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Pediatric Guidelines for IV Medication Administration

Pediatric Guidelines for IV Medication Administration

Pediatric Guidelines for IV Administration

Approved For Usual Dosing and Comments Concent- Administration ICU Telemetry Acute IV ration IVP ED Required Care Infusion Acetazolamide X X X Dilute to 5-10 mg/kg/dose MR q 8 or 6 hrs. Monitor serum electrolytes (Diamox®) MAX of MAX dose: 25 mg/kg/dose up to 500 mg/dose 100 mg/mL MAX Rate: IVP over 1 minute. X X X 30 gm/1000 Requires toxicology approval. When used in acetaminophen overdose, (Acetadote®) Bolus Infusion mL Bolus: 150mg/kg over 1 hr. monitor serum acetaminophen concentrations; + only (30 mg/mL) Maintenance: 15-7.5mg/kg/hr. See dosing protocol or monitor LFTs. Bolus doses, monitor for infusion contact pharmacy for weight-based protocol. , flushing, Bolus doses must be completed in critical care areas only. Maintenance IV infusions may be continued or initiated in acute care areas. Acyclovir X X X Diluted to Infusion over 60-90 minutes. Dose: 5-20 mg/kg/dose q Patient should be well hydrated to prevent <5 mg/mL 8hrs. nephrotoxicity. Monitor urine output, Scr. Adenosine X X X X 6 mg/2 mL. DOSE:0.05-0.1 mg/kg up to 6 mg over 1-2 seconds Restriction: In acute care areas, doses must (Adenocard®) See (3mg/ml) followed by rapid NS flush. May increase dose by 0.1- be administered by a physician. . restriction 0.2 mg/kg q2 minutes up to 12 mg/dose every 1-2 mins Communication with the ICU team prior to . till termination of to a MAX CUM dose of adenosine administration is required. An 0.3 mg/kg/dose upto 30 mg. attending Hospitalist, Cardiologist, or ICU > 50kg: 6mg, 12mg, 12mg physician must be at the bedside. A continuous ECG rhythm strip must be obtained during dosing to monitor and document drug effects Albumin 5% X X X 5% 0.5-1 gm/kg/dose (10-20 mLs/kg/dose). Infusion over 30- Rapid infusion may cause and (forhypovolemia, (50 mg/mL) 60 minutes. In emergencies, may administer over 15 pulmonary edema. Monitor vital signs and minutes. fluid balance. Use within 4 hours of opening hypoalbuminemia Adult MAX: 600mls/hr vial. 60 micron filter/tubing supplied by pharmacy

Albumin 25% X X X 25% 0.25-1 gm/kg/dose (1-4 ms/kg/dose) Rapid infusion may cause hypertension & (forhypoproteinemia (250 mg/mL) Infusion as tolerated over 30-120 minutes. pulmonary edema. Monitor vital signs and Adult MAX :180ml/hr fluid balance. Use within 4 hrs of opening. w/ generalized edema) 60 micron filter/tubing supplied by pharmacy

Alprostadil, PGE1 X X X Dilute 500 Initial: 0.05- 0.1 mcg/kg/min. Infuse via large vein. Prostin VR Contin- mcg in Range: 0.01 up to MAX 0.4mcg/kg/minute Monitor arterial pressure, RR, HR, oxygen uous 50mls NS saturation, temp. Pediatric®) (10 mcg/ml) infusion Amikacin X X X Diluted to 5-10mg/kg/dose q8hrs with NL renal function. Urine output, Serum creatinine, (Amikin®) < 5 mg/mL Infusion: Over 30 minutes. Peak and trough concentrations.

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 1 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Approved For Usual Dosing and Comments Concen- DrugDrD Administration ICU Telemetry Acute IV tration IVP ED Required Care Infusion X X X X X Bolus diluted to BOLUS: PALS for pulseless VF/VT5 mg/kg (MAX Central line preferred for concentrations (Cordarone®) Bolus in 1.5-3 mg/mLin 300 mg/dose) given over 5-10 minutes. - 0.22 micron exceeding 2 mg/mL. Dedicated filtered code only D5W filter preferred . Flush post dose. (0.22 micron) line required. No infusion Infusion 450 For perfusing VF/VT 5 mg/kg over 20-60 min, MR X Continuous BP/cardiac monitoring, thyroid mg/ 250 mL in 3 function, LFTs, and pulmonary function D5W should be monitored frequently. Infusion: Initial dose of 5 mcg/kg/min, increase to desired effect to a MAX of 15 mcg/kg/min Ampicillin X X X X Dilute to <20 IVP: not to exceed 10 mg/kg/minute. Adjust with renal dysfunction. slow mg/mL Infusion: over 15-30 minutes Dosing: 100-400 mg/kg/day divided every 6 hrs. MAX 12 gm/day

Ampicillin/ X X X X Dilute to IVP: not to exceed 15 mg/kg/minute (amp/sulb) Unsayn: Each 1.5mg unasyn=1mg apicillin Sulbactam slow <30 mg/mL Infusion: Over 15-30 minutes +0.5mg sulbactam. =(amp 20 mg/ >1 month: 150-225 mg/kg/day (amp/sulb) divided With prolonged therapy, monitor (Unasyn®) sulb 10 mg) every 6 hrs hematologic, renal and hepatic function. Children: 150-300 mg/kg/day (amp/sulb) divided Observe for change in bowel frequency. every 6 hrs. (non-meningitic doses) (MAX dose: 12 gm ampisulb/day) X X X X 0.1 mg/mL; IV Push: given over 1 minute Monitor vital signs and EKG; monitor for MD 1 mg/mL Dosing: 0.01-0.2 mg/kg (MIN 0.1 mg) side effects including dry mouth, dizziness available Child: up to 0.5 mg, MRx1 and palpitations. Adolescent: up to 1 mg, MRx 1 Please see reference for dosing for specific indications. Azithromycin X X X Dilute to 2 Infusion:MAX concentration of 2 mg/mL Monitor for pain at infusion site, LFTs, (Zithromax®) mg/mL over 1 hr WBC and infection. 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. Aztreonam X X X X Dilute to IVP: over 3-5 min Adjust dosing with renal dysfunction. (Azactam®) < 20 mg/mL 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. 2 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Approved For Usual Dosing and Comments Concen- Drug Administration ICU Telemetry Acute IV tration IVP ED Required Care Infusion X X X X 0.25 mg/mL Dosing:0.015-0.1 mg/kg/dose up to 4 mg q 6-24 hrs (MAX Monitor pressure, serum (Bumex®) dose is 10 mg/day, 20 mg/day w/ RF)) electrolytes and renal function. IV Push: over 1-2 minutes MAX 1mg/min Citrate X X X 20 mg/mL Loading: 10-20 mg/kg citrate salt infused over Clarify if dosing is as citrate salt or (Cafcit) citrate salt 30 minutes caffeine base. Must be specified on (=10 mg/mL Maintenance: 5 mg/kg/day as citrate salt once daily starting medication order. For apnea caffeine base) 24 hours after bolus doseinfused over ≥ 10 minutes May dilute in D5W Monitor heart rate, number and severity of apnea spells, and serum caffeine levels Caffeine X X X Dilute to 0.5 Adults: 500 mgs as a single dosediluted with 1000 mL NS Not to be administered in benzoate mg/mL and infused over 1 hour, followed by 1000 mL NS over 1 neonates(benzoates). Monitor heart For spinal hour. rate. headache

