IV Infusion Guide



53276501524000San Francisco General HospitalIV Infusion Guide(Adult) Kathy Pang, Kristin Slown, David Smith -- PharmacyJen Berke, Elisha Perez, Anita Roberts, Ally Villanueva, Piera Wong -- NursingWhat is the IV Infusion Guide?The list below addresses administration of medications given intravenously, delineating the location and health care personnel authorized to administer them. These guidelines do NOT address other routes of administration, such as subcutaneous, intramuscular, intrathecal, or peripheral nerve blocks. When is this guide updated? Does it always take precedent?Every effort is made to update and post this document quarterly. If this document is in conflict with a newly approved policy, practice, or procedure, then defer to the most recently approved or discuss with the nurse manager and/or pharmacy supervisor. For example: the critical care committee creates new policy on allowing a pressor agent to be used on an alternative unit, this will take precedent over the IV Infusion guide until the IV infusion guide is updated.*Note: many antibiotics listed below are listed with an “X” as a continuous IV infusion. However, in rare cases and in consult with the Infectious Disease service, they may be administered as a continuous infusion when clinical indicated. Generic NameBrand /SynonymIVPBIV Push/ bolusIV Infusion(continuous)Additional InformationabataceptOrenciaRNxxabciximabReoProxSC*SC**Restricted to high-risk patients undergoing angioplastyacetaminophenOfirmevRN*xx*Restricted to adult and pediatric patients > 2 years who are (1) NPO before/after surgery for up to 24 hours, or (2) cannot tolerate oral agents secondary to abdominal surgery, ileus or persistent nausea/vomiting for up to 72 hours. Longer duration requires Formulary manager approval or ordered by the Pain Service. acetaZOLAMIDEDiamoxRNRNx?acetylcysteineAcetadoteRNxRNActivated Prothrombin Complex Concentrate (aPCC or 4-factor PCC) FEIBASCxxOrder Form requiredacyclovirZoviraxRNxx?adenosineAdenocardxSC, BS^Cath Lab*Telemetry monitoring required. *Restricted to use in the cardiac cath lab for Fractional Flow Reserve^ - must give as rapid IV push with NS flushado-trastuzumab KadcylaCHxxalbumin, HumanAlbuminarRNxRN?alteplase (t-PA)ActivaseSCSC*SC- EKOS catheterOrder Form required for PE, stroke, EKOSFor PE: drug prepared in pharmacyFor stroke: Bolus or infusion can be initiated on any unit as part of stroke protocol by SC*if used to maintain vascular access (e.g. – chest tube) then may be given by provider for chest tubes or VAS/provider for linesamifostineEthyolRNRNRN?amikacinAmikinRNxxRequires ID approvalaminocaproic acidAmicarRNxRN?aminophyllineSCxSC?amiodaroneCordaroneSC, Ra3SC, BSSC, Ra3Order Form required for initial infusion amphotericin B (liposomal)AmbisomeRNxxRequires ID approvalamphotericin B (conventional)FungizoneRNxx?ampicillinRNxx?ampicillin/sulbactamUnasynRNxx?antihemophilic VIIIHumateP, MonoclatePRNxx?Non-formulary- hematology approval required argatrobanxxRN*Requires hematology approval.Paper Order Form required for all unitsarginineR-GeneRNxRN?ascorbic acidAscor LRNxRN (in TPN)?asparaginaseErwinaseCHxx?atropine?xSC, BSxTelemetry monitoring requiredazacitidineVidazaCHxxazithromycinZithromaxRNxx?aztreonamAzactamRNxxRequires