PICU IV InfusionChart - Michigan Medicine

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University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]STANDARDCONCENTRATIONUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferredALPROSTADIL(PGE, PROSTIN,PROSTAGLANDIN)100mcg/33.3mL (3mcg/mL)1000mcg/250mL (4mcg/mL)200mcg/33.3mL (6mcg/mL)*Used for PDApatency (newborncardiac) or graftpatency (livertransplant)AMINOPHYLLINE*IV form oftheophyllineDiluents: D5W, D10W, NSAMIODARONELOADING DOSE &BOLUS DOSE100mg/50mL (2mg/mL)250mg/50mL (5mg/mL)500mg/50mL (10mg/mL)Diluents: D5W, D10W, NS10mg/20mL (0.5mg/mL)20mg/20mL (1mg/mL)100mg/50mL (2mg/mL)Central Line ONLY:250mg/50mL (5mg/mL)300mg/50mL (6mg/mL)Diluents: D5WNONE0.03-0.2mcg/kg/minDO NOT TITRATETransplant: 1040mcg/hr based onpatient weightLoading: 5-7mg/kg IVgiven over 30 minutesLoading: 50kg: 5mg/kg IV up toMAX of 150mg/dosegiven over 60 minutes; ifcardiac rhythm responseis not achieved,prescriber may chooseto repeat loading dose(MAX 15mg/kg/day or450mg/day)0.5-1.2mg/kg/hrNote: refer to PedsLexicomp for ageappropriate dose 50kg: 5-15 mcg/kg/min[All conc] 50kg: 1mg/min x 6hrs,then 0.5mg/min[2mg/mL and 6mg/mLconc ONLY]DO NOT TITRATE§ Transplant dosing isdifferent; refer to livertransplant protocol inOTIS§ 6mcg/mL conc use“alprostodil nonstandard” in 50kgPICU Cardiac A-Isyringe pump library§ Follow theophyllinelevels 1hr post-load,then Q12-24hr§ Therapeutic: 10-15mcg/mL§ Toxicity 20mcg/mLDO NOT TITRATE§ MUST BE FILTEREDwith 0.22micron filter§ Tubing good for 72hours 50kg: 150mg/dose IVgiven over 60 minutes;if cardiac rhythmresponse is notachieved, prescribermay choose to repeat(MAX 450mg/day)* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]ARGATROBANSTANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSEUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSBolded diluent is standard/preferred20mg/20mL (1mg/mL)50mg/50mL (1mg/mL)Loading: ONLY used incath lab or to primeECMO circuit0.1-3mcg/kg/minECMO:0.5-2mcg/kg/minDO NOT TITRATELoading: 50-100mg/kgIV up to MAX of5000mg/dose givenover 60 minutes 50kg: 25-30mg/kg/hr,total hourly dose cannotexceed 1000mg/hrDO NOT TITRATEDiluents: D5W, NSAMINOCAPROICACID [AMICAR ]1000mg/50mL (20mg/mL)5000mg/250mL (20mg/mL)Diluents: D5W 50kg: 1000mg/hrBUMETANIDE[BUMEX ]CALCIUM CHLORIDECISATRICURIUM[NIMBEX ]COMMENTS5mg/20mL (0.25mg/mL)12.5mg/50mL (0.25mg/mL)No Diluent – This is straightdrugCentral Line ONLY:1000mg/50mL (20mg/mL)2000mg/100mL (20mg/mL)5000mg/250mL (20mg/mL)50mg/50mL (1mg/mL)100mg/50mL (2mg/mL)Diluents: D5W, NSNONE0.01-0.04mg/kg/hrDO NOT TITRATENONE2.5-20mg/kg/hrDO NOT TITRATECRRT Calcium Infusion:per CRRT CitrateprotocolException: For CRRTcalcium infusion, titrateper CRRT CitrateprotocolTitrate by0.5mcg/kg/min every30-60 minutes untilordered Train-of-Four ormax ordered doseachievedLoading: 0.1 mg/kg IVgiven over 5-10 secondsand then initiatecontinuous infusionBolus: May give0.1mg/kg over 5-10seconds with eachinfusion increase1-10mcg/kg/min§ Follow aPPTs or antiIIa levels§ ECMO follows ACTs§ Lower dosing neededin liver failure§ Mott infusions(syringes) run asmg/kg/hr§ UH infusion orders(250mL bags) run inmg/hr§ Found