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MassGeneral Hospital for ChildrenNICU/PICU
Pediatric Medication Administration ProcessManual
For Syringe Pumps
1st edition
Copyright 2006
MassGeneral Hospital for Children
MassGeneral Hospital for Children NICU/PICU
Pediatric Medication Administration Process Manual For Syringe Pumps
1st edition
Editor in Chief
Nat Sims, MD
Physician Advisor Partners Health Care Biomedical Engineering
Massachusetts General Hospital
Contributing Editors
Kathryn A. Beauchamp, RN, MSN, CCRN Clinical Nurse Specialist
Pediatric Intensive Care Unit MassGeneral Hospital for Children
Boston, MA
Gayle Fishman, RN, BSN, MBA Consultant
Health Systems Redesign, Inc.
Daniel Kohane, MD, PhD Staff Attending Pediatric Intensive Care Unit MassGeneral Hospital for Children
Boston, MA
Brenda Miller, RN, MSN Nurse Manager
Pediatric Intensive Care Unit and Pediatric Outpatient MassGeneral Hospital for Children
Boston, MA
Erasmo A. Mitrano, RPh, M.A. Pharmacy Operations Specialist
Massachusetts General Hospital Department of Pharmacy Boston, MA
Lisa Morlitz, PharmD Clinical Pharmacist
WakeMed Cary Hospital Cary, NC
Ellen Kinnealey, RN, BSN Advanced Infusion System Specialist
Massachusetts General Hospital Department of Biomedical Engineering
Lois Finstein Parker, RPh Senior Attending Pharmacist
Massachusetts General Hospital Department of Pharmacy Boston, MA
MassGeneral Hospital for Children
Disclaimer: © 2006 The General Hospital Corporation (d/b/a Massachusetts General Hospital) All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system, without written permission from the copyright owner. Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in any particular situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently utilized drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his/her clinical practice.
MassGeneral Hospital for Children
Editor in Chief
Nat Sims, MD Physician Advisor
Partners Health Care Biomedical Engineering Massachusetts General Hospital
Contributing Editors
Kathryn A. Beauchamp, RN, MSN, CCRN Clinical Nurse Specialist
Pediatric Intensive Care Unit MassGeneral Hospital for Children
Boston, MA
Gayle Fishman, RN, BSN, MBA Consultant
Health Systems Redesign, Inc.
Daniel Kohane, MD, PhD Staff Attending Pediatric Intensive Care Unit MassGeneral Hospital for Children
Boston, MA
Brenda Miller, RN, MSN Nurse Manager
Pediatric Intensive Care Unit and Pediatric Outpatient MassGeneral Hospital for Children
Boston, MA
Erasmo A. Mitrano, RPh, M.A. Pharmacy Operations Specialist
Massachusetts General Hospital Department of Pharmacy Boston, MA
Lisa Morlitz, PharmD Clinical Pharmacist
WakeMed Cary Hospital Cary, NC
Ellen Kinnealey, RN, BSN Advanced Infusion System Specialist
Massachusetts General Hospital Department of Biomedical Engineering
Lois Finstein Parker, RPh Senior Attending Pharmacist
Massachusetts General Hospital Department of Pharmacy Boston, MA
MassGeneral Hospital for Children
MassGeneral Hospital for Children NICU/PICU
Pediatric Medication Administration Process Manual for Syringe Infusion Pumps
Continuous Infusions
This manual describes a drug library that provides: y Mixing guidelines and flow rates for each drug and
concentration y IV administration guidelines for each drug y Starting dose; loading dose and continuous dose by drug y Usual and maximum dosing by drug y Pump flow rates by drug concentration, dose rate and patient
weight y Color Zones which assists the clinician in choosing the
best concentration for most effective flow rate* 1. Green – indicates flow rate at 0.3 mL/hr or higher 2. Yellow – indicates flow rate between 0.1 and 0.3
mL/hr may be initiated in an emergency (please page pharmacy)
3. Red – indicates flow rate <0.3 mL/hr or >20 mL/hr *Flow rates of at least 0.3mL/hr provide optimal titration Definition of Terms: “Soft Min”: Soft Minimum Refers to the recommended minimum dose “Soft Max”: Soft Maximum Refers to the recommended maximum dose Sources: References: Albany Medical Center; Dayton Children's Hospital; Eggleston Children’s Hospital, Atlanta; Minneapolis Children's Hospital; Children's Medical Center of Dallas; Yale - New Haven Children’s Hospital; MGH - Lexi-Comp's Clinical Reference Library MGH Development Team: Pharmacy; Nursing; Smart Infusion Pump Learning Lab, sponsored by the Sims Lab; Pediatrics; Biomedical Engineering
MassGeneral Hospital for Children
MassGeneral Hospital for Children NICU/PICU
Pediatric Medication Administration Process Manual for Syringe Pumps
Instructions
MGH recommends that each hospital create its drug library based on individual practice (refer to Drug Library Development Process) Establish the formulary, standard concentrations and default starting doses along with minimum and maximum dosing. Using any spread sheet application; build the flow table as follows:
1. List a range of weights in a column, in ascending order 2. List a range of drug dosing across a row – begin with the “Soft
Min” and end with the “Soft Max” 3. In the first cell (lowest weight and Soft Min), write the formula
that multiplies the weight value x Soft Min value x Drug Concentration per milliliter. The value that appears is the rate delivered to the patient.
4. Extend this formula to the rest of the table 5. Apply conditional formatting to set the colors to the following values:
Red (0.09 to 19.9); Yellow (0.09 to 0.3) and Green (0.3 to 19.9). It is important to use this order in the conditional formatting)
a. Green – indicates flow rate at 0.3 mL/hr or higher b. Yellow – indicates flow rate between 0.1 and 0.3
mL/hr may be initiated in an emergency (please page pharmacy)
c. Red – indicates flow rate <0.3 mL/hr or >20 mL/hr *Flow rates of at least 0.3mL/hr provide optimal titration
6. Remove all trailing zeros 7. If the flow rates, given the standard dosing procedure in the
hospital do not fall within the majority of green flow rates, it is necessary to create another concentration for your drug library
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC ALPROSTADIL-Ductus
Neonatal/Pediatric Alprostadil IV Dosing and Preparation Guidelines Concentration Provided Starting Dose
Continuous Infusion: 0.05-0.1mcg/kg/minute Usual/ Maximum Dose
10mcg/mL in D5W
Usual: 0.01-0.4mcg/kg/minute Maximum: 0.4mcg/kg/minute
ALPROSTADIL 10MCG/mL (DUCTUS)
INGREDIENTS QUANTITY FOR 1
SYRINGE Alprostadil 500mcg/mL
1mL
D5W
49mL
To make 50 mL: 1. Using a 1mL syringe, draw up 1mL from an Alprostadil 500mcg/mL vial. 2. Using a 60mL syringe, draw up 49mL of D5W. 3. Add the 1mL of Alprostadil to the 49mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"ALPROSTADIL 10 MCG/mL" INDICATION: DUCTUS September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.01 0.05 0.1 0.15 0.2 0.3 0.40.5 kg 0.03 0.15 0.3 0.45 0.6 0.9 1.21.5 kg 0.09 0.45 0.9 1.35 1.8 2.7 3.63 kg 0.18 0.9 1.8 2.7 3.6 5.4 7.2
6 kg 0.4 1.8 3.6 5.4 7.2 10.8 14.4
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (risk fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC ALPROSTADIL-Liver
Neonatal/Pediatric Alprostadil IV Dosing and Preparation Guidelines Concentration Provided Starting Dose
Continuous infusion: 0.1-0.6mcg/kg/hour Usual/ Maximum Dose
10mcg/mL in D5W
Maximum: Please consult the liver transplant team for additional dosing information.
ALPROSTADIL 10MCG/mL (LIVER)
INGREDIENTS QUANTITY FOR 1
SYRINGE Alprostadil 500mcg/mL
1mL
D5W
49mL
To make 50 mL: 1. Using a 1mL syringe, draw up 1mL from an Alprostadil 500mcg/mL vial. 2. Using a 60mL syringe, draw up 49mL of D5W. 3. Add the 1mL of Alprostadil to the 49mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"ALPROSTADIL 10 MCG/mL " INDICATION : LIVER September-05
Dose rate in mcg/kg/hourSoft Min Soft Max
Weight 0.1 0.25 0.5 0.60.5 kg 0.01 0.01 0.03 0.031.5 kg 0.02 0.04 0.08 0.093 kg 0.03 0.08 0.15 0.186 kg 0.06 0.15 0.3 0.36
20 kg 0.2 0.50 1 1.240 kg 0.4 1 2 2.4
Pump flow rate (mL/hr)
"ALPROSTADIL 20 MCG/mL " INDICATION : LIVER April-06
Dose rate in mcg/kg/hourSoft Min Soft Max
Weight 0.1 0.25 0.5 0.60.5 kg 0 0.01 0.01 0.021.5 kg 0.01 0.02 0.04 0.053 kg 0.02 0.04 0.08 0.096 kg 0.03 0.08 0.15 0.18
20 kg 0.1 0.25 0.5 0.640 kg 0.2 0.50 1 1.2
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (risk fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC ALTEPLASE Neonatal/Pediatric Alteplase IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose DVT: 0.03mg/kg/hour PE: Please consult hematology/oncology attending for dosing
Usual/ Maximum Dose
1mg/mL in SWFI
Maximum: 0.06mg/kg/hour
ALTEPLASE – 1MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Alteplase 50mg/50mL * * Reconstitute with supplied
diluent (SWFI)
50mL
Please page the unit pharmacist for a 24-hour supply.
