IV Medication Administration Guidelines

Jefferson Hospital
INTRAVENOUS MEDICATIONS ADMINISTRATION GUIDELINES
(Note the usual adult dose refers to common uses and routes, not all indications/uses and routes may be listed)
DESIGNATED
BRAND
GENERIC NAME
ROUTE
NURSING
RATE
SPECIAL CONSIDERATIONS
NAME
STAFF
Abciximab
Reopro
INF
IVP
A
1
Maintenance infusion:
Prevention of restenosis in PCI:
0.125 mcg/kg/min (max=10
mcg/min) for 12 hours.
For the prevention of cardiac
ischemic complications in patients
with unstable angina: 10mcg/min
X 18-24hrs
Acetazolamide
Diamox
IVP
IVF
B
Over 2-3 min
Infusion over 15 min
Acetylcysteine
Acetadote
IVF
B
First bag over 1 hr, 2nd over 4 hrs,
3rd over 16 hrs
Acyclovir
Zovirax
INF
C
Infuse over 1 hour
Adenosine
Adenocard
IVP
A
1
Rapid bolus
For treatment of PSVT: 6mg rapid
IV bolus over 1-2 seconds. Follow
IV bolus with rapid flush of NSS If
no conversion in 1 to 2 minutes
may give additional 12mg dose.
May repeat 12mg dose in 1 to 2
minutes if needed.
Albumin
SPA
Plasmanate
INF
B
For hypovolemic shock: Infuse
5%solution as rapidly as tolerated.
As blood volume approaches normal,
infusion rate should be slowed.
•For hypoproteinemic patients: The
infusion rate should not exceed 2—3
ml/minute for the25% solution.
Drug must be filtered through a 0.22-micron low protein-binding filter.
Maintenance infusion made with 7.2mg in 250ml NSS.
Bolus can be given undiluted from a vial, but must be filtered using 0.22micron filter.
Administer via a separate line; do not mix with other drugs
Unused portion should be discarded
Dilute each 500mg in 5ml sterile water. For use in metabolic alkalosis,
adjust per pH.
May also be given as infusion in 50ml over 15 minutes.
Mix in D5W. Use limited to acetaminophen toxicity only. Infusion of 3
bags over a total of 21 hours. 3rd bag may be repeated after the initial 21
hours. Weight-based dosing maxed at 100kg.
Dilute in D5W: 250mg/50ml; 500mg/100ml;
750mg/150 ml, or to a maximum concentration of 7mg/ml.
Can also be used in thallium tomography for diagnostic purposes
(Adenoscan).
When administering rapid bolus adenosine (Adenocard®) for the
treatment of PSVT the dose should be administered via a peripheral line
as proximal to the trunk as possible followed by a rapid saline flush. If
administered via a central line a reduced dose is recommended.
.
Available as 5% and 25%. Use 5% for hypovolemia, fluid resuscitation.
Use 25% solution to increase oncotic pressure.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 1 of 25
GENERIC NAME
Alteplase
BRAND
NAME
Activase/TPA
ROUTE
INF
DESIGNATED
NURSING
STAFF
ICU/CVU/ER
only
(see special
considerations)
CathFlo
RATE
Ischemic Stroke: Adults: 0.9 mg/kg
total dose administered via IV
infusion, with 10% of the total dose
administered as an initial IV
loading dose over 1 minute, and
the remainder administered over
60 minutes. Maximum dose is
90mg.
Pulmonary Embolism (PE) Adults:
100 mg IV infusion over 2 hours.
SPECIAL CONSIDERATIONS
Caution: Thrombolytic!
Use infusion device and flow stop tubing.
Peripheral Arterial Occlusion: See Atleplase Peripheral Arterial
Thrombolysis order sheet.
For Ischemic stroke dosing: Calculate total dose (bolus plus
infusion), subtract total dose from amount in bag and discard
excess.
Cathflo: Dilute to 1mg/ml with Sterile Water.
Only RN’s who have completed competency for catheter clearance can
administer Cathflo. May repeat dose in 120 minutes if needed.
Amikacin
Amikin
INF
C
Infuse over 30 – 60 minutes
Aminocaproic acid
Amicar
INF
B
Loading dose: Over 60 minutes
INF
C
Loading dose: over 30 minutes
Infusion: use caution with rate >=
30mg/hr. Do not exceed 40mg/hr
Aminophylline
Amiodarone
Cordarone
INF
A
1
Bolus: over 10 min.
