VUMC INTRAVENOUS MEDICATION ADMINISTRATION CHART Approved by Pharmacy, Therapeutics, and Diagnostics Committee, Last Revised August 2018

Transcription

1 * Refer to references such as Mosby s for additional information on administration and monitoring. Alternate infusion rates permitted at provider discretion. ** Central Line Preferred indicates that the medication is associated with venous irritation. Certain situations may require that the medication be administered peripherally (e g., emergency situations, waiting on central line placement, or very short duration planned). Infusion of these medications/solutions through a peripheral vein may lead to loss of vascular access or damage to the vein and/or surrounding tissue, resulting in chemical phlebitis and thrombus formation. Other factors including vein size, infusion rate, catheter dwell time, catheter size and location also influence the risk of phlebitis. Monitor closely for signs and symptoms of infiltration and/or phlebitis if given peripherally. Adenosine (Adenocard) Albumin Alemtuzumab (Campath) Alprostadil (Prostin VR) AlteplaseTissue Plasminogen Activator (t-pa) (Activase) Aminocaproic Acid (Amicar) = Approved for Level of Care Antiarrythmic 6 mg / 2 ml Infusion not recommended MD present MD present MD present Blood Product Not for IV Push 5% or 25% Derivative Monoclonal Antibody Not for IV Push 30 mg / 100 ml Prostaglandin < 1.5 kg: 5 mcg/ml & 1 mcg/ml 1.5 kg: 5 mcg/ml & 20 mcg/ml Thrombolytic 1 mg/ml 100 mg / 100 ml 1 mg/ml Hemostatic Agent Not for IV Push 20 Gm / 250 ml 20 mcg/ml

2 Amiodarone (Cordarone) Antiarrythmic Adult areas only with no titration of infusion = Approved for Level of Care Adult for pulseless VT or VF; 300mg in 30mL NS or D5W if conc > 2 mg/ml Bolus: 150 mg / D5W 100 ml Infusion: 360 mg / 200 ml (1.8mg/mL) (Std) 900 mg / 250 ml D5W (Max) Bolus: 2 mg/ml Infusion: 2 mg/ml or 6 mg/ml if conc > 2 mg/ml Angiotensin II (Giapreza) Vasoactive Agent Restricted to adult patients in MICU only with approval by Medical Director Not for IV Push 5,000 ng/ml (Std) 10,000 ng/ml (Max) Antithymocyte Globulin- Rabbit (Thymoglobulin) Immunosuppressant Not for IV Push 500mL (Std) May be dispensed in 250 ml for concentrated infusion. 0.5 mg/ml (Max)

3 = Approved for Level of Care Argatroban Anticoagulant 50 mg / 50 ml 1000 mcg/ml Ascorbic Acid Antioxidant Adult patients in the Burn ICU Not for IV Push Adult (Burn ICU only): 25 gms/lr 1000 ml Atropine Anticholinergic MD present MD present 1 mg /10 ml 0.4 mg/ml Basiliximab Monoclonal Antibody Not for IV Push 20 mg/ 50 ml (Simulect) Bivalirudin Anticoagulant 250 mg/50 ml (Angiomax) Bumetanide (Bumex) Diuretic 0.25 mg/ml 20 mg / 80 ml Buprenorphine (Buprenex) Butorphenol (Stadol) Opioid 0.3 mg/ml Opioid 1 mg/ml 0.25 mg/ml (Std) 0.02 mg/ml (for patients < 5 kg)

4 Calcium Chloride (CaCl) Electrolyte Intermittent infusion only = Approved for Level of Care Intermittent infusion only 1 gm / 10 ml 2 gm /100 ml Dialysis specific conc: 8 gm / 250mL 100 mg/ml Calcium Gluconate Electrolyte 1 gm / 10 ml 1 gm / 50mL chlorpromazine (Thorazine) Cisatracurium (Nimbex) Clevidipine (Cleviprex) Dialysis specific conc: 6 gm /100 ml Antipsychotic Not for IV Push 25 mg in 100 ml (Std) Neuromuscular Blocker 2 mg / ml 200 mg / 250 ml (Std) 400 mg / 250 ml (Max) 1 mg / ml 2 mg / ml Antihypertensive Not for IV Push 0.5 mg/ml CMV Intravenous Immune Globulin (Cytogam) Blood Product Derivative Not for IV Push