To make 50mL: 1. Reconstitute Alteplase 50mg vials with 50mL SWFI. 2. Using a 60mL syringe, draw up 50mL of Alteplase. 3. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"ALTEPLASE 1 MG/mL" September-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.03 0.1 0.3 0.5 0.60.5 kg 0.02 0.05 0.15 0.25 0.301.5 kg 0.05 0.15 0.45 0.75 0.90
3 kg 0.09 0.3 0.9 1.5 1.86 kg 0.18 0.6 1.8 3 4
20 kg 0.6 2 6 10 1240 kg 1.2 4 12 20 24
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC AMIODARONE Neonatal/Pediatric Amiodarone IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Load: 5mg/kg (up to 150mg) over 15-30minutes Continuous Infusion: 5mcg/kg/minute
Usual/ Maximum Dose
1.8mg/mL in D5W (1800mcg/mL)
Usual: 5-15mcg/kg/minute Maximum: 15mcg/kg/minute
AMIODARONE 1.8MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Amiodarone 50mg/mL
1.8mL
D5W
48.2mL
Please page the unit pharmacist for a 24-hour supply in a glass bottle.
To make 50mL: 1. Using a 3 mL syringe with filter needle, draw up 1.8mL
from an Amiodarone 50mg/mL ampule. 2. Using a 60mL syringe, draw up 48.2mL measure 0.2 mL of
D5W. 3. Add the 1.8mL of Amiodarone to the 48.2mL of D5W. 4. Mix the syringe contents gently. 5. 2 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"AMIODARONE 1.8 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 4 5 10 12.5 150.5 kg 0.07 0.08 0.17 0.21 0.251.5 kg 0.2 0.25 0.5 0.63 0.75
3 kg 0.4 0.5 1 1.25 1.5
6 kg 0.8 1 2 2.5 320 kg 2.67 3.33 6.67 8.33 1040 kg 5.33 6.67 13.33 16.67 20
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC Dexmedetomidine
Neonatal/Pediatric Dexmedetomidine IV Administration Guidelines Concentration Provided Starting Dose
Continuous Infusion: 0.2 mcg/kg/hour Usual/ Max Dose
4 mcg/ml in NS
Usual: 0.2-0.7 mcg/kg/hour Max: 0.7 mcg/kg/hour
DEXMEDETOMIDINE 4 MCG/mL (PRECEDEX)
INGREDIENTS QUANTITY
FOR 1 SYRINGE
Dexmedetomidine
To make 50 mL: Contact pharmacy for the syringe
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate and Patient Weight
"Dexmedetomidine 4 mcg/mL" (Precedex) September-06
Dose rate in mcg/kg/hourSoft Min Soft Max
Weight 0.2 0.3 0.4 0.5 0.6 0.70.5 kg 0.03 0.04 0.05 0.06 0.08 0.091.5 kg 0.08 0.11 0.15 0.19 0.23 0.26
3 kg 0.15 0.23 0.3 0.38 0.45 0.53
6 kg 0.30 0.45 0.6 0.75 0.9 1.0520 kg 1 1.5 2 2.5 3 3.540 kg 2 3 4 5 6 7
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC DOBUTAMINE Neonatal/Pediatric Dobutamine IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose 2-5mcg/kg/minute
Usual/ Maximum Dose 0-5kg - 1mg/mL 6-21kg - 2mg/mL
Over 21kg - 5mg/mL
Usual: 2-20mcg/kg/minute Maximum: 40mcg/kg/minute
DOBUTAMINE 1MG/mL (10mL) INGREDIENTS QUANTITY
FOR 1 SYRINGE
Dobutamine 12.5mg/mL
0.8mL
D5W 9.2mL
To make 10mL: 1. Using a 1mL syringe, draw up 0.8mL of Dobutamine
12.5mg/mL. 2. Using a 10mL syringe, draw up 9.2mL of D5W. 3. Add the 0.8mL of Dobutamine to the 9.2mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
DOBUTAMINE 1MG/mL (50mL)
INGREDIENTS QUANTITY FOR 1
SYRINGE Dobutamine 12.5mg/mL
4mL
D5W 46mL
To make 50mL: 1. Using a 10mL syringe, draw up 4mL of Dobutamine
12.5mg/mL. 2. Using a 60mL syringe, draw up 46mL of D5W. 3. Add the 4mL of Dobutamine to the 46mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
DOBUTAMINE 2MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Dobutamine 12.5mg/mL 8mL
D5W 42mL
To make 50mL: 1. Using a 10mL syringe, draw up 8mL of Dobutamine
12.5mg/mL. 2. Using a 60mL syringe, draw up 42mL of D5W. 3. Add the 8mL of Dobutamine to the 42mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
DOBUTAMINE 5MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Dobutamine 12.5mg/mL
20mL
D5W 30mL
To make 50mL: 1. Using a 60mL syringe, draw up 20mL of Dobutamine
12.5mg/mL. 2. Using a 60mL syringe, draw up 30mL of D5W. 3. Add the 20mL of Dobutamine to the 30mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"DOBUTAMINE 1 MG/mL" September-05
Dose Rate in mcg/kg/minuteSoft Min Soft Max
Weight 2 5 15 20 400.5 kg 0.06 0.15 0.45 0.6 1.21.5 kg 0.18 0.45 1.35 1.8 3.6
3 kg 0.36 0.9 2.7 3.6 7.2
6 kg 0.72 1.8 5.4 7.2 14.420 kg 2.4 6 18 24 4840 kg 4.8 12 36 48 96
Pump flow rate (mL/hr)
"DOBUTAMINE 2 MG/mL"Dose Rate in mcg/kg/minute
Soft Min Soft MaxWeight 2 5 15 20 40
0.5 kg 0 0.1 0.2 0.3 0.61.5 kg 0.1 0.2 0.7 0.9 1.8
3 kg 0.2 0.5 1.4 1.8 3.6
6 kg 0.4 0.9 2.7 3.6 7.220 kg 1.2 3 9 12 2440 kg 2.4 6 18 24 48
Pump flow rate (mL/hr)
"DOBUTAMINE 5 MG/mL"Dose Rate in mcg/kg/minute
Soft Min Soft Max Weight 2 5 15 20 40
0.5 kg 0.01 0.03 0.09 0.12 0.241.5 kg 0.04 0.09 0.27 0.36 0.723 kg 0.07 0.18 0.54 0.72 1.446 kg 0.14 0.36 1.08 1.44 2.88
20 kg 0.48 1.2 3.6 4.8 9.640 kg 0.96 2.4 7.2 9.6 19.2
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC DOPAMINE
Neonatal/Pediatric Dopamine IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose
Continuous Infusion:
Low dose: 1–5mcg/kg/minute
Moderate dose: 5-15mcg/kg/minute
High dose: > 15mcg/kg/minute
Usual/ Maximum Dose
0-1kg – 0.8mg/mL = 800mcg/mL
1-5kg - 1.6mg/mL = 1600mcg/mL
6-21kg – 3.2mg/mL =3200mcg/mL
Over 21kg- 8mg/mL = 8000mcg/mL
Usual: 1-20mcg/kg/minute
Maximum: 50mcg/kg/minute
DOPAMINE 0.8MG/ML (10mL)
INGREDIENTS QUANTITY
FOR 1
SYRINGE
Dopamine 40mg/mL 0.2mL
D5W 9.8mL
To make 10mL:
1. Using a 1mL syringe, draw up 0.2mL of Dopamine
40mg/mL.
2. Using a 10mL syringe, draw up 9.8mL of D5W.
3. Add the 0.2mL of Dopamine to the 9.8mL of D5W.
4. Mix the syringe contents gently.
5. 24 hour expiration date
DOPAMINE 0.8MG/mL
INGREDIENTS QUANTITY
FOR 1
SYRINGE
Dopamine 40mg/mL 1mL
D5W 49mL
To make 50mL:
1. Using a 1mL syringe, draw up 1mL of Dopamine
40mg/mL.
2. Using a 60mL syringe, draw up 49mL of D5W.
3. Add the 1mL of Dopamine to the 49mL of D5W.
4. Mix the syringe contents gently.
5. 24 hour expiration date
DOPAMINE 1.6MG/mL
INGREDIENTS QUANTITY
FOR 1
SYRINGE
Dopamine 40mg/mL 2mL
D5W 48mL
To make 50mL:
1. Using a 3mL syringe, draw up 2mL of Dopamine
40mg/mL.