Calcium Chloride X X IVP In X X 1 gm/ Recommend use only in symptomatic Central Line preferred unless Slow IVP code only Slow 10 mL vial emergency administration. w/MD IVP Bolus: 10-20 mg/kg/dose up to 1gm over a minimum of 10 Do not administer I.M. or S.C. or use present. minutes. scalp, small hand or foot veins for IV No administration since severe necrosis infusion. Infusion: Do not exceed 45-90 mg/kg given over 1 hour may occur. Monitor serum (ionized calcium is recommended), heart rate and EKG. Do not infuse in same IV line as phosphate-containing . X X Slow IVP X X 1 gm/50 mL 200-500 mg/kg/DAY as continuous infusion or in 4 divided Do not infuse calcium gluconate in in code Slow IVP Slow IVP Slow =20 mg/mL doses same IV line as phosphate-containing w/ MD IVP Acute::Usual 100mg/kg or 1gm MAX 3gm over 10 minutes solutions. only. present. Non-Acute: Usual 50-100mg/kg not to exceed 2gm over no Monitor serum calcium (ionized Infusion OK less than 60 minutes. calcium is recommended), heart rate MAX: 200mg/kg up to 3gm and EKG. See label comments on Pedi IV Calcium Gluconate Bags Cefazolin (Kefzol) X X X X Dilute to IVP: Over 3-5 minutes Adjust dosing with renal dysfunction. < 20mg/ml 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 NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 3 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Approved For Usual Dosing and Comments Concen- Drug Administration ICU Telemetry Acute IV tration IVP ED Required Care Infusion Cefepime X X X X Dilute to IVP over 5 minutes. ID approval required for patients (Maxipime) < 20 mg/mL Infusion over 30 minutes outside the ICU. Pseudomonal Dosing 2 mo-16yo: 100-150 mg/kg/day div q 12 or 8 hrs. infections should be dosed at the CF 50 mg/kg/dose q 8hr MAX 6 gm/day higher end of the dosing range. Adjust dosing with renal dysfunction. Cefotaxime X X X X Dilute to IVP over 3-5 minutes Indicated in neonate < 2 weeks or in (Claforan®) < 40 mg/mL Infusion: Over 10-30 minutes infants with clinically relevant <7 days:+>2000 g:100-150 mg/kg/day div every 8-12 hrs hyperbilirubinemia who may be at > 7 days: >2000 g: 150-200 mg/kg/day divided every 6-8 risk for kernicturus. hrs 1 month- 12 years: <50 kg: 100-200 mg/kg/day divided With prolonged therapy, monitor every 6-8 hoursMeningitis: 200-300 mg/kg/day divided renal, hepatic, and hematologic every 4 or 6 hours (MAX 12 gm/day) function periodically; number and > 50 kg: Moderate infection 1-2 gms q 6-8hrs, Severe 2 gms type of stools/day for diarrhea. every 4 to6 hrs (MAX 12 g/day) Adjust dosing with renal dysfunction. Cefoxitin X X X X Dilute to IVP over 5 minutes Adjust dosing with renal dysfunction. (Mefoxin®) < 40mg/ml Infusion over 10-30 minutes Monitor INR with prolonged use Ceftazidime X X X X Dilute to IVP over 3-5 minutes CO2 is produced with reconstitution. (Fortaz) <40 mg/mL Infusion over 20-60 minutes Remove pressure/air by venting vial < 7days >2 kg: 100-150 mg/kg/day div q 8-12 hrs prior to drawing up dose— >7 days >2 kg: 150 mg/kg/day div q 8h Adjust dosing with renal Infant/child: 100-150 mg/kg/day div q 8h dysfunction.. CF: 150-300 mg/kg/day usual MAX 12 gm/day Ceftriaxone X X X X Dilute to IVP over 5 minutes *Do not use in any child <5kg, (Rocephin®) < 20 mg/mL Infusion over 10-30 minutes unless short-term IV access is Infants and Children: 50-75 mg/kg/day divided every 12- unavailable. Avoid concurrent use in 24 hours all patients requiring IV calcium Meningitis: 80-100 mg/kg/day divided every 12-24 hrs supplementation. (MAX: 4 gm/day) Monitor CBC, platelet count, renal and hepatic function tests periodically, number and type of stools/day for diarrhea. Chlorothiazide X X X X 500 mg vial IVPover 3-5 Do not administer I.M. or S.C. since (Diuril®) diluted with 18 Infusionover 30 minutes in dextrose or NS extremely irritating to tissues. May mL SWI for a <6 months: 2-8 mg/kg/day in 2 divided doses up to 20 be further diluted. Monitor serum final mg/kg/day electrolytes and . concentration >6 months: 4 mg/kg/day in 1-2 divided doses up to 20 of 27.8 mg/mL mg/kg/day.

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 4 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Approved For Usual Dosing and Comments Concen- Drug Administration ICU Telemetry Acute IV tration IVP ED Required Care Infusion X X X Dilute to Infusion over 60 minutes May cause venous irritation (Cipro®) < 2 mg/mL Children 20-30 mg/kg/day divided q 12 h CF: 30 mg/kg/day divided q 8 or 12 hrs Cisatricurium X X X 40 mg/100 mL Bolus:IVP: 0.1-0.2mg/kg over 5-10 seconds Monitor muscle twitch response to (Nimbex®) 200mg/500ml Infusion: 1-4 mcg/kg/minMAX 10 mcg/kg/min peripheral nerve stimulation, heart MAX: 200 rate and blood pressure HIGH RISK MED mg/100 mL Not renally orhepatically metabolized X X X Dilute to Infusion over 10-30 minutes, not to exceed 0.5 < 18 mg/mL mg/kg/minute Dose: 20-40 mg/kg/day divided q 6 or 8 hrs (Cleocin®) Usual adult 600-900 mg IV q 8h MAX 4.8 gm/day

Cyclosporine X X X Dilute in D5W Initial: 5-6 mg/kg/dose (1/3 of oral dose) administered 4-12 Doses prepared in glass. Use Non (Sandimmune®) to hours prior to transplant PVC tubing( ie// nitro tubing) < 2.5 mg/mL Maintenance: 2-10 mg/kg/day in 2 divided doses. Patients should be monitored May be administered over 2-6 hours or as a continuous continuously for ≥ the first 30 infusion. minutes of the infusion for signs of anaphylaxis. Monitor serum drug levels, serum creatinine and BP D10W X X X X 100 mg/mL Neonates: 100-200 mg/kg /dose (=1-2 mLs/kg) over 1 Monitor blood and urine sugar, serum minute. electrolytes and I & O. D25W X X X X 250 mg/ML Bolus: MAX of 200 mg/kg (=0.8 mLs/kg) over 1 minute not For peripheral venous administration, to exceed 6 mLs/minute if undiluted dilute dextrose to MAX 2.5GM/10ML Infants <6 month: 0.25-0.5 gm/kg/dose (=1-2 mLs/kg) concentration of 12.5%. (1:1 with SYRINGE MAX of 25 g(50 mLs/dose) NS)preferred. Monitor blood and Infants >6 months-40 kg: 0.5-1 g/kg/dose (=2-4 mLs/kg); urine sugar, serum electrolytes and I MAX of 25 g(50 mLs)/dose & O. <40kg D25W-2mls/kg(0.5gm/kg) over 15-30 minutes + regular 0.1unit/kg IV (MAX 50ml (=25gm) +5 units insulin/dose. D50W X X X 500 mg/mL Bolus: >40 kg not to exceed 3 mls/minute if undiluted Avoid in infants/ young children. 25gm/50ml Adolscent/Adult: 25-50 gms (50-100 mLs) over 5-30 Dextrose 10-25% preferred. syringe minutes Peripheral: Dilution to 12.5% (1:3 Hyperkalemia:adolescent/adult 25-50 gm + 5-10 units D50:NS) preferred. insulin (5gm (10ml) per 1 unit insulin) over 5-60 minutes.

