Updated: 12/2013 Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration University of Kentucky Chandler Medical Center GENERIC/ BRAND NAME THERAPEUTIC CATEGORY TYPICAL CHILD DOSE MAXIMUM CHILD DOSE MAXIMUM CONCENTRATION MAXIMUM RATE OF ADMINISTRATION ADMINISTRATION CONSIDERATIONS ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS Alprostadil (Prostin VR, PGE1) Prostaglandin 0.01-0.4 mcg/kg/min 20 mcg/mL Apnea occurs in 10- 12% of neonates, usually within the first hour of therapy. Infusion rate should be slowed if fever or hypotension develops. Once therapeutic response is attained, gradually decrease infusion rate to lowest effective dose Monitoring Parameters: Arterial pressure, respiratory rate, heart rate, temperature, pO2, monitor for gastric obstruction in pts on drip > 120 hrs Adverse Effects: Hypotension, flushing, bradycardia, tachycardia, fever, cortical proliferation of long bones, respiratory depression, apnea Page 1 of 22
Transcript
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Alprostadil (Prostin VR, PGE1)
Prostaglandin 0.01-0.4 mcg/kg/min 20 mcg/mL Apnea occurs in 10-12% of neonates, usually within the first hour of therapy. Infusion rate should be slowed if fever or hypotension develops. Once therapeutic response is attained, gradually decrease infusion rate to lowest effective dose
Monitoring Parameters: Arterial pressure, respiratory rate, heart rate, temperature, pO2, monitor for gastric obstruction in pts on drip > 120 hrs Adverse Effects: Hypotension, flushing, bradycardia, tachycardia, fever, cortical proliferation of long bones, respiratory depression, apnea
Page 1 of 22
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Alteplase (TPA, Cathflo)
Antithrombotic Occluded catheters: <10 kg: 0.5 mg in NS in a volume required to fill lumen 10-29 kg: 1 mg/mL, dose equal to 110% of catheter lumen volume, max of 2 mL, instilled into occluded catheter, up to 2 doses may be used, separated by 120 min >30 kg: 2 mg/2 mL instilled into occluded catheter, up to 2 doses may be used, separated by 120 min Systemic thromboses: 0.1-0.6 mg/kg/hour for 6 hours (some pts may require longer or shorter duration of therapy); initiate at 0.1 mg/kg/hour if no response after 6 hours, increase infusion by 0.1 mg/kg/hr to maximum of 0.5 mg/kg/hr; maintain fibrinogen > 100 mg/dl
0.6 mg/kg/hour
1 mg/mL Administer via infusion pump; extravasation may cause bruising or inflammation catheter clearance: attempt to aspirate blood after 30 min of dwell time; if successful, aspirate 4-5 mL of blood and flush gently with NS; if unsuccessful, allow to dwell 90 more min and repeat procedure. If still unsuccessful after 120 minutes, a second dose may be instilled
Monitoring Parameters: systemic use: blood pressure, temp, CBC, reticulocyte, platelet count, fibrinogen, plasminogen, signs of bleeding Adverse Effects with systemic use: sepsis, GI bleed, venous thrombosis, hypotension, fever, intracranial or cerebral hemorrhage, bleeding, bruising
Loading dose: 5.7 mg/kg Continuous infusion: 6 wks-1 year: 0.3-0.8 mg/kg/hr (age dependent) 1-9 yrs: 1 mg/kg/hr 9-12 yrs: 0.9 mg/kg/hr > 12 yrs: 0.63 mg/kg/hr Dosage should be adjusted to serum level measurements during the first 12-24 hrs
900 mg/day (unless levels dictate higher)
25 mg/mL Bolus: 0.36 mg/kg/min (not to exceed 25 mg/min)
Do not extravasate. Do not administer IM Monitor theophylline levels Asthma levels: 5-15mcg/ml Neonatal apnea: 6-12 mcg/ml
Monitoring Parameters: Respiratory rate, heart rate, serum theophyline levels, arterial or capillary blood gases (if applicable); number and severity of apnea spells (apnea of prematurity) Adverse Effects: may cause dysrhythmias; GI upset, GE reflux, diarrhea, n/v, abd pain, nervousness, agitation, dizziness, muscle cramp, tremor, tachycardia, PVC, seizure
Amiodarone/ Cordarone
Antiarrhythmic
Loading dose: 5 mg/kg Continuous Infusion: 5 mcg/kg/min (7.2 mg/kg/day) Increase incrementally until desired effect or 15 mcg/kg/min
15 mcg/kg/min (21.6 mg/kg/day)
Peripheral line: 3mg/mL Central line: 6 mg/mL
Rapid IVP if pulseless 0.25 mg/kg/min for perfusing tachycardias
Administer via central venous catheter, if possible due to phlebitis with peripheral infusions > 3 mg/ml in D5W (but conc <= 2.5 mg/ml may be less irritating). Use of glass bottles for infusion > 2 hours; polyvinyl tubing is recommended. Infused via infusion pump.
