PICU IV InfusionChart - Michigan Medicinemed.umich.edu/surgery/burn/PICU_IV_InfusionChart.pdf · IV Guidelines for PICU / CES / TBICU (

UniversityofMichigan–DepartmentofPharmacyServicesIVGuidelinesforPICU/CES/TBICU(<12yearsofage)

*Doseslistedabovearesuggestedmaximumdosesforpatientsafety;startatlowestdosewhentitratingunlessclinicalconditionrequireshigherdose.Someclinicalconditionsmaywarranttheuseofdoseshigherthanthoselistedabove.LastRevised3/11/2013ver.4

DRUG–GENERICNAME[TRADE

NAME]

STANDARDCONCENTRATION

Boldeddiluentisstandard/preferred

LOADINGDOSE&BOLUSDOSE

USUALDOSERANGE NURSINGTITRATIONINSTRUCTIONS

COMMENTS

ALPROSTADIL(PGE,PROSTIN,PROSTAGLANDIN)

*UsedforPDApatency(newborncardiac)orgraftpatency(livertransplant)

100mcg/33.3mL (3mcg/mL)1000mcg/250mL (4mcg/mL)200mcg/33.3mL(6mcg/mL)

Diluents:D5W,D10W,NS

NONE 0.03-0.2mcg/kg/min Transplant:10-40mcg/hrbasedonpatientweight

DONOTTITRATE § Transplantdosingisdifferent;refertolivertransplantprotocolinOTIS

§ 6mcg/mLconcuse“alprostodilnon-standard”in<50kgPICUCardiacA-Isyringepumplibrary

AMINOPHYLLINE*IVformoftheophylline

100mg/50mL(2mg/mL)250mg/50mL(5mg/mL)500mg/50mL(10mg/mL)


Loading:5-7mg/kgIVgivenover30minutes

0.5-1.2mg/kg/hr Note:refertoPedsLexicompforageappropriatedose

DONOTTITRATE § Follow theophyllinelevels1hrpost-load,thenQ12-24hr

§ Therapeutic:10-15mcg/mL§ Toxicity>20mcg/mL

AMIODARONE 10mg/20mL(0.5mg/mL)20mg/20mL(1mg/mL)100mg/50mL(2mg/mL)

CentralLineONLY:250mg/50mL(5mg/mL)300mg/50mL(6mg/mL)

Diluents:D5W

Loading:<50kg:5mg/kgIVuptoMAXof150mg/dosegivenover60minutes;ifcardiacrhythmresponseisnotachieved,prescribermaychoosetorepeatloadingdose(MAX15mg/kg/dayor450mg/day)

≥50kg:150mg/doseIVgivenover60minutes;ifcardiacrhythmresponseisnotachieved,prescribermaychoosetorepeat(MAX450mg/day)

<50kg:5-15mcg/kg/min[Allconc]

≥50kg:1mg/minx6hrs,then0.5mg/min[2mg/mLand6mg/mLconcONLY]

DONOTTITRATE § MUSTBEFILTEREDwith0.22micronfilter

§ Tubinggoodfor72hours




NAME]





COMMENTS

ARGATROBAN 20mg/20mL(1mg/mL)50mg/50mL(1mg/mL)

Diluents:D5W,NS

Loading:ONLYusedincathlabortoprimeECMOcircuit

0.1-3mcg/kg/minECMO:0.5-2mcg/kg/min

DONOTTITRATE § FollowaPPTsoranti-IIalevels

§ ECMOfollowsACTs§ Lowerdosingneededinliverfailure

AMINOCAPROICACID[AMICAR®]

1000mg/50mL(20mg/mL)5000mg/250mL(20mg/mL)

Diluents:D5W

Loading:50-100mg/kgIVuptoMAX of5000mg/dosegivenover60minutes

<50kg:25-30mg/kg/hr,totalhourlydosecannotexceed1000mg/hr

≥50kg:1000mg/hr

DONOTTITRATE § Mottinfusions(syringes)runasmg/kg/hr

§ UHinfusionorders(250mLbags)runinmg/hr

BUMETANIDE[BUMEX®]

5mg/20mL(0.25mg/mL)12.5mg/50mL(0.25mg/mL)