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 5 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen- ration Usual Dosing and Comments ICU Telemetry Acute IV IV Administration ED Required Care P Infusion

Dexamethasone X X X 4 mg/mL Please see reference for dosing for specific indications Monitor hemoglobin, occult blood (Decadron) (usual range 0.3-2 mg/kg/day as a generally up to 40 loss, serum and . 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 15- 30 mins Dexmedetomidine X X X X 200 mcg/50 mL Requires pediatric ICU, moderate sedation service, or Ensure airway and respiratory support (Precedex) Moderate (4mcg/ml) anesthesiology attending approval measures in place, monitor level of sedation Bolus( attending present) 0.5-1 mcg/kg over 10 minutes sedation, heart rate, respiration, service Infusion: Usual 0.2-0.7 mcg/kg/hr. Higher doses have rhythm. + been used. Bolus doses associated with moderate and hypotension. sedation RN (Valium) X X X X 5 mg/mL IVP: Peds< 40 kg not to exceed 1-2 mg/min, >40 kg 5 May cause phlebitis mg/min Monitor heart rate, respiratory rate, Dose:0.04-0.3 mg/kg/dose (up to 10 mg/dose) every 2-4 blood pressure and mental status hours to MAX of 0.6 mg/kg within an 8-hour period if needed. Digoxin (Lanoxin) X MD adminis- X X Dilute to < 100 Infusion:Slowly administer over 5-10 mins cLoading dose requires telemetry. Not tration for Maint- mcg/mL w/NS Dosing: See age specific references for maintenance dose. Monitor heart loading doses enance Loading Dose: range 10-30 mg/kg divided in 3 doses over rate, rhythm, periodic EKGs, serum only. doses 16-24 hrs (as 50%/25%/25%) not to exceed total 1 mg dose. electrolytes, renal function and serum Maintenance: approx 1/3 of loading dose divided q 12 or levels. 24 hrs. Rarely exceeds 10 mcg/kg/day up to 0.25 mg/day. Digoxin Immune X X X X Dilute to 1-10 Requires toxicology consult! Dosing based on amount of 0.22 micron filter required Fab mg/mL with NS digoxin ingested. Each 40mg vial binds 0.5mg digoxin Monitor EKG, serum potassium and (DigiFAB) IVP: If in over3-5 minutes using. Infusion digoxin serum levels. preferred. Check for S/S of an acute allergic Infusion:Over 15-30 minutes through 0.22 micron filter. reaction. Decrease rate or hold if infusion reaction occurs. X X X X 5 mg/mL for IVP Bolus: 0.25 mg/kg over 2- 5 minutes; if inadequate During administration monitor EKG, (Cardizem) Infusion 1 response, 0.35 mg/kg dose may be administered after 15 heart rate, blood pressure and renal mg/mL minutes function. 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 X X X Dilute to <50 IVP:0.5 mg/kg/min up to 25 mg/minute Monitor symptom relief and sedation (Benadryl) mg/mL 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 NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 6 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen- tration Usual Dosing and Comments ICU Telemetry Acute IV IV Administration ED Required Care P Infusion

Dobutamine X X X <10 kg 250 mg Infusion: continuous at 2-20 mcg/kg/minute. Monitor EKG, blood pressure, heart rate, /250 mls MAX 30 mcg/kg/min CVP, MAP and urine output. > 10kg500 mg /250 mls MAX: 1000 mg/250 mL Dopamine X X X <10 kg 200 mg Infusion: continuous at 1-20 mcg/kg/min; titrate to Monitor EKG, blood pressure, heart rate, /250 mL desired response; MAX dose 30 mcg/kg/min. Central CVP, MAP and urine output. >10kg 400 mg line preferred. /250 mL MAX: 800 mg/ 250 mL Doxycycline X X X Dilute to <=1 Infusion: Doses < 100 mg over 1-2 hrs May cause phlebitis, dizziness, N/V (Vibramycin) mg/mL 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. Droperidol X X X X 2.5 mg/mL IVP: Slowly over 2-5 minutes Monitor blood pressure, heart rate, (Inapsine) In pts w/ Postop / prophylaxis 0.05-0.06 respiratory rate, temperature, serum cardiac history MAX: 2.5 mg/kg/dose; MAX 0.1 mg/kg up to 2.5 mg potassium and . Observe for mg/mL Postop nausea/vomiting treatment: 0.01-0.03 dystonias and extrapyramadial side effects. mg/kg/dose; MAX 0.1 mg/kg up to 2.5 mg EKG monitoring is recommended in Adult: 0.625-2.5 mg/dose patients with a history of QT prolongation or cardiac disease. Enalaprilat X X X X < 1.25 mg/mL I5-10 mcg/kg/dose administered every 8-24 hours (as Clinical response seen within 15 minutes, (Vasotec) MD determined by blood pressure readings) over 5-15 peak within 4 hrs. Monitor blood pressure, available minutes. renal function, WBC, serum potassium and MAX: 60 mcg/kg/day, rarely to exceed 20 mg/day serum glucose. Enoxaparin X X S SC 100 mg/mL Infants <2 months: Deep SC administration preferred(not im) (Lovenox) C For doses <10 Prophylaxis: 0.75 mg/kg every 12 hrs and allowed in all nursing units. Do not rub mg, a special Treatment: 1.5 mg/kg every 12 hours site after administration. Monitor dilution Infants >2 months and <18 years: CBC, platelets, stool occult blood tests. If of 20mg/ml will Prophylaxis: 0.5 mg/kg every 12 hours antifactorXa level are indicated, draw peak be prepared by Treatment: 1 mg/kg every 12 hours levels 4 hrs post dose. pharmacy

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 7 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen tration Usual Dosing and Comments ICU Telemetry Acute IV IV Administration ED Required Care P Infusion

Epinephrine X X X X X For IVP 1:10,000  IV Push: 0.01 mg/kg (=0.1 mL/kg) up to 1 mg (10 Do not use if pink in color. Monitor EKG, (Adrenalin®) SC, IVP (0.1 mg/mL) mLs) over 1 minute, every 3-5 minsprn. heart rate, blood pressure, pulmonary For For ET/ SC /Drips Infusion: 0.1-1 mcg/kg/min; titrate dose to desired function and injection site monitoring for anaphy- 1:1,000 (1 mg/mL) effect. Central line preferred. extravasation. laxis, Drip Concentrations CPR < 10 kg 8mg / 250mls 10-50kg 16 mg/ 250mls >50 kg 4 mg/ 250 mls MAX: 16 mg/250 mL- Ertapenem (Invanz®) X X X Dilute to < 20 Infusion: Over 30 minutes. Do not infuse with dextrose containing mg/mL in NS only. 3 mths-12yrs: 15 mg/kg/dose q 12 h up to solutions. 1 gm/24 hrs Adolescent/Adult: 1 gm q 24 hrs. Erythropoetin X X X Various, may be IVPush:Over no less than 1 minute, SC Do not shake vial. Monitor Hgb/Hct, (EPO®, Procrit®) given undiluted or preferred, stores, BP diluted 1:1 with NS See pediatric dosing recommendations for disease specific guidelines. Range 10-600units/kg Esmolol (Brevibloc®) X X X X <10 mg/mLfor Bolus: 250-500 mcg/kg over 1-2 minutes EKG, BP, HR, respiratory rate monitoring IVP Infusion: 50-300 mcg/kg/min; titrate up every 20 mandatory during administration. mins to desired effect. Dosing may be higher with 20 mg/mL drip SVT (up to 1000 mcg/kg/min in small children) Esomeprazole X X X X < 4mg/ml 1-2 mg/kg/day administered in 1-2 divided doses. Gastric pH monitoring may be needed in (Nexium®) Usual adult dose 20-40 mg/day MAX 80 mg select patients. IVP: Dilute with 5 mLs NS per vial and push over ≥ 3 minutes. Infusion: Add 40mg to 100ml X X X X 2mg/ml Moderate Sedation for Short Procedures: -.1- Has no analgesic properties. Per moderate Moderate 20 and 40mg 0.2mg/kg/dose Requires moderate sedation monitoring sedation sedation RSI/ induction of : 0.3mg/kg IV (-.2- with procedure related use. vials 0.6mg/kg) May result in transient myoclonus. Avoid protocol service + sedation IVP: Over 30-60 seconds small vessels on the dorsum of the head or RN hand. May cause discomfort at injection site.