Monitoring Parameters: cardiac, liver, renal, pulmonary, and thyroid function. EKG should be monitored. Ophthalmologic exams are recommended. Adverse Effects: bradycardia, corneal deposit, hypotension, thyroid dysfunction, photosensitivity, tremor and involuntary disturbances.
UCD: 200-600 mg/kg load over 90 minutes, followed by 8 mg/kg/hr Alkalosis: 0.5 x [HCO3 – 24] x weight (kg)
100 mg/mL 1 g/kg/hr (up to 60 g/hr)
Central line recommended Do not extravasate
Monitoring Parameters: Blood gas, BMP, ammonia and amino acid Adverse Effects: hypotension, flushing, hyperkalemia, GI upset
Bumetanide (Bumex)
Loop diuretic Initial dose: 0.01 – 0.1 mg/kg/dose Continuous infusion: Initial dose of 5 mcg/kg/hr and titrate to clinical effect to maximum of 200 mcg/kg/hr or Adult-sized patients: 0.9-1mg/hr
Maximum of 10mg/day
0.25 mg/mL IVP over 1-2 minutes
1 mg bumetanide approximately equivalent to 40 mg furosemide
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Calcium chloride Antidote for hydrofluoric acid, electrolyte supplement
(Dose expressed in mg of calcium chloride): Cardiac arrest in presence of hyperkalemia or hypocalcemia: 20 mg/kg; may repeat in 10 min if necessary Hypocalcemia: 10-20 mg/kg/dose repeated Q4-6H if needed Hypocalcemia secondary to citrated blood transfusion: give 0.45meq elemental calcium for each 100ml citrated blood transfused Tetany: 10mg/kg over 5-10 min; may repeat after 6-8 hours or follow with an infusion with a max dose of 200 mg/kg/day
2 grams per dose
Bolus IV: 100 mg/mL Continuous infusion: 20 mg/mL
IV push: 50-100 mg/min IV infusion: 45-90 mg/kg over 1 hour. (0.6-1.2 mEq/kg over 1 hour).
Infusion through central line preferred- avoid infusion into small veins in dorsum of hand or foot and scalp veins because of risk of extravasation. Infusion should be stopped if patient complains of discomfort. Must flush well between sodium bicarbonate to prevent precipitation. Do not infuse with phosphate containing solutions
Monitoring Parameters: Heart rate, ECG during IV administration, serum calcium, phosphate, magnesium. Adverse Effects: Metallic taste, cardiac arrest (with rapid IV injection), hyperkalemia, hypertension, hypomagnesemia, hypophosphatemia, milk-alkali syndrome, vasodilation, arrhythmias
Page 5 of 22
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Calcium gluconate
Antidote for hydrofluoric acid, electrolyte supplement
(Dose expressed in mg of calcium gluconate): Cardiac arrest in presence of hyperkalemia or hypocalcemia: 60-100 mg/kg; may repeat in 10 min if necessary Hypocalcemia: 50-100 mg/kg/dose repeated Q4-6H if needed Hypocalcemia secondary to citrated blood transfusion: give 0.45meq elemental calcium for each 100ml citrated blood transfused Tetany: 100-200 mg/kg over 5-10 min; may repeat after 6 hours or follow with an infusion with a max dose of 500 mg/kg/day
3g per dose IV bolus: 100 mg/mL Continuous infusion: 50 mg/mL
10-20 seconds Infusion through central line preferred. Infusion should be stopped if patient complains of discomfort. Must flush well between sodium bicarbonate to prevent precipitation. Do not infuse with phosphate containing solutions
Monitoring Parameters: Heart rate, ECG during IV administration, serum calcium, phosphate, magnesium. Adverse Effects: Metallic taste, cardiac arrest (with rapid IV injection), hyperkalemia, hypertension, hypomagnesemia, hypophosphatemia, milk-alkali syndrome, vasodilation, arrhythmias
Loading dose: 0.25mg/kg over 2-5 min; if response inadequate after 15 min, a second 0.35 mg/kg may be given Continuous infusion: 0.05-0.15mg/kg/hr Continuous infusions rates of 5-15mg/hr have been reported but are not adjusted for weight or age.