2. Using a 60mL syringe, draw up 48mL of D5W.
3. Add the 2mL of Dopamine to the 48mL of D5W.
4. Mix the syringe contents gently.
5. 24 hour expiration date
DOPAMINE 3.2MG/mL
INGREDIENTS QUANTITY
FOR 1
SYRINGE
Dopamine 40mg/mL 4mL
D5W 46mL
To make 50mL:
1. Using a 10mL syringe, draw up 4mL of Dopamine
40mg/mL
2. Using a 60mL syringe, draw up 46mL of D5W.
3. Add the 4mL of Dopamine to the 46mL of D5W.
4. Mix the syringe contents gently.
5. 24 hour expiration date
DOPAMINE 8MG/mL
INGREDIENTS QUANTITY
FOR 1
SYRINGE
Dopamine 40mg/mL 10mL
D5W 40mL
To make 50mL:
1. Using a 10mL syringe, draw up 10mL of Dopamine
40mg/mL.
2. Using a 60mL syringe, draw up 40mL of D5W.
3. Add the 10mL of Dopamine to the 40mL of D5W.
4. Mix syringe contents gently.
5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
September-05
"DOPAMINE 0.8 MG/mL- PERIPHERAL OR CENTRAL LINE"Dose rate in mcg/kg/minute
Soft Min Soft Max Weight 2 3 10 15 20
0.5 kg 0.08 0.11 0.38 0.56 0.751.5 kg 0.23 0.34 1.13 1.69 2.25
3 kg 0.45 0.68 2.25 3.38 4.5
6 kg 0.9 1.35 4.5 6.75 920 kg 3 4.5 15 23 3040 kg 6 9 30 45 60
Pump flow rate (mL/hr)
"DOPAMINE 1.6 MG/mL- CENTRAL LINE"Dose rate in mcg/kg/minute
Soft Min Soft Max Weight 2 3 10 15 20
0.5 kg 0.04 0.06 0.19 0.28 0.381.5 kg 0.11 0.17 0.56 0.84 1.13
3 kg 0.23 0.34 1.13 1.69 2.25
6 kg 0.45 0.68 2.25 3.38 4.520 kg 1.5 2.25 7.5 11.25 1540 kg 3 4.5 15 22.5 30
Pump flow rate (mL/hr)
"DOPAMINE 3.2 MG/mL- CENTRAL LINE"Dose rate in mcg/kg/minute
Soft Min Soft Max Weight 2 3 10 15 20
0.5 kg 0.02 0.03 0.09 0.14 0.191.5 kg 0.06 0.08 0.28 0.42 0.563 kg 0.11 0.17 0.56 0.84 1.136 kg 0.23 0.34 1.13 1.69 2.25
20 kg 0.75 1.13 3.75 5.63 7.540 kg 1.5 2.25 7.5 11.25 15
Pump flow rate (mL/hr)
"DOPAMINE 8 MG/mL- CENTRAL LINE"Dose rate in mcg/kg/minute
Soft Min Soft Max Weight 2 3 10 15 20
0.5 kg 0.01 0.01 0.04 0.06 0.081.5 kg 0.02 0.03 0.11 0.17 0.233 kg 0.05 0.07 0.23 0.34 0.456 kg 0.09 0.14 0.45 0.68 0.9
20 kg 0.3 0.45 1.5 2.25 340 kg 0.6 0.9 3 4.5 6
Pump flow rate (mL/hr) Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC EPINEPHRINE Neonatal/Pediatric Epinephrine IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.1mcg/kg/minute
Usual/ Maximum Dose 20mcg/mL
Usual: 0.1-1mcg/kg/minute Maximum: 1mcg/kg/minute up to 20mcg/minute
EPINEPHRINE 0.02MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Epinephrine 1mg/mL
1mL
D5W
49mL
To make 50mL: 1. Using a 1mL syringe, draw up 1mL of Epinephrine 1mg/mL
(1:1000). 2. Using a 60mL syringe, draw up 49mL of D5W. 3. Add the 1mL of Epinephrine to the 49mL of D5W. 4. Mix syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"EPINEPHRINE 0.02 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.01 0.02 0.05 0.1 0.5 10.5 kg 0.02 0.03 0.08 0.15 0.75 1.5
1.5 kg 0.05 0.09 0.23 0.45 2.25 4.5
3 kg 0.09 0.18 0.45 0.9 4.5 9
6 kg 0.18 0.36 0.9 1.8 9 18
20 kg 0.6 1.2 3 6 30 60
40 kg 1.2 2.4 6 12 60 120
Pump flow rate (mL/hr)
= MAX OF 1MCG/KG/MIN OR 20MCG/MIN, WHICHEVER IS LESS
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC ESMOLOL- Post-operative hypertension
Neonatal/Pediatric Esmolol IV Dosing and Preparation Guidelines Concentration Provided
Load: 500mcg/kg (over 1-2minutes) Continuous Infusion: 50mcg/kg/minute
Usual/ Maximum Dose
1-5kg – 10mg/mL in NS 6-21kg – 10mg/mL in NS
Over 21kg – 50mg/mL Usual: 50-250mcg/kg/minute Maximum: 1000mcg/kg/minute
ESMOLOL 10MG/mL (HYPERTENSION)
INGREDIENTS QUANTITY FOR 1
SYRINGE Esmolol 10mg/mL
10mL
To make 10mL: 1. Using a 10mL syringe, draw up 10mL of Esmolol
10mg/mL. 2. 24 hour expiration date
ESMOLOL 50MG/mL (HYPERTENSION)
INGREDIENTS QUANTITY FOR 1
SYRINGE Esmolol 250mg/mL
10mL
0.9% Sodium Chloride 40mL
To make 50mL: 1. Using a 10mL syringe, draw up 10mL of Esmolol
250mg/mL. 2. Using a 60mL syringe, draw up 40mL of 0.9% sodium
chloride. 3. Add the 10mL of Esmolol to the 40mL of 0.9% sodium
chloride. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
September-05
"ESMOLOL 10 MG/mL"INDICATION: HYPERTENSION
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 40 50 150 200 250 300 6000.5 kg 0.12 0.15 0.45 0.6 0.75 0.9 1.81.5 kg 0.36 0.45 1.35 1.8 2.25 2.7 5.4
3 kg 0.72 0.9 2.7 3.6 4.5 5.4 10.8
6 kg 1.44 1.8 5.4 7.2 9 10.8 21.620 kg 4.8 6 18 24 30 36 7240 kg 9.6 12 36 48 60 72 144
Pump flow rate (mL/hr)
"ESMOLOL 50 MG/mL"INDICATION: HYPERTENSION
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 40 50 150 200 250 300 6000.5 kg 0.02 0.03 0.09 0.12 0.15 0.18 0.361.5 kg 0.07 0.09 0.27 0.36 0.45 0.54 1.08
3 kg 0.14 0.18 0.54 0.72 0.9 1.08 2.16
6 kg 0.29 0.36 1.08 1.44 1.8 2.16 4.3220 kg 0.96 1.2 3.6 4.8 6 7.2 14.440 kg 1.92 2.4 7.2 9.6 12 14.4 28.8
Pump flow rate (mL/hr) Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC ESMOLOL- Supraventricular tachycardia (SVT) Neonatal/Pediatric Esmolol IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Load: 100-500mcg/kg (over 1-2minutes) Continuous Infusion: 200mcg/kg/minute
Usual/ Maximum Dose
1-21kg - 10mg/mL = 10,000mcg/mL in NS Over 21kg - 50mg/mL = 50,000mcg/mL in NS
Usual: 100-1000mcg/kg/minute Maximum: 1000mcg/kg/minute
ESMOLOL 10MG/ML (10mL) (SVT)
INGREDIENTS QUANTITY FOR 1
SYRINGE Esmolol 10mg/mL
10mL
To make 10mL: 1. Using a 10mL syringe, draw up 10mL of Esmolol
10mg/mL. 2. 24 hour expiration date
ESMOLOL 50MG/mL (SVT)
INGREDIENTS QUANTITY FOR 1
SYRINGE Esmolol 250mg/mL
10mL
0.9% Sodium Chloride 40mL
To make 50mL: 1. Using a 10mL syringe, draw up 10mL of Esmolol
250mg/mL. 2. Using a 60mL syringe, draw up 40mL of 0.9% sodium
chloride. 3. Add the 10mL of Esmolol to the 40mL of 0.9% sodium
chloride. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"ESMOLOL 10 MG/mL" September-05
INDICATION: SVTDose rate in mcg/kg/minute
Soft Min Soft Max Weight 100 200 400 600 800 1000
0.5 kg 0.3 0.6 1.2 1.8 2.4 31.5 kg 0.9 1.8 3.6 5.4 7.2 9
3 kg 1.8 3.6 7.2 10.8 14.4 18
6 kg 3.6 7.2 14.4 21.6 29 3620 kg 12 24 48 72 96 12040 kg 24 48 96 144 192 240
Pump flow rate (mL/hr)
"ESMOLOL 50 MG/mL"INDICATION: SVT
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 100 200 400 600 800 10000.5 kg 0.06 0.12 0.24 0.36 0.48 0.61.5 kg 0.18 0.36 0.72 1.08 1.44 1.8
3 kg 0.36 0.72 1.44 2.16 2.9 3.6
6 kg 0.72 1.44 2.88 4.32 5.8 7.220 kg 2.4 4.8 9.6 14.4 19 24.040 kg 4.8 9.6 19.2 28.8 38 48.0
Pump flow rate (mL/hr) Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC FENTANYL Neonatal/Pediatric Fentanyl IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Load: 1-2mcg/kg (over 5-10minutes) Continuous Infusion: 0.5-1mcg/kg/hour Bolus: 0.5 – 4 mcg/kg (over 5 minutes)
Usual/ Maximum Dose
0kg-1kg - 0.005mg/mL = 5mcg/mL in D5W 1kg-5kg - 0.01mg/mL = 10mcg/mL in D5W