under “PICUMisc Continuous” in 50kg PICU syringepump library§ CENTRAL LINEadministration ONLY*Neuromuscularblockade*§ Monitor withperipheral nervestimulation (Train-ofFour)§ Recommendedstarting voltage: 2 Hzevery 0.5 seconds x 4,may repeat in 12seconds* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]DEXMEDETOMIDINE[PRECEDEX ]STANDARDCONCENTRATION80mcg/20mL (4mcg/mL)200mcg/50mL (4mcg/mL)10mg/50mL (0.2mg/mL)50mg/50mL (1mg/mL)Diluents: D5W, NSDOBUTAMINEUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTS§ Common side effects:bradycardia andhypotension§ Due to nocompatibilityinformation fordexmedetomidine andTPN, placedexmedetomidinestopcock furthest fromTPN stopcock ifrunning via samelumen§ Pediatric ICUDexmedetomidineGuidelinesBolded diluent is standard/preferredDiluents: D5W, NSDILTIAZEM[CARDIZEM ]LOADING DOSE &BOLUS DOSE50mg/50mL (1mg/mL)100mg/50mL (2mg/mL)150mg/50mL (3mg/mL)Central Line ONLY:250mg/50mL (5mg/mL)Loading: Due topotential side effects,loading doses are notcurrently recommended0.2-1.5mcg/kg/hrTitrate by0.1-0.2mcg/kg/hr every30 minutes untilordered sedation or maxordered dose achievedLoading: 0.25mg/kg IVgiven over 2 minutes;after 15 minutes ifcardiac rhythm responseis not achieved,prescriber may order 2nddose of 0.35mg/kg IVNONE 50kg: 0.070.2mg/kg/hr[All conc]DO NOT TITRATE 50kg:5-15mg/hr[1mg/mL conc ONLY]2-20mcg/kg/minTitrate by2-5mcg/kg/min every 5minutes until orderedparameter or maxordered dose achievedDiluents: D5W, D10W, NS* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]DOPAMINESTANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSEUSUAL DOSE RANGE50mg/50mL (1mg/mL)100mg/50mL (2mg/mL)150mg/50mL (3mg/mL)NONE2-20mcg/kg/minTitrate by2-5mcg/kg/min every 5minutes until orderedparameter or maxordered dose achievedDiluents: D5W, D10W, NS0.2mg/20mL (0.01mg/mL)1mg/50mL (0.02mg/mLNONE0.01-1mcg/kg/minTitrate by0.01-0.02mcg/kg/minevery 5 minutes untilordered parameter ormax ordered doseachievedNONEStarting dose:2-3ng/kg/minDO NOT TITRATECentral Line ONLY:2 mg/50mL (0.04mg/mL)6 mg/50mL (0.12mg/mL)EPOPROSTANOL[FLOLAN ]COMMENTSBolded diluent is standard/preferredCentral Line ONLY:300mg/50mL (6mg/mL)EPINEPHRINEHYDROCHLORIDENURSING TITRATIONINSTRUCTIONSDiluents: D5W, D10W, NS0.03mg/10mL (3mcg/mL)0.1mg/20mL (5mcg/mL)0.75mg/50mL (15mcg/mL)1.5mg/50mL (30mcg/mL)Alternate volumes availableSpecial concentrationsavailable – must beapproved by PharmacySpecial Flolan Diluent1ng (nanogram) 0.001mcgOR1000ng (nanogram) 1mcg*Titration based onpatient response per MDorder. Usual doseincrease by1-2ng/kg/min every 8-24hours.§ Flolan cartridges arestable for 24 hours –store on ice andprotect from light§ Flolan syringes mustbe changed every 8hours – do not have tocover syringe or IVtubing§ Flolan is NOTCOMPATIBLE with anyother medications orIV fluids§ DO NOT stop, pause,or interrupt Flolaninfusion§* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]ESMOLOL[BREVIBLOC ]STANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSEFENTANYL[SUBLIMAZE ]NURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferred400mg/20mL (20mg/mL)1000mg/50mL (20mg/mL)Loading: 50-500mcg/kggiven over 1 minute1.6mg/20mL (80mcg/mL)4mg/50mL (80mcg/mL)Diluents: D5W, NS1 mg/20 mL (50 mcg/mL)0.5mg/20mL (25mcg/mL)50-200mcg/kg/minIf 2yr may run300-800mcg/kg/minwith MD orderDiluents: D5W, NSFENOLDOPAMUSUAL DOSE RANGETitrate by25mcg/kg/min every 5to 15 minutes untilordered parameter ormax ordered doseachievedDO NOT TITRATENONE0.1-0.8mcg/kg/minLoading: 1-2mcg/kg IVgiven slow IV push*1-10mcg/kg/hrTitrate by 0.5mcg/kg/hrevery 30 minutes untilordered parameter ormax ordered doseachieved 50kg:0.05-0.4mg/kg/hr[All conc]DO NOT TITRATEBolus: May give 12mcg/kg slow IV pushwith each infusionincrease§ Found under “PICUMisc Continuous” in 50kg PICU syringepump library§ Pushing IV fentanyltoo quickly will resultin chest wall rigidity*Administration ratesfor loading or bolusdoses: 5mcg/kg 3-5 minutes 5mcg/kg 5-10 minutesFUROSEMIDE[LASIX ]20mg/20 mL (1mg/mL)125mg/50mL (2.5mg/mL)250mg/50mL (5mg/mL)200mg/20mL (10mg/mL)Diluents: D5W, D10W, NSNONE 50kg:0.5-40mg/hr [5mg/mLand 10mg/mL concONLY]* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]HEPARINSTANDARDCONCENTRATIONUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is s/mL)20,000units/50mL(400units/mL)INSULIN REGULARLOADING DOSE &BOLUS DOSEDiluents: D5W, D10W, NS2units/20 mL (0.1unit/mL)20units/20mL (1unit/mL)50units/50mL (1unit/mL)250units/50mL (5units/mL)Diluents: D5W, D10W, NSLoading: 50-80units/kgIV given over 15 minutesStarting Dose:15-18units/kg/hrECMO Loading:100mg/kg IV given over15 minutesMaintenance DoseRange: EMIA ofcritical illness: 50kg:Start at 0.050.1units/kg/hr[All conc]DO NOT TITRATE§ MONITOR PTT (or antiXa level)§ Doses will be adjustedper PTT (or anti-Xalevel)§ Nomogram imbeddedin CareLink order§ ECMO uses differentconcentrations§ ECMO monitors ACTsDKA: DO NOT TITRATE§ MONITOR GLUCOSELEVELS§ For insulin infusionguidelines on pediatricdiabetic patients seePediatricEndocrinologyGuidelines for DKAHYPERGLYCEMIA ofcritical illness: DO NOTTITRATE 50kg: Start at 1unit/hr[1unit/mL and 5unit/mLconc ONLY]* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]ISOPROTERENOL[ISUPREL ]STANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSEUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferred0.2mg/20mL (0.01mg/mL)NONE0.01-2mcg/kg/minDO NOT TITRATELoading: 0.5-2mg/kg IVgiven over 1 minute5-40mcg/kg/minTitrate by 5mcg/kg/minevery 30 minutes untilordered sedation or maxordered dose achieved 50kg:0.25-3.0mg/kg/hr[All conc]DO NOT TITRATECentral Line ONLY:1mg/50mL (0.02mg/mL)KETAMINE[KETALAR ]Diluents: D5W, NS100mg/50mL (2mg/mL)250mg/50mL (5mg/mL)500mg/50mL (10mg/mL)Diluents: D5W, NSLABETOLOL20mg/20mL (1mg/mL)100mg/50mL (2mg/mL)Bolus: May give 0.52mg/kg IV over 1minute with eachinfusion increaseLoading: 0.2-1mg/kg upto MAX of 20mg/doseIV given over 5 minutesCentral Line ONLY:250mg/50mL (5mg/mL) 50kg:0.5-3mg/min[5mg/mL conc ONLY]Diluents: D5W, NSLEVOTHYROXINE(T4 – GIFT OF LIFE)[SYNTHROID ]100mcg/50mL (2mcg/mL)200mcg/500mL(0.4mcg/mL)Loading: 0.8-5mcg/kg IVgiven over 30-45minutes 50kg:0.8-1.4mcg/kg/hr[2mcg/mL conc ONLY] 50kg:1-20mcg/hr[0.4mcg/mL conc ONLY]DO NOT TITRATE§ Not in syringe pumplibrary§ Syringe expires in 12hours§ Age based dosingavailable under “Organdonor management”in dosing section* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME L (4mg/mL)Diluents: D5W, NS4mg/20mL (0.2mg/mL)20mg/20mL (1mg/mL)50mg/50mL (1mg/mL)Diluents: D5W, D10W, NSMIDAZOLAM[VERSED ]USUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferredCentral Line ONLY:2000mg/250mL (8mg/mL)LORAZEPAM[ATIVAN ]LOADING DOSE &BOLUS DOSE4mg/20mL (0.2mg/mL)20mg/20mL (1mg/mL)50mg/50mL (1mg/mL)Diluents: D5W, D10W, NSCardiac Loading: 1mg/kgIV given over 2 minutes.After 15 minutes ifcardiac rhythm responseis not achieved,prescribe may choose torepeat loading dose.Loading: 0.1-0.3mg/kgIV given over 1-2minutesFor cardiac:20-80mcg/kg/minBolus: May give 0.10.3mg/kg IV over 1-2minutes with eachinfusion increase 50kg: 1-10mg/hr[1mg/mL conc ONLY]Loading: 0.05-0.2mg/kgIV given over 2 minutes 50kg:20-200mcg/kg/hr[All conc]Bolus: May give 0.050.2mg/kg IV over 2minutes with eachinfusion increaseDO NOT TITRATE§ Check lidocaine levelQ24hr§ Therapeutic: 1.5-5mcg/mL 50kg:Titrate by10-20mcg/kg/hr every60 minutes untilordered sedation or maxordered dose achieved§ Doses above200mcg/kg/hr or10mg/hr may be usedbut patient should bemonitored forpropylene glycoltoxicity (osmolar gapmetabolic acidosis)For chronic pain:15-30mcg/kg/min 50kg:20-200mcg/kg/hr[All conc] 50kg:1-10mg/hr[1mg/mL conc ONLY] 50kg:Titrate by 0.5-1mg/hrevery 60 minutes untilordered sedation or maxordered dose achieved 50kg:Titrate by10-20mcg/kg/hr every60 minutes untilordered sedation or maxordered dose achieved 50kg:Titrate by 0.5-1 mg/hrevery 60 minutes untilordered sedation or maxordered dose achieved* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME RATIONUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferred1mg/20mL (0.05mg/mL)2mg/20mL (0.1mg/mL)25mg/50mL (0.5mg/mL)Diluents: D5W, D10W, NS4mg/20mL (0.2 mg/mL)20mg/20mL (1mg/mL)50mg/50mL (1 mg/mL)250mg/50mL (5mg/mL)Diluents: D5W, D10W, NSNALOXONE(NARCAN )LOADING DOSE &BOLUS DOSEFor pruritus orhyperalgesia:1.1mg/20mL (0.005mg/mL)1.2mg/20mL (0.01mg/mL)For opioid reversal:10mg/100mL (0.1mg/mL)Diluents: NSLoading: 50mcg/kg IVgiven over 15 minutes*Do not routinely loadin the PICULoading: 0.1-0.3mg/kgIV given over 5 minutesBolus: May give 0.10.3mg/kg IV over 5minutes with eachinfusion increaseNONE0.3-0.75mcg/kg/minDO NOT TITRATE 50kg:20-200mcg/kg/hr[0.2 and 1mg/mL concONLY] 50kg:Titrate by10-20mcg/kg/hr every60 minutes untilordered parameter ormax ordered doseachieved 50kg:1-10 mg/hr[1mg/mL or 5mg/mLconc ONLY]For pruritus orhyperalgesia:0.1-0.25mcg/kg/hrFor opioid reversal:20-40mcg/kg/hr 50kg:Titrate by 0.5-1 mg/hrevery 60 minutesordered parameter ormax ordered doseachievedDO NOT TITRATE§ To decrease opioidinduced pruritus oropioid tolerance andrapid escalation§ For opioid reversal,dose may be higher orlower based onamount opioidintoxication* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]NESIRITIDE[NATRECOR ]*Used mostcommonly indecompensatedheart failure to helpdilate veins andarteriesNICARDIPINESTANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferred0.12mg/20mL (6mcg/mL)0.3mg/50mL (6mcg/mL)NONE0.01-0.03mcg/kg/minDO NOT TITRATE§ Common side effect:HYPOTENSIONNONE 50kg:1-5mcg/kg/min[0.3mg/mL and0.5mg/mL ONLY] 50kg:Titrate