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 8 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen tration Usual Dosing and Comments ICU Telemetry Acute IV IV Administration ED Required Care P Infusion

Famotidine X X X Dilute to <3 months: 0.5 mg/kg/dose once daily Gastric pH monitoring may be needed I select patients (Pepcid®) >=4mg/ml 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 (Sublimaze® X X X X 50 mcg/mL IVP Younger infants: Bolus: 1-2 mcg/kg/dose over 3- Titrate to patient response using age ) Moderate 2000 mcg/100 mL 5 mins; may repeat every 2-4 hrs. Doses >5 appropriate pain scale.Peak response 5-10 sedation MAX: mcg/kg over 5-10 minutes. minutes post dose. Monitor respiratory rate, service 2000 mcg/40 mL Infusion: 1-2 mcg/kg bolus, then 0.5-1 mcg/kg/hr; blood pressure, heart rate, oxygen HIGH RISK MED Only 5000 mcg/ 100 mL titrate to desired effect saturation, and bowel sounds. Older infants and children 1-12 years: Bolus: 1- Rapid IV push may cause apnea/ muscle Epidural 2 mcg/kg/dose over 3-5 mins; may repeat every and chest wall rigidity. OK 30-60 mins. Doses >5 mcg/kg over 5-10 minutes. Infusion: 1-3 mcg/kg/hr; titrate to desired effect. Fenoldopam X X X 10 mg/mL vial Usual dosing: 0.1-0.8 mcg/kg/minute Do not bolus or flush line. (Corlopam®) STD infusion Recommended MAX 1.6 Monitor HR, BP, EKG, renal function 10mg/250NS mcg/kg/min (40mcg/ml) Titrate: 0.05-0.1 mcg/kg/minute q 10-20 minutes MAX Infusion 10 mg/100 mL NS (100 mcg/mL) Filgastim X X S X Dilute with D5W Infusion over 15-30 minutes. Incompatible with Do not administer 12 hrs before or after (G-CSF, Neupogen®) C only to a NS. Dosing: 5-10 mcg/kg/day radiotherapy. concentration greater than or =15 mcg/mL (ie//300 mcg/ 20-50 mLs). Fluconazole X X X Dilute to <2 Infusion: <6 mg/kg up to 400 mg over 1 hr (Diflucan® mg/mL > 6 mg/kg over 2 hrs Dosing: 3-12 mg/kg/day X X X 0.1 mg/mL 0.01 mg/kg (MAX dose: 0.2 mg) given over 15-30 Monitor level of consciousness and (Romazicon®) seconds. May repeat after 45 seconds and then resedation, airway, BP, HR and RR. every min to MAX total cumulative dose 0.05 mg/kg or 1 mg, whichever is lower. See dosing table.

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 9 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen tration Usual Dosing and Comments ICU Telemetry Acute IV IV Administration ED Required Care P Infusion

Folic Acid X X X X 0.1 mg/mL Infants: 15 mcg/kg/dose daily or 50 mcg daily Monitor CBC with differential (Folvite®) 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 X X X 25 mg PE/mL Loading dose: 10-20 mg PE/kg not to exceed 3mg Doses of fosphenytoin are expressed in (Cerebyx®) PE/kg/min up to 150 mg PE/.minute equivalents (PEs). Monitor ECG, Maintenance: 4-8 mg PE/kg/day in 2-3 divided BP and RR during loading dose q 5 minutes preferred over Note: doses and for ≥ 30 minutes thereafter. Monitor phenytoin, write all doses serum phenytoin levels, CBC, platelets, as PE equivalents glucose and LFTs. (Lasix®) X X X X 10 mg/mL IVP: MAX rate: 0.5 mg/kg/min up to 20 Monitor I & O, electrolytes, renal function, 100 mg/100 mL mg/minute BP; in high doses monitor hearing. IVP; 0.5-2 mg/kg/dose every 6-12 hrs (MAX 6 mg/kg/day) Infusion: 0.05-0.4 mg/kg/hr Gentamicin X X X Dilute to Infusion:Administerover 30 minutes. Peak levels Monitor serum levels, urine output, and 2 mg/mL drawn 30 minutes after infusion completed. serum creatinine, drug levels. Trough levels just before dose. Infants > 7 days and children <5yrs: 2.5 40mg/ml for IM mg/kg/dose every 8 hours; once daily dosing: 5-7.5 use 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. 10 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen- tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Insulin Regular X X X X < 50kg: 25 IVP: Over 1 minute Monitor urine sugar, blood sugar and (NovolinR®) In Code units/50 Infusion: (regular insulin only) electrolytes. Drug may adsorb to IV bag DKA: Initial0.05-0.1 units/kg/hour up to 10 units/hr, and tubing, when using new tubing, mlsMAX: titrate to response. prime, wait 30 mins, then flush tubing HIGH RISK MED 100 units/ > 50 kg: Normoglycemia in ICU..see adult protocol prior to starting infusion. 100 mL 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 Iron Sucrose X X X X May give Dosing: Refer to dosing references. Limited pediatric No test dose required. (Venofer) undiluted, or dosing available. May cause hypotension, esp w/ IVP. as an infusion IVP: Give each 100mg over 2-5 minutes (MAX 200mg) .Hypotension may be rate related. of < Infusion: Each 100mg over 15-30 minutes 2mg/ml X X X X X 20mg/ml, IVP: 0.25-2 mg/kg not to exceed 0.5 mg/kg/min. Monitor RR, BP,HR, O2 sats. (Ketalar®) for Critical 50mg/ml Supplemental doses usually 1/3 to ½ of initial dose. Avoid in patients with increased ICP or Infusion: Usual for analgesia/sedation or bronchospasm hypertension moderate care areas Infusion 200 sedation, only mg/100 mL 5-20 mcg/kg/minute Increases oral secretions. Pretreatment with glycopyrrolate is MD NS present recommended if used for monitored 500mg/250ml sedation. Ketorolac (Toradol®) X X X 15 mg/mL IVP: Over 1-2 minutes Monitor for signs of pain relief, BUN, 30 mg/mL Bolus: (optional): > 2yrs. MAX 1 mg/kg up to 60 mg x 1 creatinine, enzymes, blood loss and Maintenance: > 6 months 0.25-0.5 mg/kg/dose (MAX 30 urine output. Stop before surgery due to mg given every 6 hours as needed, not to exceed 20 prolonged bleeding doses/treatment course. Labetalol X X X X X 5 mg/mL Bolus: 0.25-0.5 mg/kg/dose up to 1mg/kg ECG monitoring ,HR, and BP (Normodyne®, See MD Critical 500 mg/250 MAX rate: 0.25mg/kg over 3 minutes up to 10mg/minute. recommended during administration. ® Peak effect 5-15 minutes, duration 2-4 hrs. Monitor heart rate and blood pressure Trandate ) comments avail- care areas mL only Infusion: 0.4-3 mg/kg/hour every 5 mins until stabilized and every 15 able 900 mg/250 > 50kg: 2-6mg/minute mins during hypertensive episode up to mL 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.

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 11 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen- tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Lepirudin (Refludan®) X X X X IVP Dilute Requires hematology/oncology approval! Monitor aPTT, renal function, and for to May contact anticoagulation service for dosing signs and symptoms of bleeding. recommendations and monitoring. Dosing adjustment 5 mg/mL. with renal impairment required. Infusion: Bolus: 0.4 mg/kg not to exceed 44 mg over 15-20 100 mg/250 seconds. mL Infusion (continuous): Initially 0.15 mg/kg/hr not to exceed 16.5 mg/hr, titrate based on an aPTT. X X X Dilute to < Dosing:20-60mg/kg/day divided q12hrs MAX 4GM/day Keppra® 15mg/ml Infusion:Over 15 minutes

w/NS

Levofloxacin X X X Dilute to 5 Infusion: Over 60-90 minutes Too rapid infusion may cause (Levaquin®) mg/mL 6 mths-5 yrs: 10 mg/kg/dose every 12 hours(limited hypotension. data). Monitor renal, hepatic, and Children> 5 yrs: 10 mg/kg/dose every 24 hrs (MAX hematopoietic function periodically; dose: 500 mg) number and types of stools/day for Adolescents/Adults: 250-750 mg IV q 24 hrs diarrhea. X X X X May dilute IVP: Dilute vial with 5 mL NS, use immediately, IV dose usually 50% of oral dose. ® (Synthroid ) w/NS to 40 administer over 2-3 minutes. Discard remainder. Monitor T4, TSH, heart rate, clinical signs mcg/mL See age specific initial dosing, or per endocrine; IV of hypo- and hyperthyroidism.May be (5 mLs/200 form is 50% of PO recommendation. used as a continuous infusion prior to mcg) organ donation— X X X X X 20 mg/mL Load: 1-1.5 mg/kg over 2-4 minutes up to MAX 0.7 Monitor EKG, HR, BP.UO, LFT’s and Code IVP mg/kg/min up to 50 mg/minute, MR 0.5-1 mg/kg Q 5-10 serum concentrations with continuous minutes X 2 infusion & IV site for thrombophlebitis if only 2 grams/250 Infusion: 20-50 mcg/kg/min MAX up to 6 mg/min in via peripheral administration. Contra- mL adults (usual 1-4 mg/min). indicated with heart block. Lower dosing may be required with severe CHF or hepatic impairment. Linezolid (Zyvox®) X X 2 mg/mL Infusion: Over 30-120 minutes Requires ID approval. Avoid < 12yo: 10 mg/kg/dose q 8-12 hrs up to 600 mg/dose foods/beverages high in tyramine to >12yo/adult: 400-600 mg q 12 hrs avoid hypertension (consult nutrition)