6kg to over 21kg – 0.05mg/mL = 50mcg/mL in D5W
Usual: 0.5-4mcg/kg/hour Maximum: Titrate to effect
FENTANYL 5MCG/mL/ML INGREDIENTS QUANTITY
FOR 1 SYRINGE
Fentanyl 5mcg/mL
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Fentanyl 5mcg/mL. 2. 24 hour expiration date
FENTANYL 10MCG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Fentanyl 10mcg/mL 50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Fentanyl 10mcg/mL. 2. 24 hour expiration date
FENTANYL 50MCG/mL
INGREDIENTS QUANTITY FOR 1
SYRINGE Fentanyl 50mcg/mL
20mL
To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Fentanyl 50mcg/mL. 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose and Patient Weight
"FENTANYL 5 MCG/mL" September-05
Dose rate in mcg/kg/hourSoft Min Soft Max
Weight 0.5 1 2 4 100.5 kg 0.05 0.1 0.2 0.4 11.5 kg 0.15 0.3 0.6 1.2 3
3 kg 0.3 0.6 1.2 2.4 6
6 kg 0.6 1.2 2.4 4.8 1220 kg 2 4 8 16 4040 kg 4 8 16 32 80
Pump flow rate (mL/hr)
"FENTANYL 10 MCG/mL"Dose rate in mcg/kg/hour
Soft Min Soft Max Weight 0.5 1 2 4 10
0.5 kg 0.03 0.05 0.1 0.2 0.51.5 kg 0.08 0.15 0.3 0.6 1.5
3 kg 0.15 0.3 0.6 1.2 3
6 kg 0.3 0.6 1.2 2.4 620 kg 1 2 4 8 2040 kg 2 4 8 16 40
Pump flow rate (mL/hr)
"FENTANYL 50 MCG/mL" August-05
Dose rate in mcg/kg/hourSoft Min Soft Max
Weight 0.5 1 2 4 100.5 kg 0.005 0.01 0.02 0.04 0.11.5 kg 0.015 0.03 0.06 0.12 0.3
3 kg 0.03 0.06 0.12 0.24 0.6
6 kg 0.06 0.12 0.24 0.48 1.220 kg 0.2 0.4 0.8 1.6 440 kg 0.4 0.8 1.6 3.2 8
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC FUROSEMIDE Neonatal/Pediatric Furosemide IV Dosing and Preparation Guidelines
Concentration Provided - Starting Dose Continuous Infusion: 0.05mg/kg/hour
Usual/ Maximum Dose 1-21kg - 0.5mg/mL in D5W
Over 21kg - 10mg/mL in D5W Usual: 0.05-0.15mg/kg/hour Maximum: Titrate to effect
FUROSEMIDE 0.5MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Furosemide 10mg/mL
2.5mL
D5W
47.5mL
To make 50mL: 1. Using a 3mL syringe, draw up 2.5mL of Furosemide
10mg/mL. 2. Using a 60 mL syringe, draw up 47.5mL of D5W. 3. Add the 2.5mL of Furosemide to 47.5mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
FUROSEMIDE 10MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Furosemide 10mg/mL
10mL
To make 10mL: 1. Using a 10mL syringe, draw up 10mL of Furosemide
10mg/mL. 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"FUROSEMIDE 0.5 MG/mL" September-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.05 0.15 0.2 0.30.5 kg 0.05 0.15 0.2 0.31.5 kg 0.15 0.45 0.6 0.9
3 kg 0.3 0.9 1.2 1.8
6 kg 0.6 1.8 2.4 3.620 kg 2 6 8 1240 kg 4 12 16 24
"FUROSEMIDE 10 MG/mL"Dose rate in mg/kg/hour
Soft Min Soft Max Weight 0.05 0.15 0.2 0.3
0.5 kg 0 0.01 0.01 01.5 kg 0.01 0.02 0.03 0
3 kg 0.02 0.05 0.06 0.1
6 kg 0.03 0.09 0.12 0.220 kg 0.1 0.3 0.4 0.640 kg 0.2 0.6 0.8 1.2
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC HEPARIN
Neonatal/Pediatric Heparin IV Dosing and Preparation Guidelines Concentration Provided Starting Dose
Load: 50-75units/kg (slowly over 10minutes)
Note: do not load if Alteplase (TPA) infusion is being used
Continuous Infusion: Children under 1 year: 28units/kg/hour Children 1 year & older: 20units/kg/hour
Starting Dose- Low Dose
Continuous infusion: 5-10 units/kg/hour
Usual/ Maximum Dose
1-21kg - 100UNITS/ML Over 21kg - 500UNITS/ML
Usual: Titrate to desired PTT ratio
HEPARIN REQUIRES A SECOND SIGNATURE BY AN ATTENDING OR FELLOW PRIOR TO ADMINISTRATION IN THE NEONATAL INTENSIVE CARE UNIT
HEPARIN 100UNITS/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Heparin Premixed Bag 100U/ML
(25,000 units/250 mL 0.45% Sodium chloride)
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Heparin
100Units/mL. 2. 24 hour expiration date
HEPARIN 500UNITS/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Heparin Premixed Syringe 500U/ML
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Heparin 500
Units/mL. 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"HEPARIN 100 UNIT/mL - LOW DOSE" September-05
Dose rate in units/kg/hourSoft Min Soft Max
Weight 5 8 100.5 kg 0.03 0.04 0.051.5 kg 0.08 0.11 0.15
3 kg 0.15 0.23 0.3
6 kg 0.3 0.45 0.620 kg 1 1.5 240 kg 2 3 4
Pump flow rate (mL/hr)
"HEPARIN 100 UNIT/mL"Dose rate in units/kg/hour
Soft Min Soft Max Weight 20 28 30 32 34 36 38
0.5 kg 0.1 0.14 0.15 0.16 0.17 0.18 0.191.5 kg 0.3 0.42 0.45 0.48 0.51 0.54 0.57
3 kg 0.6 0.84 0.9 0.96 1.02 1.08 1.14
6 kg 1.2 1.68 1.8 1.92 2.04 2.16 2.2820 kg 4 5.6 6 6.4 6.8 7.2 7.640 kg 8 11.2 12 12.8 13.6 14.4 15.2
Pump flow rate (mL/hr)
"HEPARIN 500 UNIT/mL"Dose rate in units/kg/hour
Soft Min Soft Max Weight 20 28 30 32 34 36 38
0.5 kg 0.02 0.03 0.03 0.03 0.03 0.04 0.041.5 kg 0.06 0.08 0.09 0.1 0.1 0.11 0.11
3 kg 0.12 0.17 0.18 0.19 0.2 0.22 0.23
6 kg 0.24 0.34 0.36 0.38 0.41 0.43 0.4620 kg 0.8 1.12 1.2 1.28 1.36 1.44 1.5240 kg 1.6 2.24 2.4 2.56 2.72 2.88 3.04
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC INSULIN Neonatal/Pediatric Insulin Regular IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Load:
Neonates: No load Infants and Children: 0.1units/kg over 2-3minutes
Continuous Infusion: Neonates: 0.01units/kg/hour Infants and Children: 0.05-0.1units/kg/hour
Usual/ Maximum Dose
0-1kg - 0.06units/mL in SWFI or NS 1-Over 21kg - 1unit/mL in SWFI or NS
Usual: 0.01-0.1units/kg/hour Maximum: Neonates: 0.1units/kg/hour Infants and Children: 0.2units/kg/hour
INSULIN REQUIRES A SECOND SIGNATURE BY AN ATTENDING OR FELLOW PRIOR TO ADMINISTRATION IN THE NEONATAL INTENSIVE CARE UNIT
INSULIN 0.06UNIT/ML (10mL) INGREDIENTS QUANTITY
FOR 1 SYRINGE
Regular Human Insulin 100u/mL (CZI)
0.1mL
SWFI or NS
20mL
(for Step 1 & 2)
To make a final volume of 10mL: Step One (1unit/mL): 1. Using a 1mL syringe, draw up 0.1 mL of regular Insulin
100units/mL. 2. Using a 10mL syringe, draw up 9.9 mL of SWFI or NS. 3. Add 0.1mL of regular insulin to 9.9 of SWFI or NS to yield
a concentration of 1unit/mL. 4. Mix the syringe contents gently. Step Two (0.06unit/mL): 1. Using a 1mL syringe, draw up 0.6mL of the regular insulin
1unit/mL. 2. Using a 10mL syringe, draw up 9.4mL of SWFI or NS. 3. Add the 0.6mL of regular insulin 1unit/mL to the 9.4mL of
SWFI or NS to yield a concentration of 0.06unit/mL 4. Mix the syringe contents gently. 5. 24 hour expiration date
INSULIN 1UNIT/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Regular Insulin Human 100u/mL (CZI)
0.5mL
SWFI or NS
49.5mL
To make 50mL: 1. Using a 1mL syringe, draw up 0.5mL of regular
insulin 100units/mL. 2. Using a 60mL syringe, draw up 49.5mL of SWFI or
NS. 3. Add the 0.5mL of regular insulin to 49.5mL of SWFI
or NS to yield a concentration of 1unit/mL 4. Mix the syringe contents gently. 5. 24 hour expiration date.