by0.2mcg/kg/min every 5minutes orderedparameter or maxordered dose achieved§ Watch peripheralinfusion site forinfiltration orextravasationDiluents: NS6mg/20mL (0.3mg/mL)40mg/200mL (0.2mg/mL) –NS onlyCentral Line ONLY:25mg/50mL (0.5mg/mL) 50kg:1-15mg/hr[0.2mg/mL and0.5mg/mL ONLY]Diluents: D5W, NSNITROGLYCERINUSUAL DOSE RANGE10mg/50mL (0.2mg/mL)Central Line ONLY:20mg/50mL (0.4mg/mL)NONE0.5-20mcg/kg/min 50kg:Titrate by 0.5-1mg/hrevery 5 minutes orderedeffects or max ordereddose achievedDO NOT TITRATE§ Use low-sorbing tubingMSC item #5101: Set,IV Low sorbing w/oportsDiluents: D5W, NS* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]NITROPRUSSIDE[NIPRIDE ]STANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSEUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSBolded diluent is standard/preferred10mg/20mL (0.5mg/mL)NONE0.5-10mcg/kg/minDO NOT TITRATENONE0.01-2mcg/kg/minTitrate by0.01-0.02mcg/kg/minevery 5 minutes orderedparameter or maxordered dose achievedNONEChylothorax:1-3mcg/kg/hrDO NOT TITRATECentral Line ONLY:50mg/50mL (1mg/mL)Diluents: D5W ONLYNOREPINEPHRINEBITARTRATE[LEVOPHED ]0.2mg/20 mL (0.01mg/mL)1mg/50 mL (0.02mg/mL)Central Line ONLY:2mg/50mL (0.04mg/mL)6mg/50mL (0.12mg/mL)OCTREOTIDEPANTOPRAZOLE[PROTONIX ]COMMENTSDiluents: D5W, D10W, NS0.05mg/20mL (2.5mcg/mL)0.25mg/50mL (5mcg/mL)0.5mg/50mL (10mg/mL)Diluents: D5W, NS16mg/20mL (0.8mg/mL)40mg/50mL (0.8mg/mL)Loading: 1-2mg/kg IV upto MAX of 80mg/dose)given over 5 minutesGI bleed:1-10mcg/kg/hr0.1-0.2mg/kg/hrDO NOT TITRATE§ Protect syringe fromlight – do not need tocover IV tubing§ Checkcyanide/thiocyanatelevel every 24 hours tomonitor for cyanidetoxicity§ Should be used for GIbleeding onlyDiluents: NS* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]PENTOBARBITAL[NEMBUTAL ]STANDARDCONCENTRATIONUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferred100mg/20mL (5mg/mL)Central Line ONLY:1000mg/20mL (50mg/mL)Diluents: D5W, D10W, NSPHENYLEPHRINE* Used mostcommonly inneurogenic shockLOADING DOSE &BOLUS DOSE2.5mg/50mL (0.05mg/mL)5mg/50mL (0.1mg/mL)Loading: 1-5mg/kg IVgiven over 20 minutes0.25-10mg/kg/hrDO NOT TITRATE0.05-5mcg/kg/minDO NOT TITRATEBolus: May give 12mg/kg IV over 20minutes with eachinfusion increaseNONE§ Vasopressor may beneeded to sustain BPdue to myocardialdepressant effects§ PICU Practice:Continuous infusionrequire in-line 0.22micron filter and use4-way ECMO stopcockto avoid drugprecipitation§ Infusion, tubing, andstopcock needs to bechanged Q12hrCentral Line ONLY:50mg/50mL (1mg/mL)Diluents: D10W, D5W, NS* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]PROCAINAMIDESTANDARDCONCENTRATIONUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferred80mg/20mL (4mg/mL)200mg/50mL (4mg/mL)Central Line ONLY:400mg/50mL (8mg/mL)2000mg/250mL (8mg/mL)Diluent: D5WPROPOFOL[DIPRIVAN ]LOADING DOSE &BOLUS DOSE500mg/50mL (10mg/mL)1000mg/100mL (10mg/mL)Loading: 50kg: 3-6 mg/kg IV upto MAX of 100mg/dosegiven over 5 minutes.After 10 minutes ifcardiac rhythm responseis not achieved,prescriber may chooseto repeat loading doseevery 5-10 minutes to atotal dose of 15mg/kgor 500mg in 30 minutes. 