ID approvalbendamustineTreandaCHxxbenztropineCogentinxRNx?belimumabBenlystaRNxxbevacizumabAvastinCHxx?Non-cytotoxic; ordered on chemo order formbivalirudinAngiomaxxSC*SC**Cardiac Cath Lab only-- may continue post-procedure in SC if neededbleomycinBlenoxanexCHx?bortezomibVelcadexxxbrentuximabAdcetrisCHxxbumetanideBumexRNRNRN?bupivacaineMarcaine, SensorcainexxxMay be given as epidural or peripheral nerve block in any area (Ra3 only). See epidural policy for additional details. caffeine citrateCafcit6Hx6HcabazitaxelJevtanaCHxxcalcitriolCalcijexxRNxcalcium chloridexSC, BSSC, RN (in TPN)Central line onlycalcium gluconateRNSC, BSSC, RN (in TPN)?capreomycinCapastat SulfateRNxxRequires ID approvalCARBOplatinParaplatinCHxx?carfilzomibKyprolisxCHxceFAZolinAncefRNxx?cefepimeMaxipimeRNxx?cefotaximeClaforanRNxxRestricted to pediatric patients only. Adult usage requires ID approval.cefoTEtanCefotanRNxx?cefOXitinMefoxinRNxx?ceftarolineTeflaroRNxxRequires ID approvalcefTAZidimeFortazRNxxRequires ID approvalcefTRIAXoneRocephinRNxx?cefuroximeZinacefRNxx?cetuximabErbituxCHxxNon-cytotoxic; ordered on chemo order formchloramphenicolChloromycetinRNxxchlorothiazideDiurilRNRNx?chlorproMAZINEThorazineRNxx?cidofovirVistideCHxxciprofloxacinCiproRNxx?cisatracuriumNimbexxSCSC?CISplatinPlatinolCHxCH?cladribineLeustatinCHxCH?clindamycinCleocinRNxx?colistinColy-Mycin? MRNXRNcopperCopperRNxRN (in TPN)?cosyntropinCortrosynRNRNx?cyclophosphamideCytoxanCHCHCH?cycloSPORINESandimmuneRNxx?cytarabineCytosar-UCHxCHdacarbazineDTICCHxCH?DACTINomycinActinomycin DCHCHx?dantroleneDantriumRNRNx?DAPTOmycinCubicinRNxxRequires ID approvaldarbepoetinAranespxRNxLuer lock syringe for IV onlydeferoxamineDesferalRNxRN?desmopressinDDAVPRNRNx?dexamethasoneDecadronRNRNxDoses ≤10mg can be given slow IV pushdexmedetomidinePrecedexxSCSCOrder Form Required**Bolus not recommended due to increased hemodynamic instabilitydexrazoxaneTotect; ZinecardRNxxdextran 40xxRN?dextran 70xxRN?dextrose 10%GlucoseRNRNRNMay be given in peripheral IVdextrose 20 – 35%GlucoseRNRNRNMust be given via central IV linedextrose 50%GlucosexRNx?diazepamValiumxRNx?digoxinLanoxinxSC, Ra3xTelemetry monitoring requireddigoxin Immune FABDigibindBSBSx?dihydroergotamineDHE 45xRNx?diltiazemCardizemxSC, Ra3SC, Ra3Telemetry monitoring requiredRN titration only allowed for SCdiphenhydrAMINEBenadrylxRNx?diphtheria antitoxinRNRNRNOnly available from the CDCDOBUTamine –critical careDOBUTamine – Ra3DobutrexxxSC, Ra3**?See link for guidelines on use in Ra3 patients. DOCEtaxelTaxotereCHxx?DOPamineIntropinxxSCdornase-alfaPulmozymexProviderxRestricted to maintain vascular access (e.g. – chest tube) onlydoxapramDopramSCSCSC?DOXOrubicinAdriamycinCHCHCH?DOXOrubicin – liposomalDoxilCHxxdoxycyclineVibramycinRNxx?edetate Ca disodiumCalcium EDTARNxRN?enalaprilatVasotecSC, Ra3SC, Ra3x?For IV push, ensure appropriate BP monitoringEPHEDrine sulfatexSCx?EPINEPHrineAdrenalinxSC, BSSC?epiRUBicinEllenceCHCHx?epoetin alfaEpogen, ProcritxRNx?epoprostenolFlolanxxSC**, RN^**Use via IV pumps is ONLY allowed in emergent situation when use of patient’s ambulatory pump is not feasible. ^ If clinically stable from hemodynamic standpoint, pt’s can continue home infusion as inpts in non-ICU unit. See