Pediatric Guidelines for IV Medication Administration

Pediatric Guidelines for IV Medication Administration

Approved For

Drug

Acetazolamide

(Diamox?)

Acetylcysteine

(Acetadote?)

Acyclovir

Adenosine

(Adenocard?)

ICU

ED

Telemetry

Required

Acute

Care

IVP

X

X

X

X

X

Infusion

only

X

X

X

Bolus

+

infusion

X

X

X

X

IV

Infusion

X

See

restriction

Concentration

Usual Dosing and

Administration

Dilute to

MAX of

100 mg/mL

30 gm/1000

mL

(30 mg/mL)

5-10 mg/kg/dose MR q 8 or 6 hrs.

MAX dose: 25 mg/kg/dose up to 500 mg/dose

MAX Rate: IVP over 1 minute.

Requires toxicology approval.

Bolus: 150mg/kg over 1 hr.

Maintenance: 15-7.5mg/kg/hr. See dosing protocol or

contact pharmacy for weight-based protocol.

Diluted to

50kg: 6mg, 12mg, 12mg

0.5-1 gm/kg/dose (10-20 mLs/kg/dose). Infusion over 3060 minutes. In emergencies, may administer over 15

minutes.

Adult MAX: 600mls/hr

.

Comments

Monitor serum electrolytes

When used in acetaminophen overdose,

monitor serum acetaminophen concentrations;

monitor LFTs. Bolus doses, monitor for

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.

Patient should be well hydrated to prevent

nephrotoxicity. Monitor urine output, Scr.

Restriction: In acute care areas, doses must

be administered by a physician. .

Communication with the ICU team prior to

adenosine administration is required. An

attending Hospitalist, Cardiologist, or ICU

physician must be at the bedside.

A continuous ECG rhythm strip must be

obtained during dosing to monitor and

document drug effects

Rapid infusion may cause hypertension and

pulmonary edema. Monitor vital signs and

fluid balance. Use within 4 hours of opening

vial.

60 micron filter/tubing supplied by pharmacy

Albumin 5%

(forhypovolemia,

hypoalbuminemia

X

X

X

5%

(50 mg/mL)

Albumin 25%

X

X

X

25%

(250 mg/mL)

0.25-1 gm/kg/dose (1-4 ms/kg/dose)

Infusion as tolerated over 30-120 minutes.

Adult MAX :180ml/hr

Rapid infusion may cause hypertension &

pulmonary edema. Monitor vital signs and

fluid balance. Use within 4 hrs of opening.

60 micron filter/tubing supplied by pharmacy

X

Dilute 500

mcg in

50mls NS

(10 mcg/ml)

Initial: 0.05- 0.1 mcg/kg/min.

Range: 0.01 up to MAX 0.4mcg/kg/minute

Infuse via large vein.

Monitor arterial pressure, RR, HR, oxygen

saturation, temp.

Diluted to

< 5 mg/mL

5-10mg/kg/dose q8hrs with NL renal function.

Infusion: Over 30 minutes.

Urine output, Serum creatinine,

Peak and trough concentrations.

(forhypoproteinemia

w/ generalized edema)

Alprostadil, PGE1

Prostin VR

Pediatric?)

X

Amikacin

(Amikin?)

X

X

Continuous

infusion

X

X

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.

Version 9/28/2008 Barb Maas Pharm. D.

1

Pediatric Guidelines for IV Medication Administration

Approved For

DrugDrD

Amiodarone

(Cordarone?)

Ampicillin

ICU

ED

Telemetry

Required

X

X

Acute

Care

IVP

IV

Infusion

X

X

X

Bolus in

code only

No

infusion

X

X

X

X

Atropine

X

X

X

X

Azithromycin

(Zithromax?)

X

X

Aztreonam

(Azactam?)

X

X

Central line preferred for concentrations

exceeding 2 mg/mL. Dedicated filtered

(0.22 micron) line required.

Infusion 450

mg/ 250 mL in

D5W

For perfusing VF/VT 5 mg/kg over 20-60 min, MR X

3

Continuous BP/cardiac monitoring, thyroid

function, LFTs, and pulmonary function

should be monitored frequently.

X

slow

Dilute to

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.

Version 9/28/2008 Barb Maas Pharm. D.

Adjust with renal dysfunction.

Unsayn: Each 1.5mg unasyn=1mg apicillin

+0.5mg sulbactam.

With prolonged therapy, monitor

hematologic, renal and hepatic function.

Observe for change in bowel frequency.

Monitor vital signs and EKG; monitor for

side effects including dry mouth, dizziness

and palpitations.

Monitor for pain at infusion site, LFTs,

WBC and infection.

Adjust dosing with renal dysfunction.

2

Pediatric Guidelines for IV Medication Administration

Approved For

Drug

ICU

ED

Telemetry

Required

Concentration

Usual Dosing and

Administration

Acute

Care

IVP

IV

Infusion

X

X

0.25 mg/mL

Dosing:0.015-0.1 mg/kg/dose up to 4 mg q 6-24 hrs (MAX

dose is 10 mg/day, 20 mg/day w/ RF))

IV Push: over 1-2 minutes MAX 1mg/min

Monitor blood pressure, serum

electrolytes and renal function.

Clarify if dosing is as citrate salt or

caffeine base. Must be specified on

medication order.