5 cyclosporine (SandIMMUNE) = Approved for Level of Care Immunosuppressant Not for IV Push Dose diluted in 250 ml glass (Std) Dose diluted in 100 ml glass (Max) Dexamethasone (Decadron) Dexmedetomidine (Precedex) 2.5 mg / ml Corticosteroid 4 mg/ml 10 mg/ml 15 mg/ml Sedative 400 mcg /100mL 400 mcg/100 ml (Std) 4 mcg/ml Dextrose in Water Nutrition Therapy 50% (Max) 5% (Std) 10% (Std) 20% (Max) - 5% (Std) 10% (Std) - Maximum given peripherally with Calcium additive 12.5% - Maximum given peripherally without Calcium additive Above 12.5% - Central Line Preferred Note: Above standards to not apply to dextrose in TPN

6 Diazepam (Valium) Benzodiazepine Digoxin(Lanoxin) Miscellaneous Adult areas only = Approved for Level of Care Intermittent Dosing Only Adult areas only 5 mg/ml 5 mg/50 ml (Std) 10 mg/50 ml (Max) 250 mcg/ml 10 mcg/ml, 100 mcg/ml Dihydroergotamine (DHE 45) diltiazem (Cardizem) diphenhydramine (Benadryl) DOBUTamine (Dobutrex) Antimigraine 1mg/mL Calcium Channel Blocker Only on 7A in Children s Hospital given as IV Push with Cardiology attending or EP fellow at bedside Antihistamine 50 mg/ml Adrenergic agonist 5 mg/ml 100 mg/100 ml (Std) 250 mg/250 ml (Std) 1000 mg/250 ml (Max) 5 kg 800 mcg/ml 1600 mcg/ml (Std) 3200 mcg/ml >5 kg 1600 mcg/ml (Std) 3200 mcg/ml

7 DOPamine (Intropin) Adrenergic agonist = Approved for Level of Care Exception: 7T3 kidney &/or pancreas transplants may receive in 1st 24hrs post-op while on 1:1 RN care 400 mg/250 ml (Std) 1600 mg/250 ml (Max) 5 kg 800 mcg/ml 1600 mcg/ml (Std) 3200 mcg/ml >5 kg 1600 mcg/ml (Std) 3200 mcg/ml 6400 mcg/ml Enalaprilat (Vasotec) ACE Inhibitor Adult areas only Adult areas only 1.25 mg/ml 25 mcg/ml

8 EPINEPHrine (Adrenalin) = Approved for Level of Care Adrenergic agonist 1:10,000 (0.1 mg/ml) 1:1,000 (1 mg/ml) 4 mg/250 ml (Std) 8 mg/250 ml (Max) Adult Emergency Dept Only: 1 mg/1000 ml (not prepared by the pharmacy; not utilized outside the Adult ED) Eptifibatide (Integrilin) Esmolol (Brevibloc) Antiplatelet Beta-blocker Restricted to VUH Cardiac Stepdown (5S, 7N, 7S and 8S) with EP physician approval and no titration of infusion 5 kg: 16 mcg/ml (Std) 32 mcg/ml > 5 kg: 32 mcg/ml (Std) 64 mcg/ml 200 mcg/ml bolus 750 mcg/ml infusion 10 mg/ml 2500 mg /250 ml (Std) 2000 mg/100 ml (Max) 10 mg/ml 20 mg/ml (premix) Note concentration of vial Etomidate (Amidate) Sedative 2 mg/ml

9 Famotidine (Pepcid) fentanyl (Sublimaze) Opioid PCA; Epidural VUH only Flumazenil (Romazicon) Fosphenytoin (Cerebyx) Furosemide (Lasix) = Approved for Level of Care Antihistamine 10 mg/ml PCA; Epidural VUH only 50 mcg/ml 5 mcg/ml 50 mcg/ml Antidote 1 mg/10 ml 50 mcg/ml 100mL 2.5 mcg/ml 10 mcg/ml 25 mcg/ml 50 mcg/ml Anticonvulsant 50 mg PE /ml Doses greater than 300 mg PE will be mixed by pharmacy. Diuretic Infusions allowed in VUH only 1000 mg PE/ 250 ml 10 mg/ml 200 mg/100 ml (Std) 10 mg/ml (Max) 1 mg/ml 2 mg/ml 4 mg/ml Glucagon Antidote 1 mg/1ml bolus 10 mg/50 ml infusion Glycopyrrolate (Robinul) Haloperidol (Haldol) HBIG (Hepagam B) Anticholinergic 0.2 mg/ml Antipsychotic 5 mg/ml Blood Derivative Product Not for IV Push ,000 units/250 mls in NS