Dose: 2-20 mcg/kg/min; titrate 2 – 2.5 mcg/kg/min every 5 minutes to desired response.
40 mcg/kg/min
8000 mcg/mL Correct hypovolemia prior to initiation of therapy. Infiltration causes local inflammatory changes or extravasation may cause dermal necrosis
Initial: 5-10 mcg/kg/min Maintenance: 2-10 mcg/kg/min; increase 2 – 2.5 mcg/kg/min every 5 minutes to desired response
50 mcg/kg/min
6400 mcg/mL Do not infuse through an umbilical artery catheter. Extravasation causes tissue necrosis.
Monitoring Parameters: EKG, heart rate, CVP, MAP, urine output, if pulmonary artery catheter is in place monitor CI, PECP, SVR, RAP, PVR Adverse Effects: anxiety, HA, injection site rxns, ectopic heartbeats, widened QRS complex, ventricular arrhythmias
Page 7 of 22
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Doxapram Respiratory stimulant
Initial: 2.5-3 mg/kg load Continuous: 1 mg/kg/hr
2.5 mg/kg/hr 2 mg/mL Infuse bolus over 15-30 minutes
Do not extravasate Monitoring Parameters: Pulse oximetry, ABG, blood pressure, heart rate, apnea epidoses (number, duration, severity) Adverse Effects: Flushing, GI upset, hypertension, pruritis
Epinephrine/ Adrenalin
Adrenergic agonist
Cardiac arrest- initial 0.01 mg/kg (10 mcg/kg) or 0.1 ml/kg of 1:10,000; may be repeated every 3-5 min. Initial Endotracheal dose: 0.1 mg/kg, may repeat q3-5 min. Continuous infusion: Initial: 0.05-0.1 mcg/kg/min Maintenance: 0.01 – 1 mcg/kg/min; titrate 0.05 – 0.1 mcg/kg/min every 5 minutes to effect
0.03 mg/kg/dose for neonates, 0.1 mg/kg/dose for infants and children by IV push.
Continuous infusion: 64 mcg/mL
Do not administer if solution is brown or otherwise discolored or if a precipitate is present. Extravasation causes tissue necrosis. Protect from light
Dose: 2 ng/kg/min up to 20 ng/kg/min; may increase by 1-2 ng/kg/min increments every 15 minutes
20 ng/kg/min 70000 ng/mL Abrupt withdrawal, interruptions in delivery, or large reductions in dosage may cause symptoms associated with rebound pulmonary hypertension (ie, dyspnea, dizziness, and asthenia. Short expiration (8 hrs) without cool pack
Monitoring Parameters: Pulmonary artery pressure, total pulmonary vascular resistance, systemic arterial pressure, cardiac output, and heart rate should be monitored during acute infusion in patients with primary pulmonary hypertension Adverse Effects: Flushing, sweating, nausea, hypotension, bradycardia, tachycardia, hyperglycemia,
Page 8 of 22
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
20 mg/mL IVP over 1 minute Do not extravasate Monitoring Parameters: blood pressure, EKG, heart rate, respiratory rate, IV site Adverse Effects: bradycardia, chest pain, HA, pain at injection site, bronchospasm (rare), seizures (rare)
Fentanyl citrate/ Sublimaze
Analgesic, narcotic, general anesthetic, opioid
Dose: 0.5-4 mcg/kg followed by continuous infusion of 1-5 mcg/kg/hr until desired effect
Diabetic ketoacidosis: 0.1 unit/kg/hour (range: 0.05-0.2 unit/kg/hour depending upon rate of decrease in serum glucose)
IV bolus: 100 units/mL Continuous infusion: 1 unit/mL
Optimal rate of decrease is 80-100 mg/dl/hour (decreasing serum glucose too rapidly may lead to cerebral edema) Only Regular Insulin can be given intravenously
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Ketamine/ Ketalar
Anesthetic adjunct
Dose: 0.5-1 mg/kg occur 2-3 minutes followed by 5-20 mcg/kg/min continuous infusion, with or without supplemental O2
Anesthesia maintenance: 0.01-0.03 mg/kg/min
Not established, but large doses prolong recovery and increase risk of adverse effects
IV bolus: 50 mg/mL Continuous infusion: 2 mg/mL
2 mg/min or 0.5 mg/kg/min
Dilute to 50 mg/mL for IV push Laryngospasm or apnea requiring intubation may occur
Monitoring Parameters: monitor cardiac function in patients with cardiac decompensation or hypertension, monitor for signs of emergency symptoms Adverse Effects: vivid dreams, increased blood pressure, tachycardia, muscle hyperactivity
Adjunct antiemetic: 0.05 mg/kg up to 2mg/dose effective in controlling chemo-induced N/V.