NoDiluent–Thisisstraightdrug

NONE 0.01-0.04mg/kg/hr DONOTTITRATE § Foundunder“PICUMiscContinuous”in<50kgPICUsyringepumplibrary

CALCIUMCHLORIDE CentralLineONLY:1000mg/50mL(20mg/mL)2000mg/100mL(20mg/mL)5000mg/250mL(20mg/mL)

NONE 2.5-20mg/kg/hr CRRTCalciumInfusion:perCRRTCitrateprotocol

DONOTTITRATE Exception:ForCRRTcalciuminfusion,titrateperCRRTCitrateprotocol

§ CENTRALLINEadministrationONLY

CISATRICURIUM[NIMBEX®]


Diluents:D5W,NS

Loading:0.1mg/kgIVgivenover5-10secondsandtheninitiatecontinuousinfusion

Bolus:Maygive0.1mg/kgover5-10secondswitheachinfusionincrease

1-10mcg/kg/min Titrateby0.5mcg/kg/minevery30-60minutesuntilorderedTrain-of-Fourormaxordereddoseachieved

*Neuromuscularblockade*§ Monitorwithperipheralnervestimulation(Train-of-Four)

§ Recommendedstartingvoltage:2Hzevery0.5secondsx4,mayrepeatin12seconds




NAME]





COMMENTS

DEXMEDETOMIDINE[PRECEDEX®]

80mcg/20mL(4mcg/mL)200mcg/50mL(4mcg/mL)

Diluents:D5W,NS

Loading:Duetopotentialsideeffects,loadingdosesarenotcurrentlyrecommended

0.2-1.5mcg/kg/hr Titrateby0.1-0.2mcg/kg/hrevery30minutesuntilorderedsedationormaxordereddoseachieved

§ Commonsideeffects:bradycardiaandhypotension

§ DuetonocompatibilityinformationfordexmedetomidineandTPN,placedexmedetomidinestopcockfurthestfromTPNstopcockifrunningviasamelumen

§ PediatricICUDexmedetomidineGuidelines

DILTIAZEM[CARDIZEM®]

10mg/50mL(0.2mg/mL)50mg/50mL(1mg/mL)

Diluents:D5W,NS

Loading:0.25mg/kgIVgivenover2minutes;after15minutesifcardiacrhythmresponseisnotachieved,prescribermayorder2nd

doseof0.35mg/kgIV

<50kg:0.07-0.2mg/kg/hr[Allconc]

≥50kg:5-15mg/hr[1mg/mLconcONLY]

DONOTTITRATE

DOBUTAMINE 50mg/50mL(1mg/mL)100mg/50mL(2mg/mL)150mg/50mL(3mg/mL)

CentralLineONLY:250mg/50mL(5mg/mL)


NONE 2-20mcg/kg/min Titrateby2-5mcg/kg/minevery5minutesuntilorderedparameterormaxordereddoseachieved




NAME]





COMMENTS

DOPAMINE 50mg/50mL(1mg/mL)100mg/50mL(2mg/mL)150mg/50mL(3mg/mL)



NONE 2-20mcg/kg/min Titrateby2-5mcg/kg/minevery5minutesuntilorderedparameterormaxordereddoseachieved

EPINEPHRINEHYDROCHLORIDE

0.2mg/20mL(0.01mg/mL)1mg/50mL(0.02mg/mL

CentralLineONLY:2mg/50mL(0.04mg/mL)6mg/50mL(0.12mg/mL)


NONE 0.01-1mcg/kg/min Titrateby0.01-0.02mcg/kg/minevery5minutesuntilorderedparameterormaxordereddoseachieved

EPOPROSTANOL[FLOLAN®]

0.03mg/10mL(3mcg/mL)0.1mg/20mL(5mcg/mL)0.75mg/50mL(15mcg/mL)1.5mg/50mL(30mcg/mL)

AlternatevolumesavailableSpecialconcentrationsavailable –mustbeapprovedbyPharmacy

SpecialFlolanDiluent

NONE Startingdose:2-3ng/kg/min

1ng(nanogram)=0.001mcg

OR

1000ng(nanogram)=1mcg

DONOTTITRATE *TitrationbasedonpatientresponseperMDorder.Usualdoseincreaseby1-2ng/kg/minevery8-24hours.