Do not exceed recommended
infusion rate due to risk of
hypotension.
Dosage adjustment required in patients with decreased renal function.
Target Peak 20-30mcg/ml, Trough < 10mcg/ml.
Max conc. for IV infusion: 5 mg/ml. Mix in D5W
Dilute 5gm in 250 ml NSS or D5W do not exceed 30 gm per day. For
prevention of subarachnoid hemorrhage may give 36gm/24 hours.
Infusion concentration may range from 20mg/ml to 100mg/ml
Loading dose should be diluted in 50ml of solution.
Mix infusion in 500ml of solution to concentration of 1mg/ml or 2mg/ml.
500mg Aminophylline = 400mg Theophylline
Use Ideal Body Weight when calculating dos
Must be delivered via infusion pump with inline filter. May give
supplemental infusions of 150mg over 10 min. Central line required for
conc. > 2mg/ml.
Mix 450mg/250ml D5W.
For cardiac arrest due to refractory VF/pulseless VT give 300mg IV push
as recommended in 2010 ACLS guidelines.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 2 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Amphotericin B
(Liposomal)
AmBisome
INF
C
Over 2 hours
Amphotericin-B
Fungizone
INF
C
Over 2 to 6 hours
INF
C
Over 15 to 30 minutes
GENERIC NAME
Ampicillin
RATE
Ampicillin/Sulbactam
Unasyn
INF
C
Over 15 to 30 minutes.
Antihemophilic Factor/
Von Willebrand Factor
Complex
Humate-P
IVP
B
Over not faster than 4ml/minute.
Antivenin
CroFab
INF
A
Over 60 minutes, starting slow at
25 m l/hr for first 10 minutes.
INF
B
Titrate based upon aPTT
INF
C
Over 15 min as IVPB; do not
exceed 250mg/min
Argatroban
Ascorbic Acid
Vitamin C
SPECIAL CONSIDERATIONS
Dilute in 250ml D5W
Flush the IV Line with Dextrose 5% Water 10 mL IV q24h Prior to Each
Ambisome dose.
Stable for 6 hours at room temperature. Injection should commence
within 6 hours of diluting amphotericin B liposome in Dextrose 5% Water
Do NOT interchange with other forms of amphotericin B.
Restricted to Infectious Disease
Test dose of 1mg/D5W 50ml over 20-30 minutes before initial dose.
Dilute to conc. of 0.1mg/ml with D5W. Do not mix with saline containing
solutions.
Do not use final filter on administration set.
Must use infusion device.
Monitor renal function.
Do NOT interchange with other forms of amphotericin B
Adjust dose for severe renal impairment. Dilute in NSS to 1gm/50ml,
2gm/100ml
Reduce dose for renal impairment. Dilute with NSS to 1.5gm/50ml,
3gm/100ml
Reconstitute under room temperature, using manufacture-provided
diluent. Draw the required dose up into a syringe to be administered as
an IV push. Do not refrigerate, and use within 3 hours of reconstitution.
For detailed information, refer to “Humate-P” document available from
Pharmacy department.
Initial dose is 4-6 vials (same as 4-6 grams) over 1 hour. Start by mixing
3 vials in 100ml NSS (total volume 150ml) and infuse at 25ml/hr for first
10 minutes; If no allergic reaction, then increase rate to 300ml/hr. While
the first bag is infusing, the remainder of the dose should be mixed in
100ml on NSS (total volume 150ml) and start immediately after
completion of the 1st bag at rate of 300ml/hr. Do not mix 2nd bag until
ensured that pt not having acute reaction to CroFab. Total dose should be
infused over 1 hr.
Use with caution in patients with liver dysfunction.
Dilute in NSS or D5W to a final conc of 1 mg/ml
(250mg in 250ml)
May be given as IVPB (1gm in D5W 50ml) or as large volume infusion
(i.e.TPN).
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 3 of 25
GENERIC NAME
Atracurium
BRAND
NAME
ROUTE
Tracrium
IVP/INF
DESIGNATED
NURSING
STAFF
RATE
A
SPECIAL CONSIDERATIONS
Patient MUST BE mechanically ventilated and sedated.
