Pediatric Guidelines for IV Medication Administration Approved For Usual Dosing and Comments Concent- Drug 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. Acetylcysteine 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. hypotension, flushing, anaphylaxis Bolus doses must be completed in critical care areas only. Maintenance IV infusions may be continued or initiated in acute care areas. 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. 0.2 mg/kg q2 minutes up to 12 mg/dose every 1-2 mins Communication with the ICU team prior to restriction . till termination of arrhythmia 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 hypertension 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 Amiodarone 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 D5W filter preferred . Flush post dose. (0.22 micron) line required. code only 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) Atropine 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 Bumetanide 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 blood 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 Caffeine 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 sodium 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 hypocalcemia Central Line preferred unless code only 10 mL vial emergency administration. Slow IVP Slow 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 calcium (ionized calcium is recommended), heart rate and EKG. Do not infuse calcium chloride in same IV line as phosphate-containing solutions. Calcium Gluconate 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.