§ Flolancartridgesarestablefor24hours–storeoniceandprotectfromlight

§ Flolansyringesmustbechangedevery8hours–donothavetocoversyringeorIVtubing

§ FlolanisNOTCOMPATIBLEwithanyothermedicationsorIVfluids

§ DONOTstop,pause,orinterruptFlolaninfusion

§




NAME]





COMMENTS

ESMOLOL[BREVIBLOC®]


Diluents:D5W,NS

Loading:50-500mcg/kggivenover1minute

50-200mcg/kg/min If>2yrmayrun300-800mcg/kg/minwithMDorder

Titrateby25mcg/kg/minevery5to15minutesuntilorderedparameterormaxordereddoseachieved

FENOLDOPAM 1.6mg/20mL(80mcg/mL)4mg/50mL(80mcg/mL)

Diluents:D5W,NS

NONE 0.1-0.8mcg/kg/min DONOTTITRATE § Foundunder“PICUMiscContinuous”in<50kgPICUsyringepumplibrary

FENTANYL[SUBLIMAZE®]

1mg/20mL(50mcg/mL)0.5mg/20mL(25mcg/mL)

Loading:1-2mcg/kgIVgivenslowIVpush*

Bolus:Maygive1-2mcg/kgslowIVpushwitheachinfusionincrease

*Administrationratesforloadingorbolusdoses:<5mcg/kg=3-5minutes≥5mcg/kg=5-10minutes

1-10mcg/kg/hr Titrateby0.5mcg/kg/hrevery30minutesuntilorderedparameterormaxordereddoseachieved

§ PushingIVfentanyltooquicklywillresultinchestwallrigidity

FUROSEMIDE[LASIX®]

20mg/20mL(1mg/mL)125mg/50mL(2.5mg/mL)250mg/50mL(5mg/mL)200mg/20mL(10mg/mL)


NONE <50kg:0.05-0.4mg/kg/hr[Allconc]

≥50kg:0.5-40mg/hr[5mg/mLand10mg/mLconcONLY]

DONOTTITRATE




NAME]





COMMENTS

HEPARIN 2000units/20mL(100units/mL)5000units/50mL(100units/mL)

ECMO:750units/30mL(25units/mL)2500units/50mL(50units/mL)5000units/50mL(100units/mL)20,000units/50mL(400units/mL)


Loading:50-80units/kgIVgivenover15minutes

ECMOLoading:100mg/kgIVgivenover15minutes

StartingDose:15-18units/kg/hr

MaintenanceDoseRange:15-40unit/kg/hr

DONOTTITRATE § MONITORPTT(oranti-Xalevel)

§ DoseswillbeadjustedperPTT(oranti-Xalevel)

§ NomogramimbeddedinCareLinkorder

§ ECMOusesdifferentconcentrations

§ ECMOmonitorsACTs

INSULINREGULAR 2units/20mL(0.1unit/mL)20units/20mL(1unit/mL)50units/50mL(1unit/mL)250units/50mL(5units/mL)


NONE DKA:0.05-0.1unit/kg/hr

HYPERGLYCEMIAofcriticalillness:<50kg:Startat0.05-0.1units/kg/hr[Allconc]

≥50kg:Startat1unit/hr[1unit/mLand5unit/mLconcONLY]

DKA:DONOTTITRATE HYPERGLYCEMIAofcriticalillness:DONOTTITRATE

§ MONITORGLUCOSELEVELS

§ ForinsulininfusionguidelinesonpediatricdiabeticpatientsseePediatricEndocrinologyGuidelinesforDKA




NAME]





COMMENTS

ISOPROTERENOL[ISUPREL®]

0.2mg/20mL(0.01mg/mL) CentralLineONLY:1mg/50mL(0.02mg/mL)

Diluents:D5W,NS

NONE 0.01-2mcg/kg/min DONOTTITRATE

KETAMINE[KETALAR®]

100mg/50mL (2mg/mL)250mg/50mL (5mg/mL)500mg/50mL(10mg/mL)

