/hour every few
hours if pruritis continues
Dose: 0.05-0.2 mg/kg/dose q24h prn
Continuous infusion: 10-500
mcg/kg/hour
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
Suggested:
5 mg/mL
Infant: 2 mg
1-6 yo: 4 mg
7-12 yo: 8 mg
>12 yo: 10mg
Injection: 1
mg/mL
Continuous
Infusion: 50
mcg/mL
Page 14 of 22
MAXIMUM RATE
OF
ADMINISTRATION
5 minutes
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
Hypotension and
chest wall rigidity
may occur with
rapid administration
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Monitoring Parameters:
respiratory and cardio status, O2
saturation, pain relief, level of
sedation
Adverse Effects: hypotension,
Respiratory
pruritis, vomiting, constipation,
depression is
somnolence, dizziness,
reversible with
respiratory depression. Use
naloxone
with caution and at lower doses
in infants and neonates less than
3 months because they are more
susceptible to respiratory
depression. Abrupt dc may
cause withdrawal.
Naloxone has been Monitoring Parameters:
used to increase
Respiratory rate, heart rate,
blood pressure in pts blood pressure
with septic shock
Adverse Effects:
Hypertension, hypotension,
tachycardia, ventricular
arrhythmias, nausea, vomiting,
increased diaphoresis
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Nicardipine /
Cardene
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
Antianginal,
Initial dose: 0.5-5 mcg/kg/min
antihypertensive, Usual dose: 1-4 mcg/kg/min
calcium channel
blocker,
dihydropyridine
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
5 mcg/kg/min 500 mcg/mL
(15 mg/hr)
MAXIMUM RATE
OF
ADMINISTRATION
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
Administration via
central line
eliminates risks for
phlebitis which is
occasionally seen
when using the max
0.5 mg/ml conc
through PIV
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Monitoring Parameters:
Blood pressure, heart rate
Adverse Effects:
Flushing, palpitations,
tachycardia, headache,
dizziness, nausea
Protect from light
Nitroglycerin/
Nitro-Bid IV,
Nitrostat IV,
Tridil
Antianginal,
antihypertensive,
nitrate,
vasodilator
Dose: 0.5-20 mcg/kg/min
20
Neonates, infants, & children:
mcg/kg/min
begin infusion at 0.1-1
mcg/kg/min and increase by
0.5-1 mcg/kg/min q3-5 min
until desired response or
toxicity occurs
Adolescents: begin infusion at 5
mcg/min until desired clinical
response
800 mcg/mL
Page 15 of 22
Do not mix with
other IV drugs.
nonPVC tubing is
recommended; must
dispense in glass
bottles (adsorbs to
plastic)
Monitoring Parameters:
blood pressure, heart rate
Adverse Effects: dizziness,
vision disorders, rash,
xerostomia, prolonged bleeding
time, syncope
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
Nitroprusside/
Nitropress
Norepinephrine/
Levophed
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
Antihypertensive Hypertension initial rate: 0.3and vasodilator
0.5 mcg/kg/min with dose
titration.
10
mcg/kg/min
(6
mcg/kg/min
After load reduction: initial rate neonates)
at 0.5-3 mcg/kg/min with dose
titration.
Alphaadrenergic
agonist
Initial: 0.05-0.1 mcg/kg/min
Maintenance: titrate according
to clinical response, using
frequent BP monitoring and
continuous EKG. Avoid abrupt
withdrawal
MAXIMUM
CONCENTRATION
800 mcg/mL
(Sodium
thiosulfate is a
cyanide antidote.
Pharmacy adds 1
gm sodium
thiosulfate for
each 100 mg of
Nitroprusside in
the drip)
1-2
64 mcg/mL
mcg/kg/min
(central line only)
in infants and
children
12 mcg/min
in adults
Updated: 12/2013
MAXIMUM RATE
OF
ADMINISTRATION
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
10 mcg/kg/min (if
adequate
reduction in BP is
not obtained after
10 min at 10
mcg/kg/min, the
infusion should be
stopped)
Continuous blood
pressure monitoring,
administer via
infusion pump;
thiocyanate levels if
requiring prolonged
infusion > 3 days or
dose >= 4
mcg/kg/min or if pt
has renal
dysfunction.
Monitoring Parameters:
blood pressure, acid-base
balance, heart rate, hepatic and
renal function, methemoglobin,
thiocyanate levels
Adverse Effects: dizziness,
drowsiness, infusion site
irritation, muscle twitching,
rash, palpitations, arrhythmias,
ileus, excessive bleeding,
cyanide toxicity
Protect from light in (Sodium thiosulfate is a cyanide
antidote. May add 1gm sodium
black bag
thiosulfate for each 100mg of
Nitroprusside in the drip)
Contains sodium
Monitoring Parameters:
metabisulfate which blood pressure, heart rate, urine
may cause allergic
output, peripheral perfusion.