10 = Approved for Level of Care Heparin Anticoagulant 5,000 units/ml 25,000 units/250 ml (Std) No concentrated infusion hydralazine (Apresoline) Nurse Managed Heparin Protocol limited to 9T3, 8T3, 6T3, 5N, Adult ED Nurse Managed Heparin Protocol limited to 8S, 7N, 7S, 5S, 5T3-COBS Nurse Managed Heparin Protocol limited to 8N, 6N, 6S, S74, TOBS Vasodilator Exception: 7T3 kidney &/or pancreas transplants may receive in 1st 24hrs post-op while on 1:1 RN care 20 mg/ml < 5 kg: 40 units/ml 5 kg: 100 units/ml Hydrocortisone sodium succinate (Solu-CORTEF) HYDROmorphone (Dilaudid) Corticosteroid 50 mg/ml Opioid Intermittent Dosing; Intermittent Dosing; 1mg/mL 50 mg/50 ml (Std) 500 mg/50 ml (Max) PCA; Epidural- VUH Only Infusions (no titration permitted) PCA; Epidural-VUH Only 30 mg/30 ml PCA (Std) 300 mg/30 ml PCA (Max) 50 mcg/ml 100 mcg/ml 1000 mcg/ml

11 Ibandronate (Boniva) Ibutilide (Corvert) Immune Globulin Intravenous -- IVIG (GAMMAGARD liquid) Immune Globulin Intravenous -- IVIG (GAMMAGARD S/D) Immune Globulin Intravenous -- IVIG (GAMUNE) = Approved for Level of Care Bisphosphonate 3 mg/ 3 ml Antiarrythmic 1 mg/50 ml Blood Product Derivative Blood Product Derivative Blood Product Derivative Not for IV Push Not for IV Push Not for IV Push *** This is the product of choice in patients with/ OR at risk of RENAL INSUFFICIENCY or RENAL FAILURE*** Immune Globulin Intravenous -- IVIG (CARIMUNE NF) *Products containing sucrose have been associated with acute renal failure* Blood Product Derivative Not for IV Push

12 Insulin Insulin : requires Q2hr BG checks- must switch to sliding scale within 8 hrs: charge nurse must agree to therapy = Approved for Level of Care Exception: 4N, 4MSC, and 5S have ICU privileges for insulin drips. of infusion: requires Q2hr BG checksmust switch to sliding scale within 8 hrs: charge nurse must agree to therapy 100 units / 100 ml 0.1 units/ml 0.5 units/ml 1 unit/ml Pharmacy will prepare all doses of U-500 concentration Isoproterenol (Isuprel) Adrenergic agonist 4 mcg/ml 0.2 mg/50 ml (for EP use) 1 mg/100 ml (Std, Max) Peds (All weights): 4 mcg/ml (for EP use) 16 mcg/ml (Std)

13 Ketamine (Ketalar) Sedative (high doses) Analgesic (low doses) = Approved for Level of Care Adult patients only on 9N and 9T3 areas (pilot areas) as low dose infusion at 2.5 mcg/kg/min with no bolus or titration of infusion 10 mg/ml (Std) Adult patients 50 mg/ml (Max) only on S44, 7T3, and 9S (pilot areas) as low dose infusion at 2.5 mcg/kg/min with no bolus or titration of infusion 100 mg/100 ml (for OR/anesthesia only) 500 mg/100 ml (Std for pain, sedation) 5 kg: 1 mg/ml (Std) 5 mg/ml (Max) > 5 kg: 5 mg/ml (Std) Ketorolac (Toradol) Labetalol (Normodyne, Trandate) Levothyroxine (Synthroid) Lidocaine (ylocaine) NSAID 15 mg/ml Beta-blocker Exception: 7T3 kidney &/or pancreas transplants may receive in 1st 24hrs post-op while on 1:1 RN care Thyroid Hormone 100 mcg/ml (intermittent dosing) Antiarrythmic Adult patients only; No titration of infusion 5 mg/ml 400 mg/500 ml (Std) 800 mg/250 ml (Max) 0.8 mg/ml 3.2 mg/ml 100 mcg/250 ml infusion used for TDS Donor Protocol only 10 or 20 mg/ml 2000 mg/250 ml (Std) 8 mg/ml

