Pediatric Guidelines for IV Medication Administration

Pediatric Guidelines for IV Medication Administration

Drug

Acetazolamide (Diamox?) Acetylcysteine (Acetadote?)

Acyclovir

Adenosine (Adenocard?)

Albumin 5% (forhypovolemia, hypoalbuminemia

Albumin 25%

(forhypoproteinemia w/ generalized edema)

Alprostadil, PGE1 Prostin VR Pediatric?) Amikacin (Amikin?)

ICU ED X X

Bolus +

infusion

X X

X

X

X

X

Approved For

Telemetry Required

Acute Care

X

IVP

IV Infusion

X

X

X

Infusion

only

X

X

X

X

X

See

restriction

.

X

X

Concentration

Dilute to MAX of 100 mg/mL 30 gm/1000

mL (30 mg/mL)

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

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

X

X

25%

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

Rapid infusion may cause hypertension &

(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.

60 micron filter/tubing supplied by pharmacy

X X

X

Continuous

infusion

X

Dilute 500 mcg in

50mls NS (10 mcg/ml)

Diluted to < 5 mg/mL

Initial: 0.05- 0.1 mcg/kg/min. Range: 0.01 up to MAX 0.4mcg/kg/minute

5-10mg/kg/dose q8hrs with NL renal function. Infusion: Over 30 minutes.

Infuse via large vein. Monitor arterial pressure, RR, HR, oxygen saturation, temp.

Urine output, Serum creatinine, Peak and trough concentrations.

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

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

Pediatric Guidelines for IV Medication Administration

DrugDrD Amiodarone (Cordarone?)

Ampicillin

Ampicillin/ Sulbactam (Unasyn?)

Atropine

Azithromycin (Zithromax?)

Aztreonam (Azactam?)

ICU ED X

X X

X X

X

Approved For

Telemetry Required

Acute Care

IVP

IV Infusion

Concentration

Usual Dosing and Administration

X

X

X

X

Bolus diluted to BOLUS: PALS for pulseless VF/VT5 mg/kg (MAX

Bolus in code only

1.5-3 mg/mLin 300 mg/dose) given over 5-10 minutes. - 0.22 micron

D5W

filter preferred . Flush post dose.

No infusion

Infusion 450 For perfusing VF/VT 5 mg/kg over 20-60 min, MR X mg/ 250 mL in 3

D5W

X

X

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

Comments

Central line preferred for concentrations exceeding 2 mg/mL. Dedicated filtered (0.22 micron) line required. Continuous BP/cardiac monitoring, thyroid function, LFTs, and pulmonary function should be monitored frequently.

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.

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

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

Pediatric Guidelines for IV Medication Administration

Drug

Bumetanide (Bumex?)

Caffeine Citrate (Cafcit) For apnea

Caffeine sodium benzoate For spinal headache

ICU ED X X

X

Approved For

Telemetry Required

Acute Care

X

X

X

IVP

IV Infusion

X

X

X

X

Concentration

0.25 mg/mL

20 mg/mL citrate salt (=10 mg/mL caffeine base)

Dilute to 0.5 mg/mL

Usual Dosing and Administration

Comments

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

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 10 minutes

Adults: 500 mgs as a single dosediluted with 1000 mL NS and infused over 1 hour, followed by 1000 mL NS over 1 hour.

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.

Calcium Chloride

X

Slow IVP

X

IVP In

X

X

code only Slow

w/MD

IVP

present.

No

infusion.

Calcium Gluconate

X

X

Slow IVP

X

X

Slow IVP

Slow IVP only.

in code

Slow

w/ MD

IVP

present.

Infusion

OK

Cefazolin (Kefzol)

X

X

X

X

1 gm/ 10 mL vial

1 gm/50 mL =20 mg/mL

Dilute to < 20mg/ml

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

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

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

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.

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

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Pediatric Guidelines for IV Medication Administration

Drug

Cefepime (Maxipime)

Cefotaxime (Claforan?)

Cefoxitin (Mefoxin?) Ceftazidime (Fortaz)

Ceftriaxone (Rocephin?)

Chlorothiazide (Diuril?)

ICU ED X X

X X X

X

Approved For

Telemetry Required

Acute Care

X

X

X X X

X

IVP

IV Infusion

Concentration

Usual Dosing and Administration

Comments

X

X

Dilute to

IVP over 5 minutes.

< 20 mg/mL Infusion over 30 minutes

ID approval required for patients 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.

X

X

Dilute to

IVP over 3-5 minutes

< 40 mg/mL Infusion: Over 10-30 minutes

Indicated in neonate < 2 weeks or in infants with clinically relevant

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: 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.

X

X

Dilute to < 40mg/ml

IVP over 5 minutes Infusion over 10-30 minutes

Adjust dosing with renal dysfunction. Monitor INR with prolonged use

X

X

Dilute to 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

X

X

Dilute to

IVP over 5 minutes

< 20 mg/mL Infusion over 10-30 minutes

*Do not use in any child 40 kg 5 mg/min

May cause phlebitis 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

Digoxin (Lanoxin)

X

MD adminis-

X

tration for

Maint-

loading doses enance

only.

doses

needed.

X

Dilute to < 100 Infusion:Slowly administer over 5-10 mins

mcg/mL w/NS Dosing: See age specific references

cLoading dose requires telemetry. Not for maintenance dose. Monitor heart

Loading Dose: range 10-30 mg/kg divided in 3 doses over rate, rhythm, periodic EKGs, serum

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

Fab

(DigiFAB)

X

X

Dilute to 1-10 Requires toxicology consult! Dosing based on amount of 0.22 micron filter required

mg/mL with NS digoxin ingested. Each 40mg vial binds 0.5mg digoxin

Monitor EKG, serum potassium and

IVP: If in Cardiac Arrest 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.

Diltiazem (Cardizem)

X

X

X

X

5 mg/mL for IVP Bolus: 0.25 mg/kg over 2- 5 minutes; if inadequate

During administration monitor EKG,

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

Diphenhydramine

X

(Benadryl)

X

X

Dilute to ................
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