epoprostenol guideline for further details. eptifibatideIntegrilinxSCSCERIbulinHalavenCHCHXertapenemINVanzRNxx?erythromycinErythrocinRNxx?esmololBreviblocxSCSC?estrogen conjugatedPremarinRNRNx?ethacrynic acidEdecrinRNRNx?ethanol lockxPICC*x*Can only be administered by VAS serviceetomidateAmidatexSCX?etoposideVePesidCHxCH?factor VIIaNovoSevenxSC, RN*xFor Trauma/Neuro cases: Requires Factor VIIa Order Form; Trauma,Neuro-Critical Care, or Neurosurgery attending approval required*For Hemophilia-related uses, order form is not required and may be given on the floor by any RNfactor VIIIHumate-P, Monoclate-PxRNxNon-formulary- hematology approval requiredfamotidinePepcidRNxx?fat emulsionIntralipidxxRN (in TPN), SC* *for local anesthetic (i.e. bupivacaine) or other toxicitiesfentaNYLSublimazexSC, RN (Comfort Care only)RN** IV Infusions should only be initiated on SC unit or comfort care patients; on floor units, only down-titrations or comfort care is appropriate. Infusions as epidurals are allowed (per those polices).fenoldopamCorlopamxxSCferric gluconateFerrlecitRNHemodialysisx?fluconazoleDiflucanRNxxfludarabineFludaraCHxCH?flumazenilRomaziconxRN*x*Consider MERT evaluation if administeredfluorouracil5-FUxCHCH?folic acidFolviteRNxRN (in TPN)?fomepizoleAntizolRNxx?foscarnetFoscavirRNxx?fosphenytoinCerebyxRN*xxRestricted to patients in status epilepticus*Consider MERT evaluation if this medication is being administeredfurosemideLasixRNRN*RN?*Doses ≤100mg can be given as IV pushganciclovirCytoveneCHxx?gemcitabineGemzarCHxx?gentamicinGaramycinRNxx?glucagonGlucagenxRN*SC?*Consider MERT evaluation if administeredglycopyrrolateRobinulxRNx?haloperidol lactateHaldolxSCxAll other units can give IM haloperidolheparinxRNRN?hydrALAZINEApresolinexSC, Ra3x?Ensure appropriate BP monitoringhydrocortisone sodium succinateSolu-CORTEFRNRNx?HYDROmorphoneDilaudidxRNSC, RN*Order Form required for infusions.?* IV Infusions should only be initiated on SC unit or comfort care patients. Infusions as epidurals/PCA are allowed (per those polices).hydroxocobalaminCyanokitSCxx?ibutilideCorvertSC*SC*x*SC, Cath Lab. Provider must be present. Pre- AF/A flutter cardioversion only.idaruCIZUMABPraxbindSCSCxOrder Form Required.ifosfamideIfexCHxCH?imipenem/cilastatinPrimaxinRNxxRequires ID approval immune globulin (IVIG)PrivigenRNxRN?indomethacinIndocin6H onlyxx?inFLIXimabRemicadeRNxxinsulin regularNovoLIN R, HumuLIN RxRN*SC*Hyperkalemia: IV may be given on any unit by RN -- always give with D50interferon alfa-2BIntron ARNxx?ipilimumabYervoyCHxxNon-cytotoxic; ordered on chemo order formirinotecanCamptosarCHxx?isoproterenolIsuprelxSCSC?kanamycinKantrexRNxx?Kcentra4F-PCCRNxxOrder form and attending approval requiredketamineKetalarxSC*SC?*Anesthesia MD only in ICU. RNs can administer in the ED per protocol.ketorolacToradolxRNxUnrestricted use up to a maximum of 72 hours in adult and pediatric patients >2 years who are NPO. Longer duration or use in pediatric patients <2 years require approval by Formulary Manager except for orders written by Chronic Pain Service or Anesthesia. labetalolNormodynexSC, Ra3SCTelemetry monitoring requiredlacosamideVimpatRNxxleucovorinFolinic