Status Epilepticus: 0.03-0.1 mg/kg and may repeat 0.05 mg/kg in 10-15 min if no response
Agitation in the ICU pt (unlabeled use): 0.01-0.1 mg/kg/hour
4 mg/dose or 0.25-0.4 mg/kg/dose
2 mg/mL 2 mg/min Protect from light and refrigerate. Expires in 60 days at room temp.
Monitoring Parameters: Respiratory rate, BP, HR, CBC w/ diff, and liver function tests w/ long term usage Adverse Effects: CNS and respiratory depression, drowsiness, GI symptoms, propylene glycol toxicity, nystagmus, hypertension or hypotension
Magnesium sulfate
Electrolyte supplement, Torsades de Pointes treatment, bronchodilator
Hypomagnesium: Neonates: 25-50 mg/kg/dose (0.2-0.4 meq/kg/dose) Q8-12H Children: 25-50 mg/kg/dose (0.2-0.4 meq/kg/dose) Q4-6H Management of seizures and hypertension: 20-100 mg/kg/dose Q4-6H Treatment of Torsades de Pointes VT: 25-50 mg/kg/dose (not to exceed 2gm/dose) Bronchodilation (asthma): 25 mg/kg/dose (max 2gm) as a single dose; 30-70 mg/kg over 20 minutes has been given
2000 mg 200 mg/mL 5-10 minutes Monitoring Parameters: Serum magnesium, deep tendon reflexes, respiratory rate Adverse Effects: Hypotension, diarrhea, hypermagnesia, abdominal cramps, gas formation, muscle weakness Adverse effects are related to serum concentration: >3 mg/dl: depressed CNS, blocked peripheral neuromuscular transmission leading to anticonvulsant effects >5 mg/dl: depressed deep tendon reflexes, flushing, somnolence >12 mg/dl: respiratory paralysis, complete heart block
Page 12 of 22
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
Anesthesia: 0.15 mg/kg initially followed by up to three doses of 0.05 mg/kg at 2 minute intervals Continuous IV: neonates <=32 weeks gestational age: 1 mcg/kg/min, then decrease to 0.5 mcg/kg/min ASAP Neonates >32 weeks: 1 mcg/kg/min Infants/children: 0.05- 0.2 mg/kg as loading dose over 2-3 min. followed by 1-2 mcg/kg/min; titrate by 1 mcg/kg/min increments q 30 min until desired effect.
1-5 minutes Respiratory depression and arrest requiring mechanical ventilation may occur following excessive dosing, rapid administration, or use with fentanyl Do not extravasate
5 minutes Hypotension and chest wall rigidity may occur with rapid administration Respiratory depression is reversible with naloxone
Monitoring Parameters: respiratory and cardio status, O2 saturation, pain relief, level of sedation Adverse Effects: hypotension, pruritis, vomiting, constipation, somnolence, dizziness, respiratory depression. Use with caution and at lower doses in infants and neonates less than 3 months because they are more susceptible to respiratory depression. Abrupt dc may cause withdrawal.