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
September-05
"INSULIN 0.06 UNIT/mL"- AVAILABLE IN THE NEONATAL INTENSIVE CARE UNIT ONLY Dose rate in units/kg/hour
Soft Min Soft Max Weight 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.1 0.2 0.4
0.5 kg 0.08 0.17 0.25 0.33 0.42 0.5 0.58 0.83 1.67 3.33
1.5 kg 0.25 0.5 0.75 1 1.25 1.5 1.75 2.5 5 10
3 kg 0.5 1 1.5 2 2.5 3 3.5 5 10 20
6 kg 1 2 3 4 5 6 7 10 20 40
20 kg 3.33 6.67 10.00 13.33 16.67 20 23.33 33.33 66.67 133.33
Pump flow rate (mL/hr)
"INSULIN 1 UNIT/mL" September-05
Dose rate in units/kg/hourSoft Min Soft Max
Weight 0.05 0.1 0.15 0.20.5 kg 0.03 0.05 0.08 0.1
1.5 kg 0.08 0.15 0.23 0.3
3 kg 0.15 0.3 0.45 0.6
6 kg 0.3 0.6 0.9 1.2
20 kg 1 2 3 4
40 kg 2 4 6 8
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC ISOPROTERENOL
Neonatal/Pediatric Isoproterenol IV Dosing and Preparation Guidelines Concentration Provided Starting Dose
Continuous Infusion: 0.05mcg/kg/minute Usual/ Max Dose
20mcg/mL
Usual: 0.05-2mcg/kg/minute Maximum: 2mcg/kg/minute
ISOPROTERENOL 0.02MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Isoproterenol 0.2mg/mL
5mL
D5W
45mL
To make 50mL: 1. Using a 10mL syringe, draw up 5mL of Isoproterenol
0.2mg/mL. 2. Using a 60mL syringe, draw up 45mL of D5W. 3. Add the 5mL of Isoproterenol to the 45mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"ISOPROTERENOL 0.02 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.05 0.1 0.2 0.4 0.8 1.6 20.5 kg 0.08 0.15 0.3 0.6 1.2 2.4 31.5 kg 0.23 0.45 0.9 1.8 3.6 7.2 9
3 kg 0.45 0.9 1.8 3.6 7.2 14.4 18
6 kg 0.9 1.8 3.6 7.2 14.4 28.8 3620 kg 3 6 12 24 48 96 12040 kg 6 12 24 48 96 192 240
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC KETAMINE
Neonatal/Pediatric Ketamine IV Dosing and Preparation Guidelines Concentration Provided Starting Dose
Load: 1-2mg/kg over 3-5 minutes Continuous Infusion: 5mcg/kg/minute
Usual/ Maximum Dose
10mg/mL
Usual: 5-20mcg/kg/minute Maximum: 20mcg/kg/minute
KETAMINE 10MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Ketamine 10mg/mL
20mL
To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Ketamine 10mg/mL 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"KETAMINE 10 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 5 10 15 200.5 kg 0.02 0.03 0.05 0.061.5 kg 0.05 0.09 0.14 0.18
3 kg 0.09 0.18 0.27 0.36
6 kg 0.18 0.36 0.54 0.7220 kg 0.6 1.2 1.8 2.440 kg 1.2 2.4 3.6 4.8
Pump flow rate (mL/hr) Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC LABETALOL Neonatal/Pediatric Labetalol IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.4mg/kg/hour
Usual/ Maximum Dose 1-21kg- 1mg/mL in D5W
Over 21kg - 5mg/mL in D5W Usual: 0.4-1mg/kg/hour Maximum: 3mg/kg/hour
LABETALOL 1MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Labetalol 5mg/mL
10mL
D5W
40mL
To make 50mL: 1. Using a 10mL syringe, draw up 10mL of Labetalol 5mg/mL2. Using a 60mL syringe, draw up 40mL of D5W. 3. Add the 10mL of Labetalol to the 40mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
LABETALOL 5MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Labetalol 5mg/mL
20mL
To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Labetalol 5mg/mL2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"LABETALOL 1 MG/mL" September-05
Dose rate in mg/kg/houSoft Min Soft Max
Weight 0.4 0.75 1 1.25 1.5 2 30.5 kg 0.2 0.38 0.5 0.63 0.75 1 1.51.5 kg 0.6 1.13 1.5 1.88 2.25 3 4.5
3 kg 1.2 2.25 3 3.75 4.5 6 9
6 kg 2.4 4.5 6 7.5 9 12 1820 kg 8 15 20 25 30 40 6040 kg 16 30 40 50 60 80 120
Pump flow rate (mL/hr)
"LABETALOL 5 MG/mL" September-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.4 0.75 1 1.25 1.5 2 30.5 kg 0.04 0.08 0.1 0.13 0.15 0.2 0.31.5 kg 0.12 0.23 0.3 0.38 0.45 0.6 0.9
3 kg 0.24 0.45 0.6 0.75 0.9 1.2 1.8
6 kg 0.48 0.9 1.2 1.5 1.8 2.4 3.620 kg 1.6 3 4 5 6 8 1240 kg 3.2 6 8 10 12 16 24
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC LIDOCAINE Neonatal/Pediatric Lidocaine IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Load: 1mg/kg (over 2-3min) q10minutes Continuous Infusion: 20mcg/kg/minute
Usual/ Maximum Dose
1-21kg - 8mg/mL Over 21kg - 40mg/mL
Usual: 20-50mcg/kg/minute Maximum: 50mcg/kg/minute
LIDOCAINE 8MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Lidocaine 1% (10mg/mL)
40mL
D5W 10mL
To make 50mL: 1. Using a 60mL syringe, draw up 40mL of Lidocaine
10mg/mL. 2. Using a 10mL syringe, draw up 10mL of D5W. 3. Add the 10mL of D5W to the 40mL of Lidocaine. 4. Mix the syringe contents gently. 5. 24 hour expiration date
LIDOCAINE 40MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Lidocaine 4% (40mg/mL)
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Lidocaine
40mg/mL 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"LIDOCAINE 8 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 20 30 40 500.5 kg 0.08 0.11 0.15 0.191.5 kg 0.23 0.34 0.45 0.56
3 kg 0.45 0.68 0.9 1.13
6 kg 0.9 1.35 1.8 2.2520 kg 3 4.5 6 7.540 kg 6 9 12 15
Pump flow rate (mL/hr)
"LIDOCAINE 40 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 20 30 40 500.5 kg 0.02 0.02 0.03 0.041.5 kg 0.05 0.07 0.09 0.11
3 kg 0.09 0.14 0.18 0.23
6 kg 0.18 0.27 0.36 0.4520 kg 0.6 0.9 1.2 1.540 kg 1.2 1.8 2.4 3
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC MIDAZOLAM Neonatal/Pediatric Midazolam IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.05mg/kg/hour
Usual/ Maximum Dose 1mg/mL
Usual: 0.05-0.1mg/kg/hour Maximum: Titrate to effect
MIDAZOLAM 1MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Midazolam 5mg/mL
10mL
D5W 40mL
To make 50mL: 1. Using a 10mL syringe, draw up 10mL of Midazolam 5mg/mL 2. Using a 60mL syringe, draw up 40mL of D5W. 3. Add the 10mL of Midazolam to the 40mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MIDAZOLAM 5MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Midazolam 5mg/mL
50mL
To make 50mL: Using a 60mL syringe, draw up 50mL of Midazolam 5mg/mL 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"MIDAZOLAM 1 MG/mL" September-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.05 0.1 0.2 0.3 0.4 0.50.5 kg 0.03 0.05 0.1 0.15 0.2 0.31.5 kg 0.08 0.15 0.3 0.45 0.6 0.8