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 12 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen- tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Lorazepam (Ativan®) X X X X IVP: May be IVP: Not to exceed 0.05 mg/kg over 2-5 minutes up to 2 Monitor respiratory rate, blood pressure, ICU only diluted to 1 mg/minute heart rate and symptoms of anxiety. mg/mL w/ NS Dosing:0.02-0.1 mg/kg/dose (given every 4-8 hours as Monitor for phlebitis/ infiltration with MAX 4 mg/mL needed). Initial MAX 2 mg for sedation, 4 mg for peripheral access. seizures. With normal renal function, doses Infusion Infusion:0.05-0.15 mg/kg/hr up to 2 mg/kg/day or 100 approaching 3 mg/kg/day( up to 170 50 mg/50 mL mg/DAY whichever is less. (see comments) mg/24 hrs should be monitored for 250 mg/250 mL Usual adult initial dosing 0.5-2mg/hr 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 , seek alternative agents, or monitor for toxicity using lower dosing. Infusion ICU only. X X X PEDI STD: Asthma: 25-75 mg/kg over 20 minutes Can cause hypotension with too rapid 1 GM/25 mLS Torsades/PALS: 25-50 mg/kg over 10-20 minutes infusion.Monitor serum magnesium, deep (40 mg/mL) Repletion(non-acute): 25-50 mg/kg/dose infused over 2-4 tendon reflexes, respiratory rate and ADULT: hrs blood pressure. 1 gram/50 mL 1 gm=8.12 mEq=98.6 mg Magnesium 2 grams/50 mLs Mannitol (Osmitrol®) X X X X 12.5 grams/ 50 IVP: 0.2gm/kg over 3-5 minutes Evaluate dose for crystal formation prior Low mL (25%) Infusion: 0.25-1 gm/kg over 15 -60 minutes. to administration. In-line <5 micron dose Requires inline filter. filter should always be used with 50 grams /250 Central line preferred. Monitor for extravasation. concentrations >20%. . Central line mLs (20%) preferred. Extravasation may cause edema and necrosis. Monitor renal function, daily I & Os, serum electrolytes, serum and urine osmolality. Meperidine X X X X Dilute to < IVP slow: 1 mg/kg/dose over 3-5 minutes every 3-4 Restricted use to post-anesthesia (Demerol®) slow 10 mg/mL hours as needed; administer over ≥ 5 mins (do not exceed shivering and rigors. Monitor 25 mg/min) MAX 100 mg/dose, up to 6 mg/kg/day. respiratory and cardiovascular status and HIGH RISK MED Avoid repeated doses with renal dysfunction. level of sedation, and pain. Meropenem X X X X Dilute to 20 IVP: Over 3-5 minutes Requires ID approval. (Merrem®) mg/mL 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. 13 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen- tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Methadone X X X 10 mg/mL Infusion: Over 5-15 minutes Monitor RR, HR, BP, sedation and pain ® Dilute w/ NS Initial Dose in narcotic naïve patients: 0.05-1 levels. Abstinence scoring is used for (Dolophine ) st to volume mg/kg/dose up to 10 mg/dose q 6-12 hrs(1 24 hrs) , as withdrawal. Monitor for QT needed to drug accumulates over 24-96 hrs, , dosing frequency may prolongation in patients with risk factors. HIGH RISK MED need to be reduced to q 12-24 hrs. infuse over 15 minutes Methyldopa X X Dilute with Initial: 2-10 mg/kg/dose every 6-8 hours. MAXdose 1 Onset: 4-6 hrs (Aldomet®) D5W to < gm, Daily dose: 65 mg/kg or 3 grams, whichever is less. Duration: 10-16 hrs Infusion:Administer slowly over 30-60 mins Monitor blood pressure, CBC with 10 mg/mL differential, hemoglobin, hematocrit, and liver enzymes. Methylprednisoloneso X X X X 40 mg, 125 Dosing: 0.5-2 mg/kg/day as high as 30 mg/kg depending Caution: Methylprednisoloneacetate is dium succinate <1.8 mg, on indication. for IM use only. Monitor blood pressure, ® IVP: <1.8 mg/kg up to 125 mg over 3-15 minutes serum glucose and electrolytes. (Solu-Medrol ) mg/ 500 mg & 1 kg Infusion:May dilute each 1gm dose in a minimum of 100 g vial mls NS (10mg/ml) (exception: spinal cord injury protocol

< 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 Metoclopramide X X X X 5 mg/mL Dosing: 0.1-1 mg/kg/dose q 4-6 hrs Consider pretreatment with (Reglan®) Low IVP: Low dose 0.1 mg/kg up to 10 mg over 1-2 minutes diphenhydramine for doses > 0.25 dose Infusion over 15-30 mins mg/kg. Monitor for EPS. Too rapid (MAX rate: 5 mg/min) administration may cause anxiety Administer diphenydramine for patients Metronidazole X X X 5 mg/mL Dosing: 20-45 mg/kg/day up to 4 gms/day divided every Do not refrigerate. Doses other than 500 (Flagyl® ) 6 or 8 hrs mg will be found in the Pyxis drop-off Infusion: Over 60minutes box. X X X X X <50kg: 6 months-5 years: Initial 0.05-0.15 mg/kg Monitor level of sedation, respiratory (Versed®) Per for 50mg/100ml (MAX total dose: up to 0.6 mg/kg up to 6 mg) rate, blood pressure, heart rate and monitored moderate MAX: 6-12 years: 0.025-0.05 mg/kg oxygen saturation sedation sedation, 100 mg/100 (MAX total dose: up to 0.4 mg/kg up to 10 mg in non- protocol MD intubated patients) mL IVP: over 2-5 mins, longer for higher doses present 1 mg/mL, Infusion: 0.06-0.4 mg/kg/hour MAX 0.4 mg/kg/hr 5 mg/mL

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 14 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen- tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Milrinone lactate X X X 1 mg/mL 10 Load: 25-100mcg/kg over 15 mins Monitor EKG, BP, HR, UO platelet (Primacor) mLs Infusion: 0.2-1.2 mcg/kg/min count, potassium, renal function, signs and symptoms of HF Infusion: 20 mg/100 mL Sulfate X X X X 2, 4, 10 Bolus: 0.05-0.1 mg/kg/dose up to initial MAX 10 mg Monitor HR, RR, BP, oxygen saturation, slow mg/ml over 5-30 mins pain relief and level of sedation. Infusion: Initial 0.005-0.15 mg/kg/hr; titrate to patient HIGH RISK MED PCA 1, 5 mg/mL pain response and tolerance. INF: 1mg/ml 100 or 250ml MAX: 500 mg/ 100 mL X X X X 20 mg/mL Dosing: 50-200 mg/kg/day divided q 4 or q 6 hrs Monitor for burning, extravasation, (Nafcil®) slow 1-1.5 gm/ MAX 12 gms/day phlebitis IVP: Over 5-10 minutes 50 mLs Infusion: Over 30-60 minutes 1.6-2 gm/100 mLs

Nalbuphine (Nubain®) X X X X 10 mg/mL Premed: 0.1-0.2 mg/kg MAX 20gm Monitor relief of pain, respiratory and slow 20 mg/mL Analgesia: 0.05-0.15 mg/kg every 3-6 hours as needed. mental status, and blood pressure. Initial MAX 10 mg MAX: 20 mg/dose up to 160 mg/day IVP: Administer over 3-5 mins Infusion:Over 15 mins