Diluents:D5W,NS

Loading:0.5-2mg/kgIVgivenover1minute

Bolus:Maygive0.5-2mg/kgIVover1minutewitheachinfusionincrease

5-40mcg/kg/min Titrateby5mcg/kg/minevery30minutesuntilorderedsedationormaxordereddoseachieved

LABETOLOL 20mg/20mL(1mg/mL)100mg/50mL(2mg/mL)


Diluents:D5W,NS

Loading:0.2-1mg/kguptoMAXof20mg/doseIVgivenover5minutes

<50kg:0.25-3.0mg/kg/hr[Allconc]

≥50kg:0.5-3mg/min[5mg/mLconcONLY]

DONOTTITRATE

LEVOTHYROXINE(T4–GIFTOFLIFE)[SYNTHROID®]

100mcg/50mL(2mcg/mL)200mcg/500mL(0.4mcg/mL)

Loading:0.8-5mcg/kgIVgivenover30-45minutes

<50kg:0.8-1.4mcg/kg/hr[2mcg/mLconcONLY]

≥50kg:1-20mcg/hr[0.4mcg/mLconcONLY]

DONOTTITRATE § Notinsyringepumplibrary

§ Syringeexpiresin12hours

§ Agebaseddosingavailableunder“Organdonormanagement”indosingsection




NAME]





COMMENTS

LIDOCAINE 200mg/50mL(4mg/mL) CentralLineONLY:2000mg/250mL(8mg/mL)

Diluents:D5W,NS

CardiacLoading:1mg/kgIVgivenover2minutes.After15minutesifcardiacrhythmresponseisnotachieved,prescribemaychoosetorepeatloadingdose.

Forcardiac:20-80mcg/kg/min

Forchronicpain:15-30mcg/kg/min

DONOTTITRATE § ChecklidocainelevelQ24hr

§ Therapeutic:1.5-5mcg/mL

LORAZEPAM[ATIVAN®]

4mg/20mL(0.2mg/mL)20mg/20mL(1mg/mL)50mg/50mL(1mg/mL)


Loading:0.1-0.3mg/kgIVgivenover1-2minutes

Bolus:Maygive0.1-0.3mg/kgIVover1-2minuteswitheachinfusionincrease

<50kg:20-200mcg/kg/hr[Allconc]


<50kg:Titrateby10-20mcg/kg/hrevery60minutesuntilorderedsedationormaxordereddoseachieved

>50kg:Titrateby0.5-1mg/hrevery60minutesuntilorderedsedationormaxordereddoseachieved

§ Dosesabove200mcg/kg/hror10mg/hrmaybeusedbutpatientshouldbemonitoredforpropyleneglycoltoxicity(osmolargapmetabolicacidosis)

MIDAZOLAM[VERSED®]

4mg/20mL(0.2mg/mL)20mg/20mL(1mg/mL)50mg/50mL(1mg/mL)


Loading:0.05-0.2mg/kgIVgivenover2minutes

Bolus:Maygive0.05-0.2mg/kgIVover2minuteswitheachinfusionincrease

<50kg:20-200mcg/kg/hr[Allconc]


<50kg:Titrateby10-20mcg/kg/hrevery60minutesuntilorderedsedationormaxordereddoseachieved

>50kg:Titrateby0.5-1mg/hrevery60minutesuntilorderedsedationormaxordereddoseachieved




NAME]





COMMENTS

MILRINONE 1mg/20mL(0.05mg/mL)2mg/20mL(0.1mg/mL)25mg/50mL(0.5mg/mL)


Loading:50mcg/kgIVgivenover15minutes

*DonotroutinelyloadinthePICU

0.3-0.75mcg/kg/min DONOTTITRATE

MORPHINESULFATE

4mg/20mL(0.2mg/mL)20mg/20mL(1mg/mL)50mg/50mL(1mg/mL)250mg/50mL(5mg/mL)


Loading:0.1-0.3mg/kgIVgivenover5minutes

Bolus:Maygive0.1-0.3mg/kgIVover5minuteswitheachinfusionincrease

<50kg:20-200mcg/kg/hr[0.2and1mg/mLconcONLY]

≥50kg:1-10mg/hr[1mg/mLor5mg/mLconcONLY]

<50kg:Titrateby10-20mcg/kg/hrevery60minutesuntilorderedparameterormaxordereddoseachieved