3 kg 0.15 0.3 0.6 0.9 1.2 1.5
6 kg 0.3 0.6 1.2 1.8 2.4 320 kg 1 2 4 6 8 1040 kg 2 4 8 12 16 20
Pump flow rate (mL/hr)
"MIDAZOLAM 5 MG/mL"Dose rate in mg/kg/hour
Soft Min Soft Max Weight 0.05 0.10 0.20 0.30 0.40 0.50
0.5 kg 0.01 0.01 0.02 0.03 0.04 0.051.5 kg 0.02 0.03 0.06 0.09 0.12 0.15
3 kg 0.03 0.06 0.12 0.18 0.24 0.3
6 kg 0.06 0.12 0.24 0.36 0.48 0.620 kg 0.2 0.4 0.8 1.2 1.6 240 kg 0.4 0.8 1.6 2.4 3.2 4
Pump flow rate (mL/hr) Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC MILRINONE Neonatal/Pediatric Milrinone IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Load: 50-75mcg/kg over 15minutes Continuous Infusion: 0.25mcg/kg/minute
Usual/ Maximum Dose
1-21kg- 0.2mg/mL = 200mcg/mL in D5W Over 21kg- 0.4mg/mL = 400mcg/mL in D5W
Usual: 0.25-0.75mcg/kg/minute Maximum: 1mcg/kg/minute
MILRINONE 0.2MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Milrinone 0.2mg/mL (40mg/200mL premixed
bag)
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Milrinone
0.2mg/mL. 2. 24 hour expiration date
MILRINONE 0.4MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Milrinone 1mg/mL
20mL
D5W 30mL
To make 50mL: 1. Using a 60mL syringe, draw up 20mL of Milrinone
1mg/mL 2. Using a 60mL syringe, draw up 30mL of NS. 3. Add the 20mL of Milrinone to the 30mL of NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as a function of Drug Concentration, Dose Rate, Patient Weight
"MILRINONE 0.2 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.25 0.4 0.5 0.6 0.7 0.75 10.5 kg 0.04 0.06 0.08 0.09 0.11 0.11 0.151.5 kg 0.11 0.18 0.23 0.27 0.32 0.34 0.45
3 kg 0.23 0.36 0.45 0.54 0.63 0.68 0.9
6 kg 0.45 0.72 0.9 1.08 1.26 1.35 1.820 kg 1.5 2.4 3 3.6 4.2 4.5 640 kg 3 4.8 6 7.2 8.4 9 12
Pump flow rate (mL/hr)
"MILRINONE 0.4 MG/mL"Dose rate in mcg/kg/minute
Soft Min Soft Max Weight 0.25 0.4 0.5 0.6 0.7 0.75 1
0.5 kg 0.02 0.03 0.04 0.05 0.05 0.06 0.081.5 kg 0.06 0.09 0.11 0.14 0.16 0.17 0.23
3 kg 0.11 0.18 0.23 0.27 0.32 0.34 0.45
6 kg 0.23 0.36 0.45 0.54 0.63 0.68 0.920 kg 0.75 1.2 1.5 1.8 2.1 2.25 340 kg 1.5 2.4 3 3.6 4.2 4.5 6
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC MORPHINE Neonatal/Pediatric Morphine IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion:
Neonates: 0.01-0.05mg/kg/hour Infants & children: 0.05-0.1mg/kg/hour
Usual/ Maximum Dose
0-1kg - 0.2mg/mL 1-over 21kg- 1mg/mL
Usual: 0.01-0.1mg/kg/hour Maximum: Titrate to effect
MORPHINE 0.2MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Morphine Sulfate 0.2mg/mL
50mL
To make 10mL: 1. Using a 60mL syringe, draw up 10mL of Morphine 0.2mg/mL. 2. 24 hour expiration date.
.
MORPHINE 1MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Morphine Sulfate 1mg/mL
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Morphine 1mg/mL. 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"MORPHINE 0.2 MG/mL" April-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.05 0.1 0.5 10.5 kg 0.13 0.25 1.25 2.5
0.75 kg 0.19 0.38 1.88 3.751 kg 0.25 0.5 2.5 5
1.5 kg 0.38 0.75 3.75 7.5
3 kg 0.75 1.5 7.5 15
6 kg 1.5 3 15 3020 kg 5 10 50 100
Pump flow rate (mL/hr)
"MORPHINE 1 MG/mL"Dose rate in mg/kg/hour
Soft Min Soft Max Weight 0.05 0.1 0.5 1
0.5 kg 0 0.05 0.25 0.51.5 kg 0.08 0.15 0.75 1.5
3 kg 0.15 0.3 1.5 3
6 kg 0.3 0.6 3 620 kg 1 2 10 2040 kg 2 4 20 40
Pump flow rate (mL/hr)
"MORPHINE 10MG/mL"Dose rate in mg/kg/hour
Soft Min Soft Max Weight 0.05 0.1 0.5 1
0.5 kg 0 0.01 0.03 0.051.5 kg 0.01 0.02 0.08 0.153 kg 0.02 0.03 0.15 0.3
6 kg 0.03 0.06 0.3 0.620 kg 0.1 0.2 1 240 kg 0.2 0.4 2 4
Pump flow rate (mL/hr)
"MORPHINE 15MG/mL"Dose rate in mg/kg/hour
Soft Min Soft Max Weight 0.05 0.1 0.5 1
0.5 kg 0 0 0.02 0.031.5 kg 0.01 0.01 0.05 0.13 kg 0.01 0.02 0.1 0.2
6 kg 0.02 0.04 0.20 0.420 kg 0.07 0.13 0.67 1.3340 kg 0.13 0.27 1.33 2.67
Pump flow rate (mL/hr)
"MORPHINE 25MG/mL"Dose rate in mg/kg/hour
Soft Min Soft Max Weight 0.05 0.1 0.5 1
0.5 kg 0 0 0 01.5 kg 0 0 0 03 kg 0 0 0 0
6 kg 0 0 0 020 kg 0 0 0 140 kg 0 0 1 2
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1- 0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC NITROGLYCERIN Neonatal/Pediatric Nitroglycerin IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 1mcg/kg/minute
Usual/ Maximum Dose 1-21kg - 0.2mg/mL = 200mcg/mL in D5W
Over 21kg – 1mg/mL = 1000mcg/mL in D5W Usual: 1-5mcg/kg/minute Maximum: 5mcg/kg/minute
NITROGLYCERIN 0.2MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Nitroglycerin 0.2mg/mL (10mg/50mL vial)
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Nitroglycerin
0.2mg/mL. 2. 24 hour expiration date
NITROGLYCERIN 1MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Nitroglycerin 1mg/mL (50mg/50mL vial)
50mL
To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Nitroglycerin
1mg/mL. 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"NITROGLYCERIN 0.2 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 1 2 3 4 50.5 kg 0.15 0.3 0.45 0.6 0.751.5 kg 0.45 0.9 1.35 1.8 2.25
3 kg 0.9 1.8 2.7 3.6 4.5
6 kg 1.8 3.6 5.4 7.2 920 kg 6 12 18 24 3040 kg 12 24 36 48 60
Pump flow rate (mL/hr)
"NITROGLYCERIN 1 MG/mL"Dose rate in mcg/kg/minute
Soft Min Soft Max Weight 1 2 3 4 5
0.5 kg 0.03 0.06 0.09 0.12 0.151.5 kg 0.09 0.18 0.27 0.36 0.45
3 kg 0.18 0.36 0.54 0.72 0.9
6 kg 0.36 0.72 1.08 1.44 1.820 kg 1.2 2.4 3.6 4.8 640 kg 2.4 4.8 7.2 9.6 12
Pump flow rate (mL/hr) Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC NITROPRUSSIDE Neonatal/Pediatric Nitroprusside IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.5mcg/kg/minute
Usual/ Maximum Dose 200mcg/mL
Usual: 1-5mcg/kg/minute Maximum: 5mcg/kg/minute * Doses greater than 4mcg/kg/minute, and/or prolonged infusions may cause cyanide toxicity
NITROPRUSSIDE 0.2MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Sodium Nitroprusside 25mg/mL
0.4mL
D5W
49.6mL
To make 50mL: 1. Using a 1mL syringe, draw up 0.4mL of Nitroprusside
25mg/mL. 2. Using a 60mL syringe, draw up 49.6mL of D5W. 3. Add the 0.4mL of Nitroprusside to the 49.6mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date 6. Protect from light (wrap dose in foil or place in a dark
colored bag).