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 15 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concent ration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Naloxone (Narcan®) X X X X 0.4 mg/ Post anesthesia narcotic reversal: Monitor respiratory rate, heart rate, and mL Narcotic naïve: 0.005-0.01 mg/kgIVP q 2-3 mins as blood pressure. needed IVP dilution: Opiate dependent: 0.001-0.002 mg/kg IVP q 2-3 mins as The duration of action of is < 40 kg 0.1 needed(1/10th-1/5th usual dose to prevent acute shorter than most opiates (20-30 mg in withdrawal) minutes). Patients who receive naloxone 9.75 mLs NS IVP: Over 30 seconds should be monitored for reoccurance of =(0.01mg/mL) respiratory depression. > 40 kg 0.4 mg Narcotic-induced pruritis: in 0.25-2 mcg/kg/hr; increase by0.25- 0.5 mcg/kg/hr every Patients with acute pain will require 9 mLs NS= few hours as needed careful titration to maintain analgesia (0.04mg/mL) while reversing respiratory depression. Infusion: Opiate intoxication: (narcotic naïve) 4 mg/100 <20 kg: 0.1 mg/kg every 2-3 minsprn mLs NS >20 kg: 2 mg/dose every 2-3 minsprn th th (0.04 mg Opiate dependent: (1/10 -1/5 usual dose to prevent acute withdrawal) =40 mcg/ mL) Infusion: calculate initial dose/hour based on effective intermittent dose used and titrate; range: 2.5-160 mcg/kg/hour Neostigmine X X X 0.5 mg/ml Non-depolarizing NMB reversal: with atropine or Atropine or glycopyrrolate recommended (Prostigmin®) slow glycopyrrolate prior to neostigmine. Epinephrine should Infants: 0.025-0.1 mg/kg/dose be available. Monitor HR, BP,RR, 1 mg/mL Children: 0.025-0.08 mg/kg/doseMAX/DOSE (see adult) muscle strength. 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 Nicardipine X X X Standard/Periph Infusion: IF< 50 kg Initial 0.5-5 mcg/kg/minute Monitor blood pressure and heart rate (Cardene) eral- Add 25 If >50 kg: 2.5-15 mg MAX: 15 mg/HOUR. mg to 250 mLs Titrate q 5-30 minutes NS (0.1mg/mL) MAX/Central: Add 100 mg to 60 mLs NS (1 mg/mL) Nitroglycerin X X X 100 mg/250 Infusion: If < 50 kg 0.25-1 mcg/kg/min titrate by 0.5-1 Monitor blood pressure and heart rate. mLs mcg/kg/min every 3-5 mins as needed. MAX 20 Protect the drugfrom light. 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. 16 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concentrati on Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusio n Nitroprusside X X X 100 mg/ Infusion: 0.3-5 mcg/kg/min Titrate by 0.1 mcg/kg/min q Protect the drugfrom light. Do not use (Nipride) 250 mL 2-3 minutes if blue-green in color. Monitor blood MAX 10 mcg/kg/min 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. Norepinephrine X X X <10 kg 8 Infusion:Initial 0.05-0.1 mcg/kg/min. Monitor blood pressure, heat rate, urine (Levophed) mg/250 Titrate by 0.1-0.2 mcg/kg/minute every 5 minutes till output, and peripheral perfusion. Central mL desired effect or toxicity line preferred. Recommended MAX 2 mcg/kg/min 10-50 kg + MAX 16 mg/250 mL

>50 kg4 mg/250 mL Octreotide Acetate X X X X 50, 100, 500 Hypoglycemia/Antisecretory: 2-10 mcg/kg/day divided Monitor baseline and periodic ultrasound (Somatostatin) mcg vial for q 8 or 12 hours or as continuous infusion: titrate to patient evaluations for cholelithiasis, blood SC/IV admin response by increasing dose or interval; sugar, thyroid function tests, fluid and electrolyte balance. Note: not to be Standard GI bleed/esophageal varices:0.5-1 mcg/kg bolus, then 1 confused with infusion: mcg/kg/hour continuous infusion; titrate to Sandostatin LAR 500 mcg in 100 response(usual adult 25-50 mCG/HR) Depot IM injection mLs NS/D5W (5 MAX DOSE: 1500 mcg/day mcg/mL) SC: usual bolus route

IV: infuse over 15-30 mins in NS REFRIGERAT IVP: over 3 minutes ED Ondansetron X X X X 2 mg/mL Chemo induced N/V: Monitor blood pressure and heart rate. (Zofran) Children: 0.15 mg/kg/dose MAX 0.45 mg/kg/day up to May cause headache. 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. 17 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concentr ation Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Pamidronate X X X Prepared by Hypercalcemia/osteopenia:0.5-1 mg/kg (MAX dose of Thrombophlebitis. Monitor serum (Aredia) pharmacy. 90 mg). Do not redose within 7 days. creatinine prior to each dose, urine Volume Infusion: Over 2-24 hrs. (Longer infusion times ↓ the output, serum electrolytes, phosphate, varies by risk of nephrotoxicity.) Infuse in dedicated line. magnesium, hemoglobin, hematocrit, dose. CBC with differential. X X X X X 50 mg/mL Sedation: Monitor vital signs, blood pressure, (Nembutal) Continuous for slow Children >6–18 mths: 1-3 mg/kg respiratory status, cardiovascular states, Infusion moderate Infusion: Children >18 mths: 2 mg/kg, then 1-2 mg/kg every 5-10 CNS status. Or per sedation, 2500 mg/ minsuntil adequate sedation moderate MD 50 mls MAX: 100 mg/dose Monitor for sedation present (50 mg/ml) *IVP: slowly (<1 mg/kg/min up to 50 mg/min) Used thrombophlebitis/extravasation. protocol only with conscious sedation monitoring or in ICU/ER. Central linr preferred and particulate IV: Over 10-30 minutes. May be further diluted to no filter required with continuous infusions. less than 5 mg/mL with NS. Do not use unless is Check infusion regularly to monitor for clear. precipitation. Pentobarbital Coma: Load: 15-35 mg/kg over 1-2 hrs For pentobarbital coma, also monitor Infusion: 1-5 mg/kg/hr viadedicated central line EEG bursts.. preferred. MAX: 10 mg/kg/hr X X X 65 mg/mL Anticonvulsant: Monitor CNS status, seizure activity, (Luminal) 130mg/ml Load: 15-18 mg/kg at 1-2 mg/kg/minute (MAX 60 LFTs, CBC, renal function, serum mg/minute). concentrations, respiratory rate, heart Maintenance: rate, blood pressure, 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 Phenylephrine X X X X (for<10 kg) Hypotension/Shock: Monitor heart rate, BP/MAP, CVP. (Neo-synephrine) ICU/ 5 mg/250 Usual 0.1-0.5 mcg/kg/min; titrate to desired effect Central line preferred ER mL only (10-+kg) PSVT: 5-10 mcg/kg over 20-30 seconds 10 mg/250 (Adult: 0.25-0.5 mg) mL MAX CONCENTR ATION 60 mg/250 mL