Naloxone / Narcan
Antidote for narcotic agonists
Opiate intoxification: 0.01 - 0.1 mg/kg, repeat every 2-3 min if needed If continuous infusion is required, calculate the initial dosage/hour based on the effective intermittent dose used and duration of adequate response seen; titrate dose; a range of 2.5-160mcg/kg/hr has been reported. Narcotic induced pruritis: initial 2 mcg/kg/hour; may increase by 0.5 mcg/kg/hour every few hours if pruritis continues
500 mcg/mL Administration via central line eliminates risks for phlebitis which is occasionally seen when using the max 0.5 mg/ml conc through PIV Protect from light
Dose: 0.5-20 mcg/kg/min Neonates, infants, & children: begin infusion at 0.1-1 mcg/kg/min and increase by 0.5-1 mcg/kg/min q3-5 min until desired response or toxicity occurs Adolescents: begin infusion at 5 mcg/min until desired clinical response
20 mcg/kg/min
800 mcg/mL Do not mix with other IV drugs. nonPVC tubing is recommended; must dispense in glass bottles (adsorbs to plastic)
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Nitroprusside/ Nitropress
Antihypertensive and vasodilator
Hypertension initial rate: 0.3-0.5 mcg/kg/min with dose titration.
After load reduction: initial rate at 0.5-3 mcg/kg/min with dose titration.
10 mcg/kg/min (6 mcg/kg/min neonates)
800 mcg/mL (Sodium thiosulfate is a cyanide antidote. Pharmacy adds 1 gm sodium thiosulfate for each 100 mg of Nitroprusside in the drip)
10 mcg/kg/min (if adequate reduction in BP is not obtained after 10 min at 10 mcg/kg/min, the infusion should be stopped)
Continuous blood pressure monitoring, administer via infusion pump; thiocyanate levels if requiring prolonged infusion > 3 days or dose >= 4 mcg/kg/min or if pt has renal dysfunction. Protect from light in black bag
Monitoring Parameters: blood pressure, acid-base balance, heart rate, hepatic and renal function, methemoglobin, thiocyanate levels Adverse Effects: dizziness, drowsiness, infusion site irritation, muscle twitching, rash, palpitations, arrhythmias, ileus, excessive bleeding, cyanide toxicity (Sodium thiosulfate is a cyanide antidote. May add 1gm sodium thiosulfate for each 100mg of Nitroprusside in the drip)
Norepinephrine/ Levophed
Alpha-adrenergic agonist
Initial: 0.05-0.1 mcg/kg/min Maintenance: titrate according to clinical response, using frequent BP monitoring and continuous EKG. Avoid abrupt withdrawal
1-2 mcg/kg/min in infants and children 12 mcg/min in adults
64 mcg/mL (central line only)
Contains sodium metabisulfate which may cause allergic type reaction. Protect from light. Do not infuse if solution is pinkish or darker than slightly yellow or contains precipitates
Diarrhea: 1 mcg/kg bolus then continuous infusion of 1 mcg/kg/hour GI bleed: 1-2 mcg/kg bolus then continuous infusion of 1-2 mcg/kg/hour Chylothorax: 0.3 - 10 mcg/kg/hour Titrate to response
10 mcg/mL (can use undiluted in emergent situations)
15-30 minutes (IVP over 3 minutes in emergent situations)
Allow to warm to room temperature before administration
Cardiac dysrhythmias, tachycardia, and hypertension have been reported. Do not alter patients state of consciousness; addition of sedation and analgesia are recommended
Monitoring Parameters: heart rate, blood pressure, assisted ventilation status, peripheral nerve stimulator measuring twitch response Adverse effects: most frequent adverse reactions are related to prolongation of pharmacologic actions: hypertension, rash, excessive salivation, burning sensation along vein, muscle weakness, wheezes, bronchospasm
Pantoprazole Proton pump inhibitor
1 mg/kg bolus, then 0.1 mg/kg/hr
80 mg IV bolus: 4 mg/mL Continuous infusion: 0.8 mg/mL
Over 15 minutes Monitoring Parameters: GI bleeding, s/s GERD Adverse Effects: HA, GI upset
Papavarine Vasodilator Arterial catheter infusions: Add 60mg per 500ml in NSS or 1/2NSS with heparin 1 unit/ml
One study showed lower risk of arterial catheter failure and longer duration of arterial catheter function
Monitoring Parameters: Liver function tests Adverse Effects: Flushing, tachycardia, diaphoresis
Page 17 of 22
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Pentobarbital Anticonvulsant, barbiturate, general anesthetic, sedative
Pentobarbital coma: loading dose = 10-30 mg/kg over 1-2 hours with continuous infusion of 1-5 mg/kg/hour to maintain burst suppression on EEG
50 mg/mL Do not inject > 50 mg/min; rapid injection may cause resp depression, apnea, laryngospasm, and hypotension
2 gm/day 4000 mcg/mL 30 minutes (slow infusion if QT interval becomes prolonged or develops heart block)
Dose adjust in renal or hepatic impairment Discontinue if hypotension or QRS interval widens to >50% baseline
Monitoring Parameters: continuous EKG monitoring, serum concentrations, IV site (thrombophlebitis may occur with prolonged infusion). Adverse Effects: hypotension, , arrhythmias, cardiac arrest, puritis, hematologic abnormalities
Page 18 of 22
Updated: 12/2013
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Propofol General anesthetic
Sedation: 100-150 mcg/kg/min for 3-5 min and titrate to desired sedation while monitoring resp function. During first 10-15 min following induction, infusion rates of 25-75 mcg/kg/min are generally required. After first 30 min, adjust infusion rate to clinical response.