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"NITROPRUSSIDE 0.2 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.5 1 1.5 2 2.5 3 3.5 4 50.5 kg 0.08 0.15 0.23 0.3 0.38 0.45 0.53 0.6 0.751.5 kg 0.23 0.45 0.68 0.9 1.13 1.35 1.58 1.8 2.25
3 kg 0.45 0.9 1.35 1.8 2.25 2.7 3.15 3.6 4.5
6 kg 0.9 1.8 2.7 3.6 4.5 5.4 6.3 7.2 920 kg 3 6 9 12 15 18 21 24 3040 kg 6 12 18 24 30 36 42 48 60
Pump flow rate (mL/hr)
Doses greater than 3 mcg/kg/min may lead to cyanide toxicity Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC NOREPINEPHRINE Neonatal/Pediatric Norepinephrine IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.1mcg/kg/minute
Usual/ Maximum Dose 0.08mg/mL
Usual: 0.05-2mcg/kg/minute
Maximum: 2mcg/kg/minute
NOREPINEPHRINE 0.08MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Norepinephrine 1mg/mL
4mL
D5W
46mL
To make 50mL: 1. Using a 10mL syringe, draw up 4mL of Norepinephrine
1mg/mL. 2. Using a 60mL syringe, draw up 46mL of D5W. 3. Add the 4mL of Norepinephrine to the 46mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"NOREPINEPHRINE 0.04 MG/mL" April-06
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.04 0.05 0.2 0.75 1 1.5 20.5 kg 0.03 0.04 0.15 0.56 0.75 1.13 1.51.5 kg 0.09 0.11 0.45 1.69 2.25 3.38 4.5
3 kg 0.18 0.23 0.9 3.38 4.50 6.75 9
6 kg 0.36 0.45 1.8 6.75 9 13.5 1820 kg 1.2 1.5 6 23 30 45 6040 kg 2.4 3 12 45 60 90 120
Pump flow rate (mL/hr)
"NOREPINEPHRINE 0.08 MG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.04 0.05 0.2 0.75 1 1.5 20.5 kg 0.02 0.02 0.08 0.28 0.38 0.56 0.751.5 kg 0.05 0.06 0.23 0.84 1.13 1.69 2.25
3 kg 0.09 0.11 0.45 1.69 2.25 3.38 4.5
6 kg 0.18 0.23 0.9 3.38 4.5 6.75 920 kg 0.6 0.75 3 11.25 15 22.5 3040 kg 1.2 1.5 6 22.5 30 45 60
Pump flow rate (mL/hr)
= MAX OF 2MCG/KG/MIN OR 20MCG/MIN, WHICHEVER IS LESS
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC PANCURONIUM Neonatal/Pediatric Pancuronium IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.05-0.1mg/kg/hour
Usual/ Maximum Dose 1mg/mL
Maximum: 0.2mg/kg/hour
PANCURONIUM 1MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Pancuronium 2mg/mL
5mL
D5W 5mL
To make 10mL: 1. Using a 10mL syringe, draw up 5mL of Pancuronium
2mg/mL. 2. Using a 10mL syringe, draw up 5mL of D5W. 3. Add the 5mL of Pancuronium to the 5mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"PANCURONIUM 1 MG/mL" September-05
Dose rate in mg/kg/hour Soft Min Soft Max
Weight 0.05 0.1 0.15 0.20.5 kg 0.03 0.05 0.08 0.1
0.75 kg 0.04 0.08 0.11 0.151.0 kg 0.05 0.1 0.15 0.21.5 kg 0.08 0.15 0.23 0.3
3 kg 0.15 0.3 0.45 0.6
6 kg 0.3 0.6 0.9 1.220 kg 1 2 3 440 kg 2 4 6 8
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC PENTOBARBITAL Neonatal/Pediatric Pentobarbital IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Pentobarbital coma: Load: 5-10mg/kg over 1-2 hours Continuous Infusion: 1mg/kg/hour
Usual/ Maximum Dose
50mg/mL
Usual: 1-5mg/kg/hour Maximum: 5mg/kg/hour
PENTOBARBITAL 50MG/mL INGREDIENTS
QUANTITY
FOR 1 SYRINGE
Pentobarbital 50mg/mL
20mL
To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Pentobarbital
50mg/mL. 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"PENTOBARBITAL 50 MG/mL" September-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.5 1 3 50.5 kg 0.01 0.01 0.03 0.051.5 kg 0.02 0.03 0.09 0.15
3 kg 0.03 0.06 0.18 0.3
6 kg 0.06 0.12 0.36 0.620 kg 0.2 0.4 1.2 240 kg 0.4 0.8 2.4 4
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC PHENYLEPHRINE Neonatal/Pediatric Phenylephrine IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.1-0.5mcg/kg/minute
Usual/ Maximum Dose 1-21kg – 0.08mg/mL = 80mcg/mL
Over 21kg – 1.2mg/mL = 1200mcg/mL Usual: 0.1-1mcg/kg/minute
Maximum: 1mcg/kg/minute
PHENYLEPHRINE 0.08MG/mL INGREDIENTS
QUANTITY
FOR 1 SYRINGE
Phenylephrine 10mg/mL
0.4mL
D5W
49.6mL
To make 50mL: 1. Using a 1mL syringe, draw up 0.4mL of Phenylephrine
10mg/mL. 2. Using a 60mL syringe, draw up 49.6mL of D5W. 3. Add the 0.4mL of Phenylephrine to the 49.6mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
PHENYLEPHRINE 1.2MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Phenylephrine 10mg/mL 6mL
D5W 44mL
To make 50mL: 1. Using a 10mL syringe, draw up 6mL of Phenylephrine
10mg/mL. 2. Using a 60mL syringe, draw up 44mL of D5W. 3. Add the 6mL of Phenylephrine to the 44mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"PHENYLEPHRINE 0.08 MG/ML" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.1 0.25 0.5 0.75 10.5 kg 0.04 0.09 0.19 0.28 0.381.5 kg 0.11 0.28 0.56 0.84 1.13
3 kg 0.23 0.56 1.13 1.69 2.25
6 kg 0.45 1.13 2.25 3.38 4.520 kg 1.5 3.75 7.5 11.25 1540 kg 3 7.5 15 22.5 30
Pump flow rate (ml/hr)
"PHENYLEPHRINE 1.2 MG/ML"Dose rate in mcg/kg/minute
Soft Min Soft Max Weight 0.1 0.25 0.5 0.75 1
0.5 kg 0.00 0.01 0.01 0.02 0.031.5 kg 0.01 0.02 0.04 0.06 0.08
3 kg 0.02 0.04 0.08 0.11 0.15
6 kg 0.03 0.08 0.15 0.23 0.320 kg 0.1 0.25 0.5 0.75 140 kg 0.2 0.5 1 1.5 2
Pump flow rate (ml/hr)
Flow rate <0.3 ml (at or near pump minumum) or >20 ml/hr (assess for fluid overload) Flow rates 0.1-0.3ml may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC Dexmedetomidine Neonatal/Pediatric Dexmedetomidine IV Administration Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.2 mcg/kg/hour
Usual/ Max Dose 4 mcg/ml in NS
Usual: 0.2-0.7 mcg/kg/hour Max: 0.7 mcg/kg/hour
PRECEDEX 4 MCG/mL (DEXMEDETOMIDINE)
INGREDIENTS QUANTITY
FOR 1 SYRINGE
Dexmedetomidine
To make 50 mL: Contact pharmacy for the syringe
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"PRECEDEX 4 MCG/mL" (Dexmedetomidine) September-06
Dose rate in mcg/kg/hourSoft Min Soft Max
Weight 0.2 0.3 0.4 0.5 0.6 0.70.5 kg 0.03 0.04 0.05 0.06 0.08 0.091.5 kg 0.08 0.11 0.15 0.19 0.23 0.26
3 kg 0.15 0.23 0.3 0.38 0.45 0.53
6 kg 0.30 0.45 0.6 0.75 0.9 1.0520 kg 1 1.5 2 2.5 3 3.540 kg 2 3 4 5 6 7
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC PROPOFOL Neonatal/Pediatric Propofol IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.5mg/kg/hour
Usual/ Maximum Dose 10mg /mL
Usual: 0.5-5mg/kg/hour Maximum: 5mg/kg/hour
PROPOFOL 10MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Propofol 10mg/mL (20mL vial)
20mL
To make 20mL: 1. Draw the 20 mL of Propofol directly from vial into 20mL syringe
2. 12 hour expiration date
PROPOFOL 10MG/mL INGREDIENTS Not for
Syringe Propofol 10mg/mL
(100mL bottle)*
* Restricted to infusion rates greater than 100mg/hr
Infusion bottles and tubing must be changed every 12 hours and unused drug discarded
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"PROPOFOL 10 MG/mL" September-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.5 1 2 3 4 50.5 kg 0.25 0.5 1 1.5 2 2.51.5 kg 0.75 1.5 3 4.5 6 7.5
3 kg 1.5 3 6 9 12 15
6 kg 3 6 12 18 24 3020 kg 10 20 40 60 80 10040 kg 20 40 80 120 160 200