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 18 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concent ration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Phenytoin sodium X X X 50 mg/mL Acute Seizures Loading doses: Monitor HR/ BP and RR (Dilantin®) (mustdil- Load: 15-20 mg/kg in a single or divided doses during loading dose q 5 minutes and for MAXinfusion rate: ≥ 30 minutes thereafter. Telemetry Fosphenytoin should Note: ute to 1-5 Neonates: 0.5 mg/kg/min monitoring recommended if patient has be used in children instead mg/mL in Children: 1-3 mg/kg/min not to exceed 50 mg/min significant underlying cardiac disease. phenytoin NS) Particulate filter required. Check for Maintenance: 4-8 mg/kg/day in 2-3 divided doses extravasation. Monitor serum levels, CBC, LFTs, and blood pressure. Phosphate as X X X All IV doses Dosing in MMols: Hypophosphatemia: Maximum Concentration: Sodium Phosphate prepared by Phos> 2: 0.05-0.1 Mm/kg up to 15mM Peripheral 30mM Phos/L (1.5mM per Each 1 Meq Na+ = 0.75mM pharmacy. Phos 1-2 mM/dl- 0.16-0.25mM/kg up to 30Mm 50mls Central: 30mM Phos/250 Phos, 1mMPhos = Volume mls= 1.33Meq Na+ depends on Phos< 1mM/dl: 0.25-0.4mM/kg up to 6mM per 50 mls dose and 0.6mM/kg to MAX 30mM/dose or 45mM/day INFUSION: Intermittent doses over 4-6 Potassium Phosphate whether via hrs. MAX: 0.06mM/kg/hr central or IV infusion: Doses < 0.5mM/kg or 30mM over 4 hrs. **in pediatrics, order doses in 50, 100, Each mMPhos= peripheral Doses >=0.5mM/kg or 30Mm over 6 hrs 150, 250, 500, OR 1000 ml volumes. 1..47 meq K+ adminis 1 meq K+ = 0.68mM Phos tration. **caution: for Kphos orders written in mM be aware of K+ dose pt will also be recieving Phytonadione (Vitamin X SC/IM X 10 mg/mL *SC, IM, or PO preferred. Monitor for potential hypersensitivity K, Mephyton®) only (ICU/ 1 mg/mL Dose: 1-10 mg, Usual 1-2.5 mg reactions, flushing. Monitor BP, HR, OR/ER IV(restricted) : Dilute w/ NS to volume needed to RR.@ baseline then q 5 min during only) administer over 15-30 minutes. (see comments) infusion . Piperacillin/Tazobactm X X X 60 mg Infants <6 mths: 150-300 mg of piperacillin Monitor serum electrolytes, bleeding (Zosyn®) piperacillin component/kg/day in divided doses every 6-8 hours time especially high dose or w/ renal and7.5 mg >6 mths: 200-350 mg of piperacillin component/kg/day impairment. periodic tests of renal, tazobactam/ in divided doses every 6-8 hours. hepatic, and hematologic function. mL CF: 350-450 mg/kg/day divided q4h or q6 hrs MAX 2.25 g/50 ml 4.5gm/dose 3.375 g/50 IV:Over ≥ 30 minutes mL 4.5 g/50 mL X X X X Pedi: 0.4 Maintenance: Usual daily dose 2-5mEq/kg/day MAX: Peripheral 0.06 mEq/mL (60 For IV doses mEq/mL-25 mEq/L) mL vials for (Adult usual: 40-80 mEq/day.) Central 0.4mEq/mL HIGH RISK MED exceeding 0.3meq/kg/hr central bolus RATE: non-telemetry <0.3 mEq/kg/hr up to doses (10 Hypokalemia: Dosing depends on severity, etiology, and up to 10 mEq/hr 10meq/hr mEq) renal function. See comments on individual dosing Telemetry-0.6 mEq/kg/hr up to limitations. 20 mEq/hr 20 mEq/50 Monitor serum potassium, glucose, ml bags chloride, pH, urine output if indicated NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 19 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Prochlorperazine X X X X 5 mg/mL Antiemetic: Children >10 kg: In children < 5yo, reserve this agent for (Compazine®) Dose IV/IM: 0.1-0.15 mg/kg/dose every 6-12 hours patients who are unresponsive to other (MAX: 10mg/dose) alternatives due to the higher risk of IV: May be further diluted in a sufficient volume with extrapyramidal effects. Alternative NS and administered over 15-30 minutes routes to IV preferred. IVP: Administer at MAX rate of 0.1 mg/kg/minute(MAX 5 mg/min) Monitor for extrapyramidal reactions, hypotension, and signs of extravasation.

Promethazine X X X 25 mg/mL Not recommended in patients < 2yrs of age due to Monitor for extrapyramidal reactions, (Phenergan®) significant respiratory depression. respiratory depression, hypotension, and For use in children >2 years. Oral/rectal routes signs of pain and extravasation. 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

IV: Further diluted 1:10 (v/v) or greater in NS to minimize extravasation injuryand administered over 10- 20 minutes. X X X X X 10 mg/mL ICU SEDATION: (> 24 hrs) Avoid in patients with significant peanut/ (Diprivan®) Moderate Infusion 5-50 mcg/kg/minute. Titrate upward by 5-10 soy/ or egg . mcg/kg/min q 5-10 minutes to desired level of sedation sedation 200 mg/20 and as hemodynamically tolerated. Monitor respiratory rate, blood pressure, service mLs PRN boluses w/ infusion: 0.25-1 mg/kg up to 50 mg/dose heart rate, oxygen saturation, ABGs, + 500 mg/50 MAX MAINTENANCE ICU sedation rate not to exceed depth of sedation, serum lipids or moderate mLs 50 mcg/kg/minute. triglycerides if use is >24 hours. sedation 1000 mg/100

RN mLs MONITORED PROCEDURAL SEDATION- To minimize pain at injection site,

Initiation: administer through central line or large Do not dilute IVP: 0.5-3 mg/kg over 20-30 seconds peripheral veins. to less than 2 OR mg/mL with 0.25-0.5 mg/kg/dose MAX 40 mg/dose Use filter with pore size > 5 microns. D5W (even q 10 seconds via y-site) OR Insure strict aseptic technique. Unused due to 100-300 mcg/kg/min x 3-5 minutes, then drug and tubing must be discarded every titrate to desired effect 12 hrs to minimize risk of infection. instability. Maintenance infusion: usual 50-300 mcg/kg/min 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. 20 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Propranolol X X X 1 mg/mL 0.01-0.025 mg/kg slow IV over 10 mins (MAX dose: 0.5 Conversion from PO to IV unpredictable (Inderal®) mg/dose for infants and 1 mg/dose for children) due to first pass metabolism. May dilute Usual adult dose: 1-3 mg slow over 10 minutes, not to Recommend alternative IV each MG in exceed 1 mg/minute hypertensive’s (labetolol or metoprolol 10-50 mLs for BP control) NS Monitor blood pressure, CVP, and EKG