14 Liothyronine (Triostat) LORazepam (Ativan) Lymphocyte immune globulin; Antithymocyte Globulin Equine (Atgam) = Approved for Level of Care Thyroid Hormone 0.2 mcg/ml Benzodiazepine Intermittent dosing only B.A.D. syringe only, otherwise intermittent dosing only 2 mg or 4 mg/ml 50 mg/50 ml (Std) 0.5 mg/ml 1 mg/ml Immunosuppressant Not for IV Push Dose diluted in 250 ml (Std) Dose diluted in 500 ml (Max) Magnesium Sulfate Electrolyte 1000 mg / 2 ml 2 gm / 50 ml (Std) Mannitol (Osmitrol) Meperidine (Demerol) Methyldopa (Aldomet) Methylergonovine (Methergine) Methylprednisolone sodium succinate (Solu-MEDROL) Osmotic agent 20% or 25% Opioid 10 mg/ml Antihypertensive Miscellaneous 0.2 mg/ml Dilute dose to 10mg/mL concentration with NS Corticosteroid Varies by vial size 300 mg / 30 ml PCA (Std) 50 mg/ml Add dose to 100 ml D5W or NS Methylprednisolone acetate is for IM use only. Metoclopramide Antiemetic 5 mg/ml (Reglan)

15 Metoprolol (Lopressor) Beta-blocker = Approved for Level of Care Exception: 1 mg/ml 7T3 kidney &/or pancreas transplants may receive in 1st 24hrs post-op while on 1:1 RN care Midazolam (Versed) Benzodiazepine Moderate sedation with MD present; 6A patients receiving MIBG therapy may receive per MIBG Anxiolysis Protocol 1 mg/ml 5 mg/ml 70 mg/70 ml (Std) 0.25 mg/ml 0.5 mg/ml 1 mg/ml 5 mg/ml Milrinone (Primacor) Inotropic agent Pediatric Cardiac Inpatient Unit Only 200 mcg/ml bolus 40 mg/200 ml (Std) 80 mg/200 ml (Max) 100 mcg/ml 200 mcg/ml 800 mcg/ml

16 Morphine Sulfate Opioid 4 mg/ml 10 mg/ml 15 mg/ml = Approved for Level of Care 1 mg/ml (Std) 30 mg/30 ml PCA (Std) 150 mg/30 ml PCA 300 mg/30 ml PCA (Max) Muromonab CD-3 (Orthoclone OKT3) Naloxone (Narcan) Immunosuppressant 5 mg/5ml Antidote 0.04 mg/ml 0.4 mg/ml 1 mg/ml 0.5 mg/ml 1 mg/ml 5 mg/ml Adults: 0.4 mg/ 1000 ml (for pruritis) 10 mg/ 100 ml (for overdose) 4 mcg/ml (for pruritus) 400 mcg/ml (for clonidine overdose) Neostigmine (Prostigmin) nicardipine (Cardene) Antidote 0.25 mg/ml 0.5 mg/ml Calcium Channel Blocker 1 mg/ml 50 mg / 250 ml (Std) 40 mg / 200 ml (ED, Radiology, Lifeflight only) 100 mg/250 ml (Max) 500 mcg/ml

17 Nitroglycerin (Nitrostat) Vasodilator = Approved for Level of Care 100 mcg/ml (intermittent dosing) 25 mg/250 ml (Std) 100 mg/250 ml (Max) 100 mcg/ml 400 mcg/ml Nitroprusside (Nipride) Vasodilator 50 mg/250 ml (Std) 100 mg/250 ml (Max) Norepinephrine (Levophed) Adrenergic agonist 200 mcg/ml 400 mcg/ml 800 mcg/ml 8 mg/250 ml (Std) 16 mg/250 ml (Max) 5 kg: 16 mcg/ml (Std) 32 mcg/ml (central line only) > 5 kg: 32 mcg/ml (Std-if central line) 16 mcg/ml 64 mcg/ml Octreotide (SandoSTATIN) Miscellaneous 50, 100, 500 mcg/ml 500 mcg / 250 ml (Std) 10 mcg/ml (Std)

