6 th Floor and 7 East Nurses Guide Intravenous Drip List Approved for RN Administration University of Kentucky Chandler Medical Center
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1 RATE Abciximab (Reopro) Alteplase (tpa, Activase) All units 6S and 6W ONLY Platelet aggregation inhibitor Thrombolytic agent Bolus: 0.25 mg/kg IV over 5 min Infusion: mg/kg (max 90 mg); 10% of dose over 1 min, remainder infused over 60 min (for stroke) Amiodarone All units Antiarrhythmic Bolus: mg Infusion: 1 mg/min x 6hr, 0.5 mg/min thereafter Aminophylline All units Bronchodilator 0.5 mg/kg/hr (depending on levels) mcg/min Infuse with 0.2 or 0.22 micron filter 90 mg (stroke); 100 mg (PE and MI) Maintenance: 900 mg/24 hours Argatroban All units Anti-coagulant 2 Adjusted based on aptt (physician - - Consider bedrest, Avoid invasive procedures, Establish separate IV line 750 mg/500ml (1.5 mg/ml) 1 mg/min continuous infusion Infusions greater than 2 hours must be in a glass bottle mg/min May monitor theophylline levels 1 mg/ml Variable based on aptt (physician Will lead to increases in PT and INR Monitor for bleeding, use with ASA and heparin to minimize bleeding risk Monitor PT/aPTT; Monitor Bleeding Hypotension, bradycardia, N/V, HA, fatigue, prolonged QT interval Agitation, tachyarrhythmia, seizure Monitor for Bleeding Monitor aptt Page 1 of 6
2 RATE Bivalirudin (Angiomax) Bumetanide (Bumex) All units Anti-coagulant 0.25 mg/kg/hr All units Diuretic mg/hour Diltiazem All units Calcium Channel Blocker Bolus: 0.25mg/ kg (~20mg) IV over 2 min Infusion: 5-15 mg/hr Dobutamine All units Inotropic Agent Adjusted based on aptt (physician - Variable based on aptt (physician - Monitor for Bleeding Monitor aptt 2 mg/hour 0.25 mg/ml 2 mg/hour - Volume depletion, hypotension hypokalemia 15 mg/hour 1 mg/ml 15 mg/hr Overdosage: Bradycardia- Atropine 10 mcg/kg/ min on the floor 1000 mcg/ml 2000 mcg/ml 10 Administer through a Central line; Hypotension, bradyarrhythmia, and flushing Hypotension, tremors tachycardia, chest pain, anxiety, HA, and PVC's Dopamine (Renal Dose Only) All units Vasopressor 1-5 (Renal dose) - Usual: 1600 mcg/ml Max: 6400 mcg/ml 5 Infuse through a central line; Monitor urinary output, BP and HR (tachyarrhythmia) Page 2 of 6
3 RATE Epoprostenol (Flolan) 6 North ONLY Vasodilator/ Antiplatelet for Pulmonary Hypertension 2-16 ng/kg/ min Patient specific - - Numerous see Flolan guidelines. Do not let bag run dry-sudden death can occur N & V, Hypotension, Flushing, Chest pain, Anxiety, Dizziness, Bradycardia, and Dyspnea, Eptifibatide (Integrilin) Fenoldopam Mesylate (Corlopam) Furosemide (Lasix) All units Antiplatelet agent Bolus: 180 mcg/kg Infusion: 1-2 All units Anti-hypertensive 0.1 mcg/ kg/min mcg/ kg/min (maximum on floor) All units Diuretic 1-4 mg/hr 40 mg/hr 1 mg/ml 100 mg/ml 0.75 mg/ml 15 mg/hr Monitor for IV infiltration (maximum on floor) May be d/c d abruptly without tapering Monitor for bleeding, respiratory distress Monitor BP Q15 min x4 upon initiation or change in dose followed by q30 min x1, then q1h x2, then q4h. can alter ECG, can cause arrhythmias - - Volume depletion, hypotension, and hypokalemia Page 3 of 6
4 RATE Heparin Infusion (Heparin Drip Protocol) - Anticoagulant/ DVT/PE/MI 500-1,800 units Initial bolus: units/kg - 50 units/ml - Nursing managed infusion and titration protocol. See order in SCM for specific instructions Bleeding, APTT (nursing, HCT, Hgb Thrombocytopenia (HIT- Heparin induced) Infusion: units/kg/hr Reversal agent- Protamine Takes 6 hours to see maximal effects of dose change Insulin Regular Intensive Insulin Protocol 6S and 6W ONLY Pancreatic Hormone Pt. Specific Usual: 2-10 units/hr - 1 unit/ml - Monitor Blood glucose as ordered Lidocaine All Units Antiarrhythmic 1-4 mg/min 4 mg/min - - Use cautiously in liver patients and elderly Hypoglycemia, hypokalemia Hypotension; CNS toxicity Page 4 of 6
5 RATE Milrinone All Units Vasodilator mcg/ml - Incompatible with furosemide, Caution in renal patients Tachyarrhythmia, chest pain, Hypotension, and HA Thrombocytopenia Morphine All Units Narcotic Analgesic 1-5 mg/hr - 1 mg/ml - Naloxone at bedside Monitor for respiratory depression and hypotension Nesiritide (Natrecor) All Units Vasodilator/ diuretic Nitroglycerin All Units Vasodilator/ Nitrate 0.01 mcg/kg/ min 5-50 mcg/ min 0.03 Procainamide All Units Antiarrhythmic 1 6 mg/min 17 mg/kg loading dose 6 mcg/ml Monitor BP Q15 min x4 upon initiation or change in dose followed by q30 min x1, then q1h x2, then q4h mcg/ml (50 mcg/250 ml) 50 mcg/min Maximum on Floor Use non-pvc, Duo-Vent spike Tubing Nursing is not to titrate without specific physician parameters Monitor BP Q15 min x4 upon initiation or change in dose followed by q30 min x1, then q1h x2, then q4h. HA, hypotension, and syncope 8 mg/ml 50 mg/min Hypotension, bradycardia, rash, nausea Pantoprazole - Gastrointestinal Proton Pump inhibitor 80 mg bolus followed by 8mg/hr infusion - - 8mg/hr Infusion for 5 days Headache, dyspepsia, and nausea Page 5 of 6
6 RATE Sodium Bicarbonate Treprostinil (Remodulin) - Alkalinization Agent 6N Only Vasodilatory/ Antiplatelet for Pulmonary Hypertension meq in 1 liter of D5W 2-10 ng/kg/min Valproic acid - Anticonvulsant mg/kg/day meq/1000ml Patient specific - Many Incompatibilities - - Numerous see guidelines mg/ml 6 mg/kg/min (IVPB bolus) May be infused by patient s own subcutaneous pump or IV infusion Edema, hypernatremia - Blood pressure N & V, Hypotension, Flushing, Chest pain, Anxiety, Dizziness, Bradycardia, and Dyspnea, : Revised by: Christy Taylor, PharmD and Lori Proeschel, PharmD Approved by: Nina Barnes, Staff Development; Leslie Cumming-Kinney, RN; and Kimberley Hite, MS, PharmD Contact person for revisions: Kimberley Hite, MS, PharmD (khite2@uky.edu) Page 6 of 6
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