10 mg/mL IVP over 20-30 seconds
MD to IVP Cardiorespiratory depression may result from bolus dosing or rapid increase in infusion rate. Therefore, wait 3-4 min between dosage adjustments to assess pt response.
Monitoring Parameters: Respiratory rate, blood pressure, heart rate, oxygen saturation, ABG, depth of sedation, serum lipids or triglycerides with use >24hr Adverse Effects: Hypotension (dose related), bradycardia, myocardial depression, flushing, fever, headache, dizziness, hyperlipidemia, respiratory depression, apnea, myalgia
Pediatric Intensive Care Unit (PICU) Nurse’s Guide Intravenous Drip List – Approved for RN Administration
University of Kentucky Chandler Medical Center
GENERIC/ BRAND NAME
THERAPEUTIC CATEGORY
TYPICAL CHILD DOSE MAXIMUM CHILD DOSE
MAXIMUM CONCENTRATION
MAXIMUM RATE OF
ADMINISTRATION
ADMINISTRATION CONSIDERATIONS
ADVERSE EFFECTS/COMMENTS MONITORING PARAMETERS
Tromethamine (THAM)
Alkalinizing agent
Dose depends on severity and progession of acidosis:
Neonates: manufacturer’s recommendation: 1 ml/kg for each Ph unit < 7.4
Empiric dose based upon base deficit: Tromethamine dose = wt (in kg) x base deficit (mEq/L) (max 500 mg/kg/dose) = 13.9 ml/kg using 0.3 M solution
Metabolic acidosis with cardiac arrest: tromethamine = 3.5-6 ml/kg/dose; maximum 500 mg/kg/dose = 13.9 ml/kg using 0.3 M soln
33-40 mL/kg/day
0.3 Molar solution 3-16 mL/kg/hr Infuse slowly over at least one hour Administer through a central line and avoid low-lying umbilical venous lines 1 mM = 120mg = 3.3ml = 1 mEq THAM Extravasation may cause tissue necrosis, severe inflammation, and sloughing.
Monitoring Parameters: Serum electrolyes, arterial blood gases, serum pH, blood sugar, EKG monitoring, renal function tests Adverse Effects: Overdose or excessively rapid administration may cause prolonged hypoglycemia, respiratory depression, apnea, hemmorhagic liver necrosis, venospasm, hyperosmolality of serum, hyperkalemia
Valproic Acid Antiepileptic; used for treatment of refractory migraines
Status epilepticus:
loading dose: 20-40 mg/kg
continuous infusion: 1-2 mg/kg/hour (max of 6 mg/kg/hour)
100 mg/kg/day
25-50 mg/mL Bolus: 3-6 mg/kg/min
Maintenance doses should be determined based on clinical response and total serum valproate concentrations (50-100 mg/L)
If the medication is not approved for administration and alternative routes of administration are not available, approval for this individual
situation must be obtained through collaboration with pharmacy and the patient care manager Updated: December 2013 Developed by: Abby Bailey and Brian Gardner Approved by: - Contact person for revisions: Brian Gardner ([email protected])