18 Oxytocin (Pitocin) Pamidronate (Aredia) Paracalcitrol (Zemplar) PENTobarbital (Nembutal) = Approved for Level of Care Miscellaneous 10 units/ml 15 Units / 250 mls Bisphosphonate Vitamin D Analog 5 mcg/ml Sedative 6 mg/ml 3000 mg/500 ml (Std) PHENobarbital Anticonvulsant 130 mg/ml 50 mg/ml Phenylephrine (Neosynephrine) Adrenergic agonist CRC only, per Nesiritide study protocol with provider at bedside 100 mcg/ml 30 mg/250 ml (Std) 120 mg/250 ml (Max) 60 mcg/ml (Std) 120 mcg/ml Phenytoin Sodium (Dilantin) Phytonadione (Aquamephyton) Anticonvulsant 50 mg/ml Doses 250 mg = IV push Doses 250 mg to 499 mg in NS 50 ml Doses 500 mg in NS 100 ml Antidote Not for IV Push Adults: Dose diluted in 50 mls of NS 0.2 mg/ml

19 Potassium Chloride (KCl) = Approved for Level of Care Electrolyte Not for IV Push Adult Infusion: 10 meq/50 ml (Std) 20 meq/100 ml (Std) Max maintenance fluid conc: 80 meq/l Adult Parenteral Nutrition (PN) Maximum: Peripheral PN: 60 meq/l Central PN: 240 meq/day Peds Supplemental Infusion (K runs): Peripheral KCl run: 80 meq/l Central line KCl run: 200 meq/l Max dose for less than 20 kg = 10 meq infused at meq/kg/hr (Max 10 meq/hr) Max dose for greater than or equal to 20 kg and K less than 2.5 = 20 meq infused over 1-2 hrs Peds Maintenance Fluid: Max conc: 80 meq/l Peds Parenteral Nutrition (PN) Max: Peripheral PN: 80 meq/l Central PN: 200 meq/l Procainamide (Procan) Antiarrythmic 1000 mg/250 ml NS (Std) 2000 mg/250 ml NS (Max) 4000 mcg/ml

20 Prochlorperazine (Compazine) Promethazine (Phenergan) = Approved for Level of Care Antiemetic 5 mg/ml Antiemetic 2.5 mg/ml Dilute 25mg to volume of 10mL Restricted to central line and requires attending approval Propofol Sedative 10 mg/ml 10 mg/ml (Diprivan) Propranolol (Inderal) Beta-blocker 1 mg/ml Protamine Sulfate Antidote 10 mg/ml Ranitidine (Zantac) Remifentanil (Ultiva) Antihistamine 25 mg/ml Opioid Bolus: 50 mcg/ml 5 mg/250 ml Rituximab (Rituxan) 40 mcg/ml 200 mcg/ml Monoclonal Antibody Not for IV Push 1 mg/ml (Std) (50 mg/hr = 50 ml/hr) For Rapid Rate: Mix all doses in NS 300 ml total volume Rocuronium (Zemuron) Neuromuscular Blocker 10 mg/ml

21 = Approved for Level of Care Sodium Bicarbonate Electrolyte 50 meq/50 ml NICU: 4.2% (0.5 meq/ml) 23.4% Sodium Chloride Electrolyte Restricted use see IV Push Column Undiluted concentration = 4 meq/ml Restricted to the following indications: 1. Elevated Intra-Cranial Pressure (ICP) administered by MD Not for IV infusion 2. Treatment of muscle cramping in Dialysis Patients 3. Vein sclerosing in cosmetic and dermatology clinics administered by MD 3% Sodium Chloride Electrolyte (VCH & VUH) VUH only VUH only Not for IV Push meq/ml 5% Sodium Chloride Electrolyte For Dialysis Unit Use Only by Dialysis Staff Not for IV Push meq/ml