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC TERBUTALINE Neonatal/Pediatric Terbutaline IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Load: 10mcg/kg over 3-5minutes Continuous Infusion: 0.4mcg/kg/minute
Usual/ Maximum Dose
1000mcg/mL
Usual: 0.4-6mcg/kg/minute Maximum: 6mcg/kg/minute
TERBUTALINE 1000MCG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Terbutaline 1mg/mL (20mg/20mL vial)
20mL
To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Terbutaline
1mg/mL. 2. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"TERBUTALINE 1000 MCG/mL" September-05
Dose rate in mcg/kg/minuteSoft Min Soft Max
Weight 0.4 0.8 1 2 3 4 5 60.5 kg 0.01 0.02 0.03 0.06 0.09 0.12 0.15 0.181.5 kg 0.04 0.07 0.09 0.18 0.27 0.36 0.45 0.54
3 kg 0.07 0.14 0.18 0.36 0.54 0.72 0.9 1.08
6 kg 0.14 0.29 0.36 0.72 1.08 1.44 1.8 2.1620 kg 0.48 0.96 1.2 2.4 3.6 4.8 6 7.240 kg 0.96 1.92 2.4 4.8 7.2 9.6 12 14.4
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC VASOPRESSIN Neonatal/Pediatric Vasopressin
DIABETES INSIPIDUS IV Dosing and Preparation Guidelines Concentration Provided Starting Dose
Continuous Infusion: 0.5milliunits/kg/hour Usual/ Maximum Dose
6-21kg – 0.02unit/mL = 20milliunits/mL in NS Over 21kg – 1unit/mL = 1000milliunits/mL in NS
Usual: 0.5-1milliunit/kg/hour
Maximum: 10 milliunits/kg/hour
VASOPRESSIN 0.02UNIT/mL (DIABETES INSIPIDUS)
INGREDIENTS QUANTITY FOR 1
SYRINGE Vasopressin 20unit/mL
0.05mL
NS 49.95mL
To make 50mL: 1. Using a 1mL syringe, draw up 0.05mL of Vasopressin
20u/mL. 2. Using a 60mL syringe, draw up 49.95mL of NS. 3. Add the 0.05mL of Vasopressin 20U/mL to the 49.95mL
of NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date
VASOPRESSIN 1UNIT/mL (DIABETES INSIPIDUS)
INGREDIENTS QUANTITY FOR 1
SYRINGE Vasopressin 20unit/mL
2.5mL
NS 47.5mL
To make 50mL: 1. Using a 3mL syringe, draw up 2.5mL of Vasopressin
20u/mL. 2. Using a 60mL syringe, draw up 47.5mL of 0.9%. 3. Add the 2.5mL of Vasopressin 20U/mL to the 47.5mL of
NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"VASOPRESSIN 0.02 UNITS/mL" September-05
INDICATION: DIABETES INSIPIDUSDose rate in milliunit/kg/hour
Soft Min Soft Max Weight 0.5 1 2.5 5 7.5 10
0.5 kg 0.01 0.03 0.06 0.13 0.19 0.251.5 kg 0.04 0.08 0.19 0.38 0.56 0.75
3 kg 0.08 0.15 0.38 0.75 1.13 1.5
6 kg 0.15 0.3 0.75 1.5 2.25 320 kg 0.5 1 2.5 5 7.5 1040 kg 1 2 5 10 15 20
Pump flow rate (mL/hr)
Note: for Pediatric Patients >40KG use Adult ICU Protocol (below)
"VASOPRESSIN >40KG 1 UNIT/mL"INDICATION: DIABETES INSIPIDUS
Dose rate in units/hourSoft Min Soft Max
Weight 2.4 4 5 6 7 101.0 kg 2.4 4 5 6 7 10
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC VASOPRESSIN Neonatal/Pediatric Vasopressin
GASTROINTESTINAL BLEED IV Dosing and Preparation Guidelines Concentration Provided Starting Dose
Continuous Infusion: 0.002units/kg/minute Usual/ Maximum Dose
0.02unit/mL = 20milliunits/mL in NS Over 21kg – 1unit/mL = 1000milliunits/mL in NS
Usual: 0.002-0.005 units/kg/minute Maximum: 0.01 units/kg/minute
VASOPRESSIN 1UNIT/mL (GI BLEED) GI
INGREDIENTS QUANTITY FOR 1
SYRINGE Vasopressin 20u/mL
2.5mL
NS 47.5mL
To make 50mL: 1. Using a 3mL syringe, draw up 2.5mLof Vasopressin
20u/mL. 2. Using a 60mL syringe, draw up 47.5mL of NS. 3. Add the 2.5mL of Vasopressin 20U/mL to the 47.5mL of
NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"VASOPRESSIN 1 UNIT/mL" September-05
INDICATION: GI BLEED
Dose rate in units/kg/minuteSoft Min Soft Max
Weight 0.002 0.005 0.01 0.030.5 kg 0.06 0.15 0.3 0.91.5 kg 0.18 0.45 0.9 2.73 kg 0.36 0.9 1.8 5.4
6 kg 0.72 1.8 3.6 10.820 kg 2.4 6 12 3640 kg 4.8 12 24 72
Pump flow rate (mL/hr)
Note: for Pediatric Patients >40KG use Adult ICU Protocol (below)
"VASOPRESSIN >40KG 1 UNIT/mL"INDICATION: GI BLEED
Dose rate in units/minuteSoft Min Soft Max
Weight 0.1 0.2 0.4 0.81.0 kg 6 12 24 48
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
Neonatal/Pediatric Vasopressin VASODILATORY SHOCK IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.3milliunits/kg/minute
Usual/ Maximum Dose 6-21kg - 0.4units/mL = 400milliunits/mL in NS
Over 21kg - 1unit/mL = 1000milliunits/mL in NS Usual: 0.3-2milliunits/kg/minute Maximum: 2milliunits/kg/minute
VASOPRESSIN 0.4 UNIT/mL (VASODILATORY SHOCK)
INGREDIENTS QUANTITY FOR 1
SYRINGE Vasopressin 20u/mL
1 mL
NS 50mL
To make 50mL: 1. Using a 1mL syringe, draw up 1 mL of Vasopressin
20u/mL. 2. Using a 60mL syringe, draw up 49mL of NS. 3. Add the 1mL of Vasopressin to the 49mL of NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date
VASOPRESSIN 1UNIT/mL (VASODILATORY SHOCK)
INGREDIENTS QUANTITY FOR 1
SYRINGE Vasopressin 20u/mL
2.5mL
NS 47.5mL
To make 50mL: 1. Using a 3mL syringe, draw up 2.5mLof Vasopressin
20u/mL. 2. Using a 60mL syringe, draw up 47.5mL of NS. 3. Add the 2.5mL of vasopressin 20U/mL to the 47.5mL of
NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"VASOPRESSIN O.4 UNITS/mL" September-05
INDICATION: VASODILATORY SHOCKDose rate in milliunit/kg/minute
Soft Min Soft Max Weight 0.3 0.5 1 2 5 7.5 10
0.5 kg 0.02 0.04 0.08 0.15 0.38 0.56 0.751.5 kg 0.07 0.11 0.23 0.45 1.13 1.69 2.25
3 kg 0.14 0.23 0.45 0.9 2.25 3.38 4.5
6 kg 0.27 0.45 0.9 1.8 4.5 6.75 920 kg 0.9 1.5 3 6 15 22.5 30
Pump flow rate (mL/hr)
"VASOPRESSIN 1 UNIT/mL"INDICATION: VASODILATORY SHOCK
Dose rate in milliunit/kg/minuteSoft Min Soft Max
Weight 0.3 0.5 1 2 5 7.5 100.5 kg 0.01 0.02 0.03 0.06 0.15 0.23 0.31.5 kg 0.03 0.05 0.09 0.18 0.45 0.68 0.9
3 kg 0.05 0.09 0.18 0.36 0.9 1.35 1.8
6 kg 0.11 0.18 0.36 0.72 1.8 2.7 3.620 kg 0.36 0.6 1.2 2.4 6 9 1240 kg 0.72 1.2 2.4 4.8 12 18 24
Pump flow rate (mL/hr)
Note: for Pediatric Patients >40KG use Adult ICU Protocol (below)
"VASOPRESSIN >40KG 1 UNIT/mL"INDICATION: VASODILATORY SHOCK
Dose rate in units/minuteSoft Min Soft Max
Weight 0.01 0.02 0.03 0.040.5 kg 0.6 1.2 1.8 2.4
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children
NEONATAL / PEDIATRIC VECURONIUM Neonatal/Pediatric Vecuronium IV Dosing and Preparation Guidelines
Concentration Provided Starting Dose Continuous Infusion: 0.1mg/kg/hour
Usual/ Maximum Dose
1mg/mL
Usual: 0.1-0.15mg/kg/hour Maximum: 0.2mg/kg/hour
. VECURONIUM 1MG/mL INGREDIENTS QUANTITY
FOR 1 SYRINGE
Vecuronium 10mg/mL* 10mL
* Reconstitute Vecuronium 10 mg vial with 10mL SWFI
To make 10mL: 1. Reconstitute Vecuronium 10mg vial with 10mL SWFI. 2. Using a 10mL syringe, draw up 10mL of Vecuronium. 3. 24 hour expiration date
MassGeneral Hospital for Children
Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight
"VECURONIUM 1 MG/mL" September-05
Dose rate in mg/kg/hourSoft Min Soft Max
Weight 0.04 0.05 0.1 0.20.5 kg 0.02 0.03 0.05 0.1
0.75 kg 0.03 0.04 0.08 0.151.00 kg 0.04 0.05 0.1 0.21.5 kg 0.06 0.08 0.15 0.33 kg 0.12 0.15 0.3 0.66 kg 0.24 0.3 0.6 1.2
20 kg 0.8 1 2 440 kg 1.6 2 4 8
Pump flow rate (mL/hr)
Pump flow rate (mL/hr)
Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range
MassGeneral Hospital for Children