May dilute in D5W

Monitor heart rate, number and

severity of apnea spells, and serum

caffeine levels

Not to be administered in

neonates(benzoates). Monitor heart

rate.

Bumetanide

(Bumex?)

X

X

Caffeine Citrate

(Cafcit)

For apnea

X

X

X

20 mg/mL

citrate salt

(=10 mg/mL

caffeine base)

Loading: 10-20 mg/kg citrate salt infused over

30 minutes

Maintenance: 5 mg/kg/day as citrate salt once daily starting

24 hours after bolus doseinfused over ¡Ý 10 minutes

Caffeine sodium

benzoate

For spinal

headache

X

X

X

Dilute to 0.5

mg/mL

Adults: 500 mgs as a single dosediluted with 1000 mL NS

and infused over 1 hour, followed by 1000 mL NS over 1

hour.

X

1 gm/

10 mL vial

Calcium Chloride

X

X

Slow IVP

Calcium Gluconate

Cefazolin (Kefzol)

X

X

Slow IVP

Slow IVP

only.

X

Comments

IVP In

code only

w/MD

present.

No

infusion.

Slow IVP

in code

w/ MD

present.

Infusion

OK

X

X

Slow

IVP

Recommend use only in symptomatic hypocalcemia

Bolus: 10-20 mg/kg/dose up to 1gm over a minimum of 10

minutes.

Infusion: Do not exceed 45-90 mg/kg given over 1 hour

X

X

1 gm/50 mL

=20 mg/mL

200-500 mg/kg/DAY as continuous infusion or in 4 divided

doses

Acute::Usual 100mg/kg or 1gm MAX 3gm over 10 minutes

Non-Acute: Usual 50-100mg/kg not to exceed 2gm over no

less than 60 minutes.

MAX: 200mg/kg up to 3gm

X

Dilute to

< 20mg/ml

IVP: Over 3-5 minutes

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

Slow

IVP

X

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.

Version 9/28/2008 Barb Maas Pharm. D.

Central Line preferred unless

emergency administration.

Do not administer I.M. or S.C. or use

scalp, small hand or foot veins for IV

administration since severe necrosis

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.

Do not infuse calcium gluconate in

same IV line as phosphate-containing

solutions.

Monitor serum calcium (ionized

calcium is recommended), heart rate

and EKG.

See label comments on Pedi IV

Calcium Gluconate Bags

Adjust dosing with renal dysfunction.

3

Pediatric Guidelines for IV Medication Administration

Approved For

Drug

ICU

ED

Telemetry

Required

Acute

Care

IVP

IV

Infusion

Concentration

Usual Dosing and

Administration

Cefepime

(Maxipime)

X

X

X

X

Dilute to

< 20 mg/mL

IVP over 5 minutes.

Infusion over 30 minutes

Dosing 2 mo-16yo: 100-150 mg/kg/day div q 12 or 8 hrs.

CF 50 mg/kg/dose q 8hr MAX 6 gm/day

Cefotaxime

(Claforan?)

X

X

X

X

Dilute to

< 40 mg/mL

IVP over 3-5 minutes

Infusion: Over 10-30 minutes

2000 g:100-150 mg/kg/day div every 8-12 hrs

> 7 days: >2000 g: 150-200 mg/kg/day divided every 6-8

hrs

1 month- 12 years: 50 kg: Moderate infection 1-2 gms q 6-8hrs, Severe 2 gms

every 4 to6 hrs (MAX 12 g/day)

Cefoxitin

(Mefoxin?)

Ceftazidime

(Fortaz)

X

X

X

X

Dilute to

< 40mg/ml

IVP over 5 minutes

Infusion over 10-30 minutes

X

X

X

X

Dilute to

2 kg: 100-150 mg/kg/day div q 8-12 hrs

>7 days >2 kg: 150 mg/kg/day div q 8h

Infant/child: 100-150 mg/kg/day div q 8h

CF: 150-300 mg/kg/day usual MAX 12 gm/day

IVP over 5 minutes

Infusion over 10-30 minutes

Infants and Children: 50-75 mg/kg/day divided every 1224 hours

Meningitis: 80-100 mg/kg/day divided every 12-24 hrs

(MAX: 4 gm/day)

Chlorothiazide

(Diuril?)

X

X

X

X

500 mg vial

diluted with 18

mL SWI for a

final

concentration

of 27.8 mg/mL

IVPover 3-5

Infusionover 30 minutes in dextrose or NS

6 months: 4 mg/kg/day in 1-2 divided doses up to 20

mg/kg/day.

NOTE: This is not a comprehensive medication list. For items not listed, review standard medication resources or consult the pharmacist.

Version 9/28/2008 Barb Maas Pharm. D.

Comments

ID approval required for patients

outside the ICU. Pseudomonal

infections should be dosed at the

higher end of the dosing range.

Adjust dosing with renal dysfunction.

Indicated in neonate < 2 weeks or in

infants with clinically relevant

hyperbilirubinemia who may be at

risk for kernicturus.

With prolonged therapy, monitor

renal, hepatic, and hematologic

function periodically; number and

type of stools/day for diarrhea.

Adjust dosing with renal dysfunction.

Adjust dosing with renal dysfunction.

Monitor INR with prolonged use

CO2 is produced with reconstitution.

Remove pressure/air by venting vial

prior to drawing up dose¡ª

Adjust dosing with renal

dysfunction..

*Do not use in any child ................
................

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