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4095755969000CONTINUOUS INFUSION TITRATION GUIDELINES (Critical Care)THESE ARE DOSING GUIDELINES ONLY. An order is required for each medication with the following parameters: 1. Name of medication 2. Initial rate 3. Goal/titration end point 4. Maximum doseStandard concentrations are used per WMC policy.Drug Name Units of AdminInitial Rate of Infusion (unless order specifies a rate) LD = loading dose Initial dose = initial infusion rateTitration By end point with documentation Maximum Dose(unless order specifies a max)CommentsCISatracurium[mcg/kg/min]INITIAL DOSE: 3mcg/kg/min0.5 mcg/kg/min every 60 min10mcg/kg/minMonitor with BIS for sedation and train of 4 for neuromuscular blockadedexmedetomidine [mcg/kg/hr]LD: 1 mcg/kg over 10 minINITIAL DOSE: 0.3 mcg/kg/hr0.1 mcg/kg/hr every 30 min1.4 mcg/kg/hrCall MD if RASS not achieved with dose of 1 mcg/kg/hr.48 hours or less. Automatically dc’d in 36 hours from initial order.diltiazem[mg/hr]LD: 20 mg over 2 minutesINITIAL DOSE: 5 mg/hr2.5 to 5 mg/hr every 15 min15 mg/hr HYDROmorphonemcg/hrINITIAL DOSE: 0.4 mg 0.2 mg bolus every 10 minutes, max dose 3.2 mg/2 hours, then increase by 0.2mg/hr every 20 minper Sedation Protocol 3mg/hrPer End of Life orders 1.5mg/hrRebolus x 2 before increasing infusion.If continuous infusion not required, use bolus dosing.DOBUamine[mcg/kg/min]INITIAL DOSE: as ordered2.5- 10 mcg/kg/min every 10 min20 mcg/kg/minCentral line preferred.DOPamine[mcg/kg/min]INITIAL DOSE: as ordered1-10 mcg/kg/min every 5 min20 mcg/kg/minCentral line preferred.EPINEPHrine[mcg/min]INITIAL DOSE: Sepsis 2 mcg/minINITIAL DOSE: CT Surgery 1 mcg/min1-10 mcg/min every 3 minCT Surgery 8mg/min10 mcg/minSEPSIS: If rate exceeds 10 mcg/min, notify MD.Central line preferred.esmolol[mcg/kg/min]LD: 500 mcg/min over 1 minINITIAL DOSE: 50 mcg/kg/min50 mcg/kg/min every 5 minutes300 mcg/kg/minfenoldopam[mcg/kg/min]INITIAL DOSE: 0.03-0.05 mcg/kg/min0.05-0.1 mcg/kg/min every 15 minutes1.6 mcg/minfentanylmcg/hrLD: 50 mcgINITIAL DOSE: 50 mcg every 5 minutes50 mcg/hr, if 200 mcg reached in 2 hoursSedation Protocol200 mcg/hrRebolus x 2 before increasing infusion.If continuous infusion not required, use bolus dosing.isoproterenol[mcg/min]LD: 1-2mcgINITIAL DOSE: 1mcg/min1mcg/min every 15min10mcg/minCentral line preferred.labetalol[mg/min]INITIAL DOSE: 2mg/min2mg/min, titrate every 5 min6mg/minLORazepam[mg/hour]LD: 1 to 2 mg (RASS dependent)INITIAL DOSE: 1 mg/hr1 to 2 mg/hr every 15 minutes8 mg/hrRebolus x 2 before increasing infusion.If continuous infusion not required, use bolus dosing.midazolam[mg/hr]LD: 2 to 5 mg (RASS dependent)INITIAL DOSE: 1 mg/hr2 to 5 mg/hr every 10 minutes 10 mg/hrRebolus x 2 before increasing infusion.If continuous infusion not required, use bolus dosing.milrinone[mcg/kg/min]LD 25mcg/kg/minINITIAL DOSE: 0.25 mcg/kg/min0.025mcg/min every 5 min0.75 mcg/kg/minmorphine[mg/hr]Initial dose: 1mg/hr1mg/hr every 15 min10mg/hrniCARdipine[mg/hour]INITIAL DOSE: 5 mg/hr2.5 mg/hr every 5 minutes15 mg/hrnitroGLYCERIN[mcg/min]INITIAL DOSE: 10 mcg/min5 mcg/min every 5 min; until 20 mcg/min, then by 10 mcg/min ever 5 min200 mcg/minnitroPRUSSIDE[mcg/kg/min]INITIAL DOSE: 0.1 mcg/kg/min0.5 mcg/kg/min every 5 minutes10 mcg/kg/min; 5 mcg/kg/min if SrCr above 1.5 mg/dLCentral line preferred.norepinephrine[mcg/min]INITIAL DOSE: as orderedSEPSIS: 2 mcg/min2.5-10 mcg/min every 3 minutes20 mcg/minSEPSIS: If rate exceeds 30 mcg/min, notify MD.Central line preferred.pancuronium[mcg/kg/min]INITIAL DOSE: as ordered0.1-0.2mcg/kg/kg every 60 min1mcg/kg/minMonitor with BIS for sedation and train of 4 for NMBPENTobarbital[mg/kg/hr]INITIAL DOSE: as ordered0.5-1mg/kg/hr every 60min4mg/kg/hrphenylephrine[mcg/min]INITIAL DOSE: as ordered20 mcg/min every 3 minutes200 mcg/minCentral line preferred.propofol[mcg/kg/min]INITIAL DOSE: 10 mcg/kr/min5 mcg/kg/min every 5 minutes60 mcg/kg/minCheck orders for supplemental sedative is max rate reached.rocuronium[mcg/kg/min]LOADING DOSE: 0.6-1mg/kgINITIAL DOSE: 8mcg/kg/minincrease dose by 10% every 2 hours based on Train of Four results15mcg/kg/minMonitor with BIS for sedation and train of 4 for NMBvasopressinReplacement/shock dose[units/min]INITIAL DOSE: 0.03 units/minNontitrating dose for shock.CT Surgery 0.01 units/min every 30 min0.03 units/minCT Surgery 0.08 units/minCentral line preferred.vecuronium[mcg/kg/min]0.05 mcg/kg every 60 min based on train of four results1mcg/kg/minMonitor with BIS for sedation and train of 4 for NMBReviewed at P&T May 9, 2013 ................
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