22 Succinylcholine (Anectine) Tacrolimus (Prograf) Vasopressin (Pitressin) = Approved for Level of Care Neuromuscular Blocker 20 mg/ml Immunosuppressant 5 mg/ml Dose diluted in 250 ml glass (Std) Vasoconstrictor Bolus: 20 unit/ml (0.5 or 1 ml) Dose diluted in 100 ml glass (Max) 20 units/50 ml (Std) Infusion: 1 unit/ml For DI dosing: units/ml 0.01 units/ml 0.02 units/ml For CV dosing: 0.05 units/ml; 0.1 units/ml 1 units/ml Vecuronium (Norcuron) Verapamil (Isoptin, Calan) Zolendronic Acid (Reclast or Zometa) Neuromuscular Blocker 1 mg/ml 20 mg/100 ml (Std) 100 mg/100 ml (Max) Calcium Blocker Channel 1 mg/ml 2.5 mg/ml 100 mg/250 ml (Std) Bisphosphonate 4 mg / 100 ml (Zometa) 5 mg / 100 ml (Reclast)

23 Unit / Area VUMC INTRAVENOUS MEDICATION ADMINISTRATION CHART Unit Designations Revised July 2018 ICU Designation Step down Designation General Care Designation VUH / CCT 11 North - Myelosuppression 11 South Burn ICU / Stepdown (beds 23-30) (all other beds) 10 North - Trauma 10 South - Orthopedic/Trauma 10T3 - Stem Cell Transplant 9 North 9 South - Urology 9T3 SICU 8 MCE - Medicine / Cardiac Stepdown 8 North 8 South - Cardiac/Medicine 8T3 MICU 7 North - Cardiac Stepdown 7 South - Cardiac Vascular Surgical 7 South - Dialysis 7T3 - Transplant and Surgical Care 6 North Neurology / Epilepsy 6 South Ortho/Spine 6T3 Neuro ICU / Stepdown (all other beds) (6642, 6644, 6646, 6648, 6649, 6651, 6653, 6655, 6656, 6657, 6659, 6661) 5 North CVICU 5 South Cardiac Stepdown 5T3 - Cardiac Cath Lab /Hybrid OR / EP Lab / PACU 5T3 - HR /Cardiac Observation (COBS) 4 MSC - Maternal Special Care 4 North Labor and Delivery 4 South - Holding and Recovery 4 South - Surgical areas 4 East 3 North CTU - Clinical Transition Unit ED MCN-A Wing - VFF Program OR / HR / PACU PTU - Psychiatric Transition Unit Radiology Outpatient Recovery S Clinical Research Center S GYN / General Surgery S Colorectal Surgical S Palliative Care / Medicine ICU level medications may be given to patients covered by a Palliative Care attending. Otherwise, patients are considered to be General Care S Orthopaedic Surgical Unit S Medicine / ACE Unit TOBS TVC OR VUH Newborn Nursery VUH Stahlman NICU Alternate infusion rates permitted at physician discretion. Note: Please refer to other references, such as Mosby's for additional information on administration and monitoring.

24 Unit / Area VUMC INTRAVENOUS MEDICATION ADMINISTRATION CHART Unit Designations Revised July 2018 ICU Step down General Care Designation Designation Designation VMG Any clinics not listed are considered to be general care designation Cool Springs Oncology Infusion Cool Springs Rheum infusion Med. Spec. Infusion (OHO) Oncology Infusion Peds Infusion Stem Cell Infusion VSAP Clinic Procedure Suites 5MCE-S ECHO/TEE Cosmetic Surgery Endoscopy Lab FEL Vanderbilt Bone and Joint Surgery Center Interventional Pain Clinic (OHO) MCE OR / HR / RR Oral Surgery Plastic Surgery Radiation Oncology TVC MOHS Dermatology Urology Children s Hospital ED 4A & 4B - NICU 5A & B & C 6 A - Myelosuppression 6 B Hematology / Oncology 6 C Acute Care Cardiology Unit 7A & B & C 8A & B & C OR / HR / PACU Vanderbilt Psychiatric Hospital ECT Suite All other areas Alternate infusion rates permitted at physician discretion. Note: Please refer to other references, such as Mosby's for additional information on administration and monitoring.