>50kg:Titrateby0.5-1mg/hrevery60minutesorderedparameterormaxordereddoseachieved

NALOXONE(NARCAN®)

Forpruritusorhyperalgesia:1.1 mg/20mL(0.005mg/mL)1.2 mg/20mL(0.01mg/mL)

Foropioidreversal:10mg/100mL(0.1mg/mL)

Diluents:NS

NONE Forpruritusorhyperalgesia:0.1-0.25mcg/kg/hr

Foropioidreversal:20-40mcg/kg/hr

DONOTTITRATE § Todecreaseopioid-inducedpruritusoropioidtoleranceandrapidescalation

§ Foropioidreversal,dosemaybehigherorlowerbasedonamountopioidintoxication




NAME]





COMMENTS

NESIRITIDE[NATRECOR®]*Usedmostcommonlyindecompensatedheartfailuretohelpdilateveinsandarteries

0.12mg/20mL(6mcg/mL)0.3mg/50mL(6mcg/mL)

Diluents:NS

NONE 0.01-0.03mcg/kg/min DONOTTITRATE § Commonsideeffect:HYPOTENSION

NICARDIPINE 6mg/20mL(0.3mg/mL)40mg/200mL(0.2mg/mL)–NSonly

CentralLineONLY:25mg/50mL(0.5mg/mL)

Diluents:D5W,NS

NONE <50kg:1-5mcg/kg/min[0.3mg/mLand0.5mg/mLONLY]

≥50kg:1-15mg/hr[0.2mg/mLand0.5mg/mLONLY]

<50kg:Titrateby0.2mcg/kg/minevery5minutesorderedparameterormaxordereddoseachieved

≥50kg:Titrateby0.5-1mg/hrevery5minutesorderedeffectsormaxordereddoseachieved

§ Watchperipheralinfusionsiteforinfiltrationorextravasation

NITROGLYCERIN 10mg/50mL(0.2mg/mL) CentralLineONLY:20mg/50mL(0.4mg/mL)

Diluents:D5W,NS

NONE 0.5-20mcg/kg/min DONOTTITRATE § Uselow-sorbingtubingMSCitem#5101:Set,IVLowsorbingw/oports




NAME]





COMMENTS

NITROPRUSSIDE[NIPRIDE®]

10mg/20mL(0.5mg/mL) CentralLineONLY:50mg/50mL(1mg/mL)

Diluents:D5WONLY

NONE 0.5-10mcg/kg/min DONOTTITRATE § Protectsyringefromlight–donotneedtocoverIVtubing

§ Checkcyanide/thiocyanatelevelevery24hourstomonitorforcyanidetoxicity

NOREPINEPHRINEBITARTRATE[LEVOPHED®]

0.2mg/20mL(0.01mg/mL)1mg/50mL(0.02mg/mL)

CentralLineONLY:2mg/50mL(0.04mg/mL)6mg/50mL(0.12mg/mL)


NONE 0.01-2mcg/kg/min Titrateby0.01-0.02mcg/kg/minevery5minutesorderedparameterormaxordereddoseachieved

OCTREOTIDE 0.05mg/20mL(2.5mcg/mL)0.25mg/50mL(5mcg/mL)0.5mg/50mL(10mg/mL)

Diluents:D5W,NS

NONE Chylothorax:1-3mcg/kg/hr

GIbleed:1-10mcg/kg/hr

DONOTTITRATE

PANTOPRAZOLE[PROTONIX®]

16mg/20mL(0.8mg/mL)40mg/50mL(0.8mg/mL)

Diluents:NS

Loading:1-2mg/kgIVuptoMAXof80mg/dose)givenover5minutes

0.1-0.2mg/kg/hr DONOTTITRATE § ShouldbeusedforGIbleedingonly




NAME]





COMMENTS

PENTOBARBITAL[NEMBUTAL®]

100mg/20mL(5mg/mL) CentralLineONLY:1000mg/20mL(50mg/mL)


Loading:1-5mg/kgIVgivenover20minutes

Bolus:Maygive1-2mg/kgIVover20minuteswitheachinfusionincrease

0.25-10mg/kg/hr DONOTTITRATE § VasopressormaybeneededtosustainBPduetomyocardialdepressanteffects