acidRNxx?levETIRAcetamKeppraRNxx?levOCARNitineCarnitorRNRNx?levofloxacinLevaquinRNxx?levothyroxineSynthroidxRNSC?lidocaineXylocainexSCSClinezolidZyvoxRNxxRequires ID approvalLORazepamAtivanxRNSC, Ra3*, RN^ *Ra3 – weaning to off only^RN palliative/comfort care onlymagnesium sulfateRNSC, BSSC, OBmanganesexxRN (in TPN)?mannitolRNRNx?mechlorethamineNitrogen mustardxCHx?melphalanAlkeranCHxx?meperidineDemerolxRNx?meropenemMerremRNxxRequires ID approvalmesnaMesnexRNRNRN?methadonexSCxmethotrexateCHCHxException: administration in ED for ectopic pregnancy by charge RNs in ED (often performed by OB/Gyn provider).methylene blueRNRNx?methylergonovineMetherginexRNx?methylPREDNISoloneSolu-MEDROLRNRNRNDoses ≤125mg can be given slow IV pushmetoclopramideReglanRNRNx?metoprololLopressorRN*RNxTelemetry monitoring required except for replacement doses in strict NPO patients with no cardiac disease or other indications for cardiac monitoring. (see P&T memo 2006 on pharmacy website).In NPO patients using metoprolol as IV push, the maximum dose is 10mg every 4 hrs.*IVPB: appropriate only for NPO & non-1st dose patients; no dosing limits apply for IVPB. Doses may be increased to IV equivalent of the maximum oral dose. metroNIDAZOLEFlagylRNxx?micafunginMycamineRNxxRequires ID approvalmidazolamVersedxSCSC?milrinone lactatePrimacorxSCSC?mitoMYcinxCHx?mitoXANtroneNovantroneCHCHx?morphine sulfatexRNRN*Order Form required for infusions.?* IV Infusions should only be initiated on SC unit or comfort care patients. Infusions as epidurals/PCA are allowed (per those polices).moxifloxacinAveloxRNxxMVI-12MVIxxRN (in TPN)?nafcillinRNxx?naloxoneNarcanxRN*SC?*Consider MERT evaluation if administerednatalizumabTysabriRNxxneostigmineProstigminxSCx?niCARdipineCardenexxSCnitroglycerinxCath labSC?nitroprussideNipridexxSC?nitroprusside + thiosulfateNipride + thiosulfatexxSCnivolumabOpdivoCHNon-cytotoxic; ordered on chemo order formnorepinephrineLevophedxxSC?octreotideSandostatinRNRNRN?ondansetronZofranRNRN*x*Doses ≤ 8mg can be given as IV push. Maximum dose is 16mg/doseoxaliplatinEloxatinCHxx?oxytocinPitocinxxOB, SC?PACLitaxelTaxolCHxCH?PACLitaxel (protein bound)AbraxaneCHxx?pancuroniumPavulonxSCSC?panitumumabVectibixCHxxNon-cytotoxic; ordered on chemo order formpantoprazoleProtonixRNRNRN80mg bolus can be given as slow IV push over 2 minpapaverinePapaverinexProviderx?paricalcitolZemplarxRNx?pegaspargaseOncasparCHxxNon-cytotoxic; ordered on chemo order formpembrolizumabKeytrudaCHxxNon-cytotoxic; ordered on chemo order formPEMEtrexedAlimtaCHxx?penicillin GRNxRNpentamidinePentamRNxx?PENTobarbitalNembutalSC*xSC*?OR and ICU use onlypentostatinNipentCHxx?pertuzumabPerjetaCHxxNon-cytotoxic; ordered on chemo order formPHENobarbitalSC (seizure)SCxphentolamineRegitinexSCSC?phenylephrineNeosynephrinexSCSC?phenytoinDilantinRNSCx?physostigmineAntiliriumxSCx?phytonadioneVitamin KRNxx?piperacillin/tazobactamZosynRNxxRequires ID approvalpolymyxin B sulfateAerosporin InjectionRNxRN?potassium acetatexxRN (in TPN)?potassium chlorideRNxRN (in TPN)Maximum infusion rate: 10 mEq/hr PERIPHERAL; 20 mEq/hr CENTRAL line onlypotassium phosphateRNxRN (in TPN)?pralidoximeProtopamRNRNRN?procainamidePronestylSCSCSCprochlorperazineCompazineRNRNx?propofolDiprivanxProviderSC?propranololInderalxSC, Ra3xTelemetry monitoring requiredprotamine sulfatexRNxMust