Mix 100mg in 250ml of D5W or NSS.
Atropine
IVP/ INF
A
1
2
Oncology nurse may give for hospice pt only (to dry secretions or 0.25mg
for Camptosar intractable diarrhea)
Azithromycin
Zithromax
INF
C
Over 60 minutes
Aztreonam
Azactam
INF
C
Over 30 to 60 minutes
Benztropine
Cogentin
IVP
A
IVP Over 2-3 min
Bivalirudin
Angiomax
INF
A
1
See dosing
Bumetanide
Bumex
IVP
INF
B
IVP: Over 2-3 min
INF: 2mg/hr
Buprenorphine
Buprenex
IVP
B
Over 3 to 5 min
Butorphanol
Stadol
IVP
B
Over 3 to 5 min
BP should be monitored q15 min. for 1st hr. Has partial antagonist
properties and may cause withdrawal symptoms.
INF
B
Over 60 to 90 minutes
Dilute 500mg in 500ml of D5W, NSS or LR
Caffeine sodium
benzoate
Encourage change to PO azithromycin if patient tolerating oral
medications. Dilute in 250ml NSS
Adjust dose for renal impairment. Dilute with D5W. Premix 1-2gm/50ml,
1gm/50ml
2gm/100ml.
IM administration is the preferred route, but can be given IV for severe
symptoms.
Mix 250mg vial with 5 ml Sterile Water. Standard concentration
5mg/ml (dilute in 50 ml D5W or NSS). May dilute in 500 ml D5W or NSS
to 0.5 mg/ml if specified or otherwise required.
At the discretion of the prescriber, the infusion can be continued for up to
4 hours post-procedure. A low-dose, IV infusion of 0.2 mg/kg/hr can be
administered for an additional 20 hours, if necessary.
Time of end of infusion must be specified prior to transfer to floor.
Total dose should not exceed 10mg /24 hrs (in some cases 20mg/24hr
have been used).
May be given as continuous infusion – dilute in 100ml NSS.
**Light protect**
1mg Bumetanide = 40mg Furosemide
Decrease dose by 50% if increased risk of respiratory depression. May
cause withdrawal symptoms.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 4 of 25
GENERIC NAME
BRAND
NAME
ROUTE
DESIGNATED
NURSING
STAFF
Calcium chloride
IVP
A
B –emergency
only
Calcium Gluconate
IVP
INF
Cefepime
Ancef
Kefzol
Maxipime
IVP
INF
INF
Cefoxitin
Mefoxin
Cefotaxime
RATE
SPECIAL CONSIDERATIONS
No > than 1.5 mEq/MIN
Emergency use: 250-500 mg IVP over 2 min & repeat every 10 min if
needed (125-250 mg for digitalized patients). Caution with extravasation;
sloughing may occur. Three times more potent than calcium gluconate.
B
Infuse 1gm over 15-30min
C
Over 15 to 30 minutes
For calcium replacement, dilute 1gm in 100ml.
IVP method not preferred due to hemodynamic instability with fast
infusions.
Mix in D5W 50ml. May also dilute in NSS.
C
Over 30 minutes
INF
C
Over 15 to 30 minutes
Claforan
INF
C
Over 30 to 60 minutes
Ceftazidime
Fortaz
INF
C
Over 15 to 30 minutes
Ceftriaxone
Rocephin
INF
C
Over 15 to 30 minutes
Cefuroxime
Zinacef
INF
C
Over 15 to 30 minutes
Chloramphenicol
Chloromycetin
INF
C
Over 30 minutes.
Chlorpromazine
Thorazine
IVP
INF
B
25mg over 30 min
50mg over 1 hour
Chlorthiazide
Diuril
IVP
INF
B
Ciprofloxacin
Cipro
INF
C
IVP: Over 5 min
INF: 500mg/50ml over 15 min;
1000mg/100ml infuse over 30 min
Over 60 minutes
Cefazolin
Adjust dose for patients with decreased renal function. Mix in NSS:
1gm/50ml
2gm/100ml or to a conc. of 20mg/ml. May also be mixed in D5W.
Adjust dose in patients with decreased renal function.
Maximum recommended dose in elderly patients 2gm q 8hrs. Dilute in
D5W: 1-2 gm/50 ml. Also stable in NSS.