§ PICUPractice:Continuousinfusionrequirein-line0.22micronfilteranduse4-wayECMOstopcocktoavoiddrugprecipitation

§ Infusion, tubing, andstopcockneedstobechangedQ12hr

PHENYLEPHRINE*Usedmostcommonlyinneurogenicshock

2.5mg/50mL(0.05mg/mL)5mg/50mL(0.1mg/mL)



NONE 0.05-5mcg/kg/min DONOTTITRATE




NAME]





COMMENTS

PROCAINAMIDE 80mg/20mL (4mg/mL)200mg/50mL(4mg/mL)

CentralLineONLY:400mg/50mL(8mg/mL)2000mg/250mL(8mg/mL)

Diluent:D5W

Loading:<50kg:3-6mg/kgIVuptoMAXof100mg/dosegivenover5minutes.After10minutesifcardiacrhythmresponseisnotachieved,prescribermaychoosetorepeatloadingdoseevery5-10minutestoatotaldoseof15mg/kgor500mgin30minutes.

≥50kg:15-18mg/kgIVgivenover25-30minutesOR100mgIVover2minutesrepeatedevery5minutesasneededtoatotaldoseof1000mg.

<50kg:20-80mcg/kg/min[Allconcinsyringes]

≥50kg:1-4mg/min[8mg/mLconcONLY]

DONOTTITRATE § CheckProcainamideandNAPAlevels6to12hoursafterstartofcontinuousinfusion

PROPOFOL[DIPRIVAN®]


NONE 10-150mcg/kg/min Titrateby5-10mcg/kg/minevery5minutesuntilorderedsedationormaxordereddoseachieved

§ SeePediatricPropofolPolicy




NAME]





COMMENTS

ROCURONIUM 50mg/50mL(1mg/mL)


Loading:1mg/kgIVgivenover5-10secondsandtheninitiatecontinuousinfusion

Bolus:Maygive1mg/kgIVover5-10secondswitheachinfusionincrease

7-12mcg/kg/min Titrateby1mcg/kg/minevery30-60minutesuntilorderedTrain-of-Fourormaxordereddoseachieved



TERBUTALINE 5mg/50mL(0.1mg/mL)25mg/50mL(0.5mg/mL)50mg/50mL(1mg/mL)

Diluents:D5W,NS

Loading:2-10mcg/kgIVover5minutes

0.08-4mcg/kg/min DONOTTITRATE § Commonsideeffects:tachycardia,HTN,tremor,N/V,seizures

VASOPRESSIN(SHOCK)

4units/20mL(0.2unit/mL)25units/50mL(0.5unit/mL)

CentralLineONLY:50units/50mL(1unit/mL)

Diluents:D5W,NS

NONE 0.0003-0.002unit/kg/min

DONOTTITRATE

VASOPRESSIN(DIABETESINSIPIDUS)

NostandardconcentrationBasedonpatientweight

Tocalculateconcentration:Thevasopressindoseis5%ofpatient’sweightin50mLExample:12kgpatient12kgx5%=0.6units0.6units/50mL=0.012units/mL

NONE 1milliunit/kg/hr=1unit/hr

Titrateby0.25-0.5milliunit/kg/hrevery60minutestoorderedUOP




NAME]





COMMENTS

VECURONIUM 20mg/20mL(1mg/mL)50mg/50mL(1mg/mL)

Nodiluents–thisisstraightdrug

Loading:0.1mg/kgIVgivenover5-10secondsandtheninitiatecontinuousinfusion

Bolus:Maygive0.1mg/kgIVover5-10secondswitheachinfusionincrease

1-2.5mcg/kg/min Titrateby0.5mcg/kg/minevery30-60minutesuntilorderedTrain-of-Fourormaxordereddoseachieved



Approved: PediatricCriticalCareJointPractice:2/2013PediatricMedicationSafety: 2/2013Pharmacy&TherapeuticsCommittee: 2/2013

Documents

PICU IV InfusionChart - Michigan Medicinemed.umich.edu/surgery/burn/PICU_IV_InfusionChart.pdf · IV Guidelines for PICU / CES / TBICU (