be pushed over 10 minutes to decrease the risk of hypotensionProthrombin Complex Concentrate, 4 factorKcentra, 4F-PCCRNxxOrder form and attending approval requiredProthrombin Complex Concentrate – activated 4 factorFEIBARNxxpyridostigmineMestinonxSCx?pyridoxinexRNx?quiNIDineSCxSC?rasburicaseElitekRNXXremifentanilUltivaxOBOBRHO(D) Intravenous-Human)Globulin WinRho SDF xRNx?rifampinRifadinRNxxRequires ID approval for non-TB useriTUXimabRituxanCHxxNon-cytotoxic; ordered on chemo order formrocuroniumZemuronxSCSC?romiPLOStimNplatexxxFor SQ administration onlyropivacaineNaropinxxxMay be given as epidural or peripheral nerve block in any med-surg area.Restricted to Anesthesiology Department for use in the OR or epidural anesthesia (all epidural orders must be co-signed by an attending)seleniumTrace Element (Selenium)xxRN (in TPN)?sodium acetatexxRN (in TPN)?sodium bicarbonatex6H, SC, BSRN?sodium chloride 2%Hypertonic NaClxxRNFor Peripheral IV. Refer to SFGH Hypertonic Saline Guidelines for more specific information.sodium chloride 3%Hypertonic NaClxxRNFor Central Line. Refer to SFGH Hypertonic Saline Guidelines for more specific information.sodium chloride 23.4%Hypertonic NaClxSC - Provider only*xVial MUST be returned to pharmacy- used or unused. *Restricted to providers from neurology, neurosurgerysodium phosphateRNxRN (in TPN)?sodium thiosulfateRNRNx?streptomycinRNxxstreptozocinZanosarxCHx?succinylcholineAnectinexSCx?SUFentanilSufentaSCSCxsulfamethoxazole/ trimethoprim (SMX/TMP)Septra, BactrimRNxx?temsirolimusToriselCHxxtenecteplaseTNKaseSCSCx?THAM (tromethamine)SCxSCtreprostinil RemodulinxxxthiamineRNxRN (in TPN)?tigecyclineTygacilRNxxRequires ID approvaltirofibanAggrastatSCxSC?tobramycinNebcinRNxxRequires ID approvaltocilizumabActemraRNxxtopotecanHycamtinCHxx?TPA (alteplase)ActivaseSCSC*SC (EKOS catheter)Order Form required for PE, stroke, EKOSFor PE: drug prepared in pharmacyFor stroke: Bolus or infusion can be initiated on any unit as part of stroke protocol by SC*if used to maintain vascular access (e.g. – chest tube) then may be given by provider for chest tubes or VAS/provider for linestrace elementsMulti-TracexxRN (in TPN)?tranexamic acid (TXA)CyklocapronSC, OBXSC, OBRestricted to Anesthesia, ED and Trauma services for use in trauma patients. Refer to SFGH Tranexamic Acid Protocol for more information (Administration Policy # 2.06 Appendix F to Massive Transfusion Protocol) related to trauma use. Also approved for OR patients undergoing total joint replacements or obstetric patients with post-partum hemorrhage (PPH).trastuzumabHerceptinCHxx?Non-cytotoxic; ordered on chemo order formtrimethoprim/ sulfamethoxazoleSeptra, BactrimRNxx?tromethamineTHAMSCxSC?valproic acidDepaconRNxxvancomycinVancocinRNxx?vasopressinPitressinxSC, BSSC?vecuroniumNorcuronxSCSC?vedolizumabEntyvioRNxxverapamilIsoptinxSC, BSx?vinBLAStineVelbanCHCHx?vinCRIStineOncovinCHCHCH?vinorelbineNavelbineCHCHx?voriconazoleVFENDRNxxRequires ID approvalzidovudineRetrovirRNxOB**Continuous IV infusion can be given during laborzincxxRN (in TPN)?zoledronic acidZometa, ReclastRNxxRestricted to oncology-related indications. Use for osteoporosis requires non-formulary approval ................
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