Protamine Sulfate X X X X 10 Dose determined by the most recent time and dosage of Use cautiously in pts with fish or mg/mL* or low molecular weight heparin, (please see allergies. dosing references) MAX dose: 50 mg Hypotension, bradycardia and flushing * After vial MAX rate: IVP < 5 mg/minute may be infusion rate related reactions. reconstitutio Continue to monitor , blood n with pressure, and cardiac status. 5 mLSWI. May be further diluted with NS or D5W. Rasburicase X X X 1.5 mg/mL 0.15-0.2 mg/kg/dose MAX: 0.4 mg/kg/day for up to 5-7 Monitor for potential anaphylaxis. (Elitek®) Requires days. Dedicated line preferred. Do not shake oncology Infuse over 30 minutes. Flush with NS pre- and post or filter. attending infusion. Recommended as a single course of approval. therapy. Prepared by chemo pharmacy in 10-50 mLs NS. Rho(D) Immune X X X Approx 230- Dose for ITP: 25-75mcg/kg slow IV over 3-5 minutes Hgb should be >8 gm/dl prior to Globulin (WinRho®) 240 administration. units/mL, as May be further diluted with NS. 0.5, 1.3, 2.2, 4.4, 13 mL vials Does not require further dilution. Rocuronium X X 1 mg/mL Infants: 0.5 mg/kg/dose, repeat every 20-30 minutes as Monitor peripheral nerve stimulator needed measuring twitch response, heart rate, Children: Initial: 0.6 mg/kg/dose with repeat doses of blood pressure and assisted ventilator HIGH RISK MED 0.075-0.125 mg/kg every 20-30 mins to desired effect status. Infusion: 10-12 mcg/kg/min NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 21 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Sodium Bicarbonate X X X X 5 mEq/10 Please see reference for dosing for specific indications. Monitor serum electrolytes, urinary pH mL(4.2%) Code: 1 mEq/kgdose over 3-5 minutes and arterial blood gases if indicated, pain (=0.5 and phlebitis with peripheral mEq/mL)* Non-Code:Not to exceed 1 mEq/kg/hr up to 50 meq/hr administration. *Preferred in infants Prevention of tumor lysis: 120-200 mEq/m2/day Hyperosmolar: Central line preferred, or and small dilute 1 mEq to 2 or 3 mLs for peripheral children administration 50 mEq/50 mL(8.4%) Verify compatability before Y-site (=1 administration with other . mEq/mL) 3% X X Concentrated Symptomatic IsovolemicHyponatremia: Central line preferred. For correction of (hypertonic) electrolyte uptp4mls/kg/dose over 15 minutes. (equivalent to ~ 12- acute hyponatremia, avoid rapid May not be 15mls/kg NS). increases in serum sodium. In 0.513meq Na+/ml stored at HypovolemicHyponatremia:Use NS fluid bolus symptomatic patients or is serum sodium bedside or in ICP Management: 1-4 mls/kg undiluted over 15 minutes < 120meq/L, target for an initial increase pyxis. of 4-6meq/L, not to correct beyond 12- Available for 15meq/L per 24hrs Sodium Chloride X X STAT ICP Management Adults: 15-30mls undiluted over 15 Central line required. Monitor serum 23.4%(hypertonic) Call minutes Na+ and osmolar gap. pharmacy. 4 meq Na+/ml Succinylcholine X Preferred Emergency X 20 mg/mL Initial: 1-2 mg/kg (MAXtotal dose: 150 mg) Avoid in any patients with intubation Does not Administer over 30 seconds. neuromuscular disorder/acute only Maintenance: Avoid repeated dosing. 0.3-0.6 mg/kg secondary to risk of hyperkalemia. HIGH RISK MED require futher every 5-10 mins as needed. For short-term administration Avoid with increased ICP. dilution. due to risk of hyperkalemia. Because of the risk of malignant REFRIGER hyperthermia, use of continuous ATE infusions is not recommended. Monitor heart rate and rhythm, serum potassium, assisted ventilator status, muscle twitching. Sulfamethoxazole and X X X 16 mg/mL Evaluate risk-benefit in infants<2 months:. Avoid use if Use a particulate filter. Monitor for Trimethoprim TMP infant has hyperbilirubinemia or in patients with renal precipitates, especially in maximally ® failure. concentrated dilutions. (Bactrim, Septra ) 80 mg/mL Mild-Mod infections: 6-12 mg TMP/kg/day divided Monitor for rash, phlebitis, urine output, SMZ every 12 hours CBC, renal function tests. Note:dosin Serious infections: 15-20 mg TMP/kg/day divided every g based on 6-8 hours. TMP Administer MAX concentration of 1:10 dilution (each 5 component 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. 22 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concent- ration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Terbutaline X X X X 1 mg/mLvials See infusion chart Monitor heart rate, blood pressure, (Brethine®) Infusion: 20 Bolus: 2-10 mcg/kg (administer from infusion bag0.01- respiratory rate, serum potassium, CPK, mg/100 mLs 0.05 mls/kg over 5-10 mins bag) EKG, and blood gases if applicable. NS (200 Infusion:0.1-6mcg/kg/minute (MAX 10 mcg/mL) mcg/kg/minute).Titrate by increments of 0.1-0.2 Prepared by mcg/kg/min every 30 mins to desired effect. pharmacy unless emergent. Tobramycin (Nebcin®) X X X Dilute to Infusion:Administerover 30 minutes. Peak levels drawn Monitor serum levels, urine output, and < 5 mg/mL 30 minutes after infusion completed. Trough levels just serum creatinine 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. Tromethamine X X X 18 gm/500 Neonates: 1 mL/kg for each pH unit below 7.4. Intended for short-term use. (THAM®) mLs Infants/Children/Adults: Central line or large peripheral vein Dose (in mLs)= kg X base deficit (mEq/L) X 1.1 (pH10.5) preferred. Monitor for (0.3 mM/mL) up to 13.9 mLs/kg/dose extravasation, tissue injury, thrombosis. Infusion:Over≥ 1 hr. 1 mEq=1 0.7-1 mL/kg/hr MAX 23 mls/kg/day. Monitor for respiratory depression, mm= Acute Acidosis: 25% of dose over 5-10 minutes followed hypoglycemia, hyperkalemia, renal 120 mg per by remainder over 1 hr. functiom, serum pH, ABG’s, 3.3 mLs hyperosmolarity Vancomycin X X X Dilute to <5 Infusion:Over 60-90 minutes, slower if pt experiencing Monitor periodic renal function tests, (Vancocin®, mg/mL red-man syndrome (histamine-like reaction). urinalysis, serum vancomycintrough ® Central: < < 7 days: 10-15 mg/kg every 12 hours levels, and WBC. Vancoled ) 10mg/ml per > 7 days: 10-15 mg/kg every 6-8 hrs Use caution with concurrent NSAID use request if fluid Infants> 1 month, children: 40-60 mg/kg/day divided and/or dehydration + high dose restricted every 6-8 hours up to initial MAX 1.5 gm/dose up to 4 vancomycin gm/day. Adjust for renal dysfunction. secondary to risk of induced acute renal failure

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist. 23 Version 9/28/2008 Barb Maas Pharm. D.

Pediatric Guidelines for IV Medication Administration

Drug Approved For Concen tration Usual Dosing and Comments ICU Telemetry Acute IVP IV Administration ED Required Care Infusion

Vasopressin X X X PTS <50 kg: IVP: ACLS 40 units over 15-30 seconds Central Vein Preferred. Monitor fluid DI: 5 units/ PTS <50 kg: intake and output, urine specific gravity, 500 mlsNS DI :0.0005 unit/kg/hr; double dose as needed every 30 urine and serum osmolality, serum and SHOCK: 50 mins to MAX 0.01 units/kg/hr urine sodium. units/ SHOCK:0.02-0.12 units/kg/hr up to 2.4 units total/hr Monitor BP, S/S ischemia( digital, gut, 250 mLs NS PTS>50 kg/adults: coronary) PTS>50 DI :0.0005 unit/kg/hr; double dose as needed every 30 kg/adults mins to MAX 0.01 units/kg/hr DI: 10 Hypotension/Shock: 0.04-0.1 units/MINUTE units/250 mls NS SH0CK: 40units/ 100 mLNS Vecuronium X X X IVP: Dilute to IVP: Over seconds Monitor assisted ventilator status, heart (Norcuron®) 1 mg/mL Pedi Dosing: Neonates: 0.05-0.2mg/kg/dose IV q1=2 hrs rate, blood pressure, peripheral nerve Continuous or per hr as continuous infusion. stimulator measuring twitch response. Infusion: Patients must be intubated and properly HIGH RISK MED 50 mg/100 mL sedated. D5W (Isoptin®, X X X X IVP: 1-2.5 IVP: Over 2-5 minutes Not recommended in infants. Monitor ® Calan ) mg/mL Children 1-16 years: 0.1-0.3 mg/kg/doseMAX initial EKG, blood pressure and heart rate. IV Infusion: calcium should be readily available. dose 5 mg MR in 15-30 minutes x 1 with MAX of 0.3 50 mg/100 mL , D5W mg/kg to 10 mg/dose Voriconazole X X X Diluted by Infusion: Over 1-2 hrs not to exceed 3 mg/kg/hr Patients may commonly experience (VFend®) pharmacy to Dose:3-6 mg/kg/dose q 12 hr, esophageal candidiasis reversible visual changes. Monitor 0.5-5 mg/mL doses may be lower electrolytes. Use cautiously in patients with proarrythmic conditions. Infectious disease approval required. Do not use IV form in renal failure

References Editor: Barbara Maas Pharm. D. th Lexi-Comp’s Pediatric Dosage Handbook- 14 Edition Primary Reviewers/Co-editors: Angela Gilchrist Pharm. D., Amy Hellinger Pharm. D., Pediatric Injectable Drugs-8th Edition th CharlesTurck Pharm. D. 2008 Intravenous -24 Edition Primary Nursing Reviewers: Carol Kronopolis, Charles Wheeler, Lynn D’Angelo, Micromedex Rosemary Cerquiera UMMMC Adult Guidelines for IV Medication Administration 2007 Primary Physician Reviewers: Hospitalist- Tom Guggina ICU Attending- Scott Bateman VUMC IV Medication Administration Chart revised 09/21/04 ER Attending-Mariann Manno 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 Appoved by Pharmacy and Therapeutics 09/14/08

NOTE: This is not a comprehensive medication list. For items not listed, review standardAdd for medication future: Cosyntropin, resources or alteplase, consult the lopressor, pharmacist. gancyclovir , immune globulin, sodium 24 Version 9/28/2008 Barb Maas Pharm. D. chloride 3%, etomidate

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