Adverse Effects: anxiety,
type reaction.
urinary retention, extravasation
Protect from light.
Do not infuse if
leading to necrosis, cardiac
solution is pinkish or
arrhythmias
darker than slightly
yellow or contains
precipitates
Page 16 of 22
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
Octreotide /
Sandostatin
Antisecretory
agent,
Somatostatin
analog,
antidiarrheal
Diarrhea: 1 mcg/kg bolus then
continuous infusion of 1
mcg/kg/hour
GI bleed: 1-2 mcg/kg bolus
then continuous infusion of 1-2
mcg/kg/hour
Chylothorax: 0.3 - 10
mcg/kg/hour
Titrate to response
Pancuronium/
Pavulon
Neuromuscular
blocker, skeletal
muscle relaxant,
paralytic
Neonates and infants:
Intermittent: 0.05-0.1 mg/kg
Continuous: 0.02-0.04 mg/kg/hr
MAXIMUM
CHILD DOSE
10 mcg/mL
Children:
Intermittent: 0.15 mg/kg
Continuous: 0.03-0.1 mg/kg/hr
Adolescents and adults:
Intermittent: 0.15 mg/kg
Continuous: 0.02-0.04 mg/kg/hr
Pantoprazole
Proton pump
inhibitor
1 mg/kg bolus, then 0.1
mg/kg/hr
Papavarine
Vasodilator
Arterial catheter infusions: Add
60mg per 500ml in NSS or
1/2NSS with heparin 1 unit/ml
MAXIMUM
CONCENTRATION
80 mg
MAXIMUM RATE
OF
ADMINISTRATION
15-30 minutes
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
Allow to warm to
room temperature
before
administration
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Monitoring Parameters:
Blood sugar, thyroid function
(can use undiluted (IVP over 3
test, fluid and electrolyte
in emergent
minutes in
balance
situations)
emergent
Adverse Effects:
Hyperglycemia, nausea,
situations)
hypoglycemia, diarrhea,
hypothyroidism, Abdominal
discomfort, Constipation,
Flatulence, Pancreatitis,
dizziness, headache
Continuous
IV Push over 7-12 Cardiac
Monitoring Parameters: heart
infusion: 2
seconds
dysrhythmias,
rate, blood pressure, assisted
mg/mL
tachycardia, and
ventilation status, peripheral
hypertension have
nerve stimulator measuring
been reported.
twitch response
Do not alter patients Adverse effects: most frequent
state of
adverse reactions are related to
consciousness;
prolongation of pharmacologic
addition of sedation actions: hypertension, rash,
and analgesia are
excessive salivation, burning
recommended
sensation along vein, muscle
weakness, wheezes,
bronchospasm
IV bolus: 4
Over 15 minutes
Monitoring Parameters: GI
mg/mL
bleeding, s/s GERD
Adverse Effects: HA, GI upset
Continuous
infusion: 0.8
mg/mL
One study showed
Monitoring Parameters:
lower risk of arterial
Liver function tests
catheter failure and
Adverse Effects:
longer duration of
Flushing, tachycardia,
arterial catheter
diaphoresis
function
Page 17 of 22
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
Pentobarbital
Anticonvulsant,
barbiturate,
general
anesthetic,
sedative
Pentobarbital coma: loading
dose = 10-30 mg/kg over 1-2
hours with continuous infusion
of 1-5 mg/kg/hour to maintain
burst suppression on EEG
50 mg/mL
Phenylephrine/
Neosynephrine
Adrenergic
agonist,
vasoconstrictor
IV bolus: 5-20 mcg/kg
400 mcg/mL
Antiarrhythmic
Loading:
2 gm/day
Neonate: 7-10 mg/kg
Child: 3-6 mg/kg repeated (max
15mg/kg)
Procainamide
Continuous infusion: 0.1-0.5
mcg/kg/min, titrate to effect
4000 mcg/mL
Continuous infusion:
Neonate: 0-80 mcg/kg/min
Child:
Page 18 of 22
MAXIMUM RATE
OF
ADMINISTRATION
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Do not inject > 50
mg/min; rapid
injection may cause
resp depression,
apnea,
laryngospasm, and
hypotension
Monitoring Parameters:
Vital signs, respiratory status,
cardiovascular status, CNS
status, ICP, CCP
Adverse Effects:
Arrhythmias, bradycardia,
hypotension, lethargy, CNS
excitation or depression,
laryngospasm, respiratory
depression, apnea
Dilute to 1 mg/mL Dilute to 1 mg/mL
Monitoring Parameters:
and IVP over 20- by adding 1 mL
Heart rate, blood pressure,
30 seconds
phenylephrine
central venous pressure, arterial
blood gases (hypotension/shock
10mg/mL to 9 mL
tx)
SWFI
Adverse Effects:
Infuse in large vein hypertension, myocardial
to prevent
infarction, pulmonary edema,
extravasation which tachycardia, ventricular
may cause severe
arrhythmias
necrosis
30 minutes (slow
infusion if QT
interval becomes
prolonged or
develops heart
block)
Dose adjust in renal
or hepatic
impairment
Monitoring Parameters:
continuous EKG monitoring,
serum concentrations, IV site
(thrombophlebitis may occur
Discontinue if
with prolonged infusion).