50kg: 15-18mg/kg IVgiven over 25-30minutes OR 100mg IVover 2 minutes repeatedevery 5 minutes asneeded to a total doseof 1000mg.NONE 50kg:20-80mcg/kg/min[All conc in syringes]DO NOT TITRATE§ Check Procainamideand NAPA levels 6 to12 hours after start ofcontinuous infusionTitrate by5-10mcg/kg/min every 5minutes until orderedsedation or max ordereddose achieved§ See Pediatric PropofolPolicy 50kg:1-4mg/min [8mg/mLconc ONLY]10-150mcg/kg/min* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]ROCURONIUMSTANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSEUSUAL DOSE RANGENURSING TITRATIONINSTRUCTIONSCOMMENTS7-12mcg/kg/minTitrate by 1mcg/kg/minevery 30-60 minutesuntil ordered Train-ofFour or max ordereddose achievedLoading: 2-10mcg/kg IVover 5 minutes0.08-4mcg/kg/minDO NOT TITRATE*Neuromuscularblockade*§ Monitor withperipheral nervestimulation (Train-ofFour)§ Recommendedstarting voltage: 2 Hzevery 0.5 seconds x 4,may repeat in 12seconds§ Common side effects:tachycardia, HTN,tremor, N/V, seizuresNONE0.0003-0.002unit/kg/minDO NOT TITRATENONE1milliunit/kg/hr 1unit/hrTitrate by0.25-0.5milliunit/kg/hrevery 60 minutes toordered UOPBolded diluent is standard/preferred50mg/50 mL (1mg/mL)Diluents: D5W, D10W, NSLoading: 1mg/kg IVgiven over 5-10 secondsand then initiatecontinuous infusionBolus: May give 1mg/kgIV over 5-10 secondswith each 0mL (0.1mg/mL)25mg/50mL (0.5mg/mL)50mg/50mL (1mg/mL)Diluents: D5W, NS4units/20 mL (0.2unit/mL)25units/50 mL (0.5unit/mL)Central Line ONLY:50units/50 mL (1unit/mL)VASOPRESSIN(DIABETESINSIPIDUS)Diluents: D5W, NSNo standard concentrationBased on patient weightTo calculate concentration:The vasopressin dose is 5%of patient’s weight in 50mLExample: 12kg patient12kg x 5% 0.6 units0.6units/50mL 0.012units/mL* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

University of Michigan – Department of Pharmacy ServicesIV Guidelines for PICU / CES / TBICU ( 12 years of age)DRUG – GENERICNAME [TRADENAME]VECURONIUMSTANDARDCONCENTRATIONLOADING DOSE &BOLUS DOSENURSING TITRATIONINSTRUCTIONSCOMMENTSBolded diluent is standard/preferred20mg/20mL (1mg/mL)50 mg/50 mL (1mg/mL)No diluents – this is straightdrugLoading: 0.1mg/kg IVgiven over 5-10 secondsand then initiatecontinuous infusionBolus: May give0.1mg/kg IV over 5-10seconds with eachinfusion increaseApproved:USUAL DOSE RANGE1-2.5mcg/kg/minTitrate by0.5mcg/kg/min every30-60 minutes untilordered Train-of-Four ormax ordered doseachieved*Neuromuscularblockade*§ Monitor withperipheral nervestimulation (Train-ofFour)§ Recommendedstarting voltage: 2 Hzevery 0.5 seconds x 4,may repeat in 12secondsPediatric Critical Care Joint Practice: 2/2013Pediatric Medication Safety: 2/2013Pharmacy & Therapeutics Committee: 2/2013* Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditionsmay warrant the use of doses higher than those listed above.Last Revised 3/11/2013 ver. 4

IV Guidelines for PICU / CES / TBICU ( 12 years of age) * Doses listed above are suggested maximum doses for patient safety; start at lowest dose when titrating unless clinical condition requires higher dose. Some clinical conditions may warrant the use of doses higher than those listed above. Last Revised

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