hypotension or QRS Adverse Effects: hypotension,
, arrhythmias, cardiac arrest,
interval widens to
puritis, hematologic
>50% baseline
abnormalities
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
Propofol
General
anesthetic
Sedation: 100-150 mcg/kg/min
for 3-5 min and titrate to desired
sedation while monitoring resp
function. During first 10-15
min following induction,
infusion rates of 25-75
mcg/kg/min are generally
required. After first 30 min,
adjust infusion rate to clinical
response.
10 mg/mL
Rocuronium
Neuromuscular
blocker (nondepolarizing),
skeletal muscle
relaxant,
paralytic
Bolus:
0.6-1.2 mg/kg/dose
Continuous
IVP over 7-12
infusion: 5 mg/mL seconds
Alkalinizing
agent;
Electrolyte
supplement
1-2 mEq/kg
Sodium
bicarbonate
IVP over 20-30
seconds
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
MD to IVP
Monitoring Parameters:
Respiratory rate, blood
Cardiorespiratory
pressure, heart rate, oxygen
depression may
saturation, ABG, depth of
result from bolus
sedation, serum lipids or
dosing or rapid
triglycerides with use >24hr
increase in infusion Adverse Effects:
rate. Therefore, wait Hypotension (dose related),
3-4 min between
bradycardia, myocardial
dosage adjustments depression, flushing, fever,
to assess pt
headache, dizziness,
response.
hyperlipidemia, respiratory
depression, apnea, myalgia
Continous Infusion:
0.4-0.7 mg/kg/hr
50 mEq
Infant: 0.5
mEq/mL
Child: 1 mEq/mL
Page 19 of 22
10 mEq/minute
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Do not extravasate
Monitoring Parameters:
monitor muscle twitch response
to peripheral nerve stimulation,
HR, BP, ventilation status
Adverse Effects: anaphylactic
reaction (rare), apnea (rare),
bronchospasm (rare), prolonged
paralysis and/or muscle
weakness, rash, tachycardia,
hypotension or hypertension
Monitoring Parameters:
ABG, BMP
Adverse Effects:
hypernatremia, hypocalcemia,
metabolic alkalosis,
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/
BRAND NAME
THERAPEUTIC
CATEGORY
TYPICAL CHILD DOSE
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
Updated: 12/2013
ADMINISTRATION
CONSIDERATIONS
Tacrolimus
Immunosuppress 0.01-0.06 mg/kg/day continuous
ant
infusion
0.02 mEq/mL
Polyvinyl chloridefree tubing required
to minimize drug
absorption.
Terbutaline/
Brethine
Beta-Adrenergic
agonist, antiasthmatic B2
agonist,
bronchodilator,
tocolytic
1000 mcg/mL
May administer
undiluted, direct IV
over 5-10 minutes
Loading: 2-10 mcg/kg over 5-30 10
minutes.
mcg/kg/min
Maintenance: 0.08-0.4
mcg/kg/min with an increase of
0.1-0.2 mcg/kg/min every 30
minutes until response
Page 20 of 22
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Monitoring Parameters: Daily
tacrolimus levels, BMP,
magnesium, LFTs, CBC, blood
pressure
Adverse Effects: hypertension,
hyperglycemia, hyperkalemia
hypomagensium, tremor,
edema, headache,
nephrotoxicity
Monitoring Parameters: heart
rate, blood pressure, respiratory
rate, serum potassium, arterial
or blood gases
Adverse Effects:
hyperglycemia, tremor,
tachycardia , headache,
flushing, hypokalemia, nausea,
vomiting, nervousness
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
Intravenous Drip List – Approved for RN Administration
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GENERIC/
BRAND NAME
Tromethamine
(THAM)
THERAPEUTIC
CATEGORY
Alkalinizing
agent
TYPICAL CHILD DOSE
Dose depends on severity and
progession of acidosis:
MAXIMUM
CHILD DOSE
33-40
mL/kg/day
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
Antiepileptic;
used for
treatment of
refractory
migraines
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Infuse slowly over at Monitoring Parameters:
least one hour
Serum electrolyes, arterial
blood gases, serum pH, blood
Administer through sugar, EKG monitoring, renal
a central line and
function tests
avoid low-lying
Adverse Effects:
umbilical venous
Overdose or excessively rapid
lines
administration may cause
prolonged hypoglycemia,
1 mM = 120mg =
respiratory depression, apnea,
3.3ml = 1 mEq
hemmorhagic liver necrosis,
THAM
venospasm, hyperosmolality of
serum, hyperkalemia
Extravasation may
cause tissue
necrosis, severe
inflammation, and
sloughing.
25-50 mg/mL
Maintenance doses
should be
determined based on
clinical response and
total serum
valproate
concentrations (50100 mg/L)
Empiric dose based upon base
deficit: Tromethamine dose =
wt (in kg) x base deficit
(mEq/L) (max 500 mg/kg/dose)
= 13.9 ml/kg using 0.3 M
solution
Valproic Acid
ADMINISTRATION
CONSIDERATIONS
0.3 Molar solution 3-16 mL/kg/hr
Neonates: manufacturer’s
recommendation: 1 ml/kg for
each Ph unit < 7.4
Metabolic acidosis with cardiac
arrest: tromethamine = 3.5-6
ml/kg/dose; maximum 500
mg/kg/dose = 13.9 ml/kg using
0.3 M soln
Status epilepticus:
100
mg/kg/day
loading dose: 20-40 mg/kg
Updated: 12/2013
continuous infusion: 1-2
mg/kg/hour (max of 6
mg/kg/hour)
Page 21 of 22
Bolus: 3-6
mg/kg/min
Monitoring Parameters:
Monitor for seizure activity,
LFT, ammonia, CBC
Adverse Effects:
Drowsiness, irritability,
confusion, restlessness,
headache, ataxia,
hyperammonemia, nausea,
vomiting, diarrhea, tremor
Pediatric Intensive Care Unit (PICU) Nurse’s Guide
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GENERIC/
BRAND NAME
Vasopressin
THERAPEUTIC
CATEGORY
Antidiuretic
hormone analog,
hormone
TYPICAL CHILD DOSE
Diabetes insipidus: 0.5
milliunits/kg/hour; double
dosage as needed every 30 min
to max of 10 milliunit/kg/hour
MAXIMUM
CHILD DOSE
MAXIMUM
CONCENTRATION
MAXIMUM RATE
OF
ADMINISTRATION
1 unit/mL
Vecuronium/
Norcuron
Neuromuscular
blocker (nondepolarizing),
skeletal muscle
relaxant,
paralytic
Children and Adolescents:
Intermittent: 0.1 mg/kg
Continuous: 1.5-2.5 mcg/kg/min

ADMINISTRATION
CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS
MONITORING PARAMETERS
Extravasation may
cause tissue
necrosis.
Monitoring Parameters:
MAP, fluid intake and output,
urine specific gravity, urine and
serum osmolality, serum and
After hemorrhage
urine sodium, hemoglobin and
has been controlled hematocrit (GI bleeding)
for 12 hours,
Adverse Effects:
Circumoral pallor (with high
gradually taper
dosage over next 24- doses), hypertension,
bradycardia, arrhythmias,
48 hours.
venous thrombosis,
vasoconstriction, distal limb
ischemia, tremor, wheezing,
bronchoconstriction,
diaphoresis
GI hemorrhage: 2
milliunits/kg/min; titrate 1
milliunit/kg/min every 20-30
minutes to max of 10
milliunits/kg/min
Vasodilatory shock: 0.3
milliunits/kg/min; titrate 0.1-0.2
milliunits/kg/min every 20-30
minutes to max of 2
milliunit/kg/min
Neonates:
0.27 mg/kg/hr 1 mg/mL
Intermittent: 0.1 mg/kg
for 21 hr is
the largest
Infants:
reported
Intermittent: 0.1 mg/kg
continuous
Continuous: 1-1.5 mcg/kg/min infusion
Updated: 12/2013
IVP over 7-12
seconds
Dilute vial to 1-2
mg/mL
Monitoring Parameters:
monitor muscle twitch response
to peripheral nerve stimulation,
HR, BP, ventilation status
Adverse Effects: anaphylactic
reaction (rare), apnea (rare),
bronchospasm (rare), prolonged
paralysis and/or muscle
weakness, rash, tachycardia,
hypotension or hypertension
If the medication is not approved for administration and alternative routes of administration are not available, approval for this individual
situation must be obtained through collaboration with pharmacy and the patient care manager
Updated: December 2013
Developed by: Abby Bailey and Brian Gardner
Approved by: Contact person for revisions: Brian Gardner ([email protected])
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