Mix in 50ml NSS. May also be mixed in D5W.
Use instead of Ceftriaxone in pediatric patients.
Adjust dose for patients with decreased renal function. Dilute in NSS: 1
gm/50 ml
2 gm 100 ml. Also dilute in D5W.
Total daily dose should not exceed 4gm. Dilute in D5W: 1-2 gm/50 ml or
to a max conc. of 40 mg/ml. Can also be mixed in NSS. Do not mix with
IV calcium-containing solutions and/or administered via the same IV line
as IV calcium-containing products.
Adjust dose for patients for patients with decreased renal function. Dilute
in D5W 50ml. Can also be mixed in NSS.
Dilute in 50 of D5W. Can also be mixed in NSS.
May cause serious anemias, thrombocytopenia, and/or granulocytopenia.
Monitor blood counts.
Dilute 25mg in 50ml and 50mg in 100ml of NSS. Monitor BP and pulse
before, during and after administration. IM route preferred.
PROTECT from light
Dilute with at least 18 ml of NSS or D5W
Adjust dose for patients with decreased renal function. Dilute in D5W:
200 mg/ 100 ml
400mg/200 ml. Can also be mixed in NSS.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 5 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Cisatracurium
Nimbex
IVP/INF
A
INF: 0.5-10 mcg/kg/min.
Clindamycin
Cleocin
INF
C
Over 30 minutes
Colistin (Colistimethate)
Coly-Mycin
INF
C
Over 30 minutes
Conivaptan
Vaprisol
INF
A
1
2
Loading dose: over 30 min.
Infusion: 20mg over 24 hours for
up to 4 days.
GENERIC NAME
RATE
SPECIAL CONSIDERATIONS
Standard Infusion: 200mg/200ml D5W.
Patient MUST BE mechanically ventilated and sedated.
Use train of four to assess effect.
Only give as IV infusion in D5W or NSS: 300-600mg/50ml: 900 mg/150
ml:
Do not give as IV push.
Dose based upon colistin base activity.
Dilute in 50ml NSS; once diluted in 50ml use within 8 hours.
Must be administered via a central line.
Available as premixed bag of 20mg/100ml D5W.
Administration and Monitoring Guidelines: Conivaptan will be automatically
discontinued at 48 hours. Physician may reorder for an additional 48 hours if
appropriate. Maximum duration of therapy is four days.
For serum Na = or < 125mmol/L (at time of initiation of treatment)
Patient must be on a monitored unit.
Serum Na levels monitored every 4 hours. Prescriber to be notified if Na
increases by more than 2mmol in any 4 hours.
For serum Na > 125mmol/L (at time of initiation of treatment)
Can be administered on non-monitored unit.
Serum Na levels to be ordered by prescriber.
Conjugated estrogen
Premarin
IVP
B
Over 5-6 min.
Cosyntropin
Cortrosyn
IVP/INF
B
IVP: Over 2-3 min
Give slow to avoid flushing
Monitor BP regularly
Dilute IV push dose with 2-5ml of NSS; dilute infusion in D5W or NSS.
See Cosyntropin Stimulation Test Protocol for more details.
Draw cortisol levels just before Cosyntropin administration and 30 & 60
minutes after administration.
Patients who fail to increase their serum cortisol level by greater than
9mcg/dl over baseline at 30 or 60 minutes may be considered adrenally
insufficient.
B
Cyclosporine
Sandimmune
INF
Over 2 to 6 hrs
IV dose =1/3 oral dose
Dilute in 100ml D5W or NSS. Prepare in AVIVA bag with low sorption
See: CHEMOTHERAPY/BIOLOGICAL MEDICATIONS INTRAVENOUS AND ORAL ADMINISTRATION GUIDELINES
tubing. Stable for 12 hrs in NSS; stable 24hrs in D5W.
for more information
Monitor patients for any signs of reaction.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 6 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Dantrolene
Revonto
IVP/INF
A
Over 60 minutes
Daptomycin
Cubicin
INF
B
Over 30 minutes
Deferoxamine
Desferal
INF
C
No > than 15mg/kg/hr
DEFINITY® (Perflutren
Lipid Microsphere)
Definity
IVP
Over 30-60 seconds
Desmopressin
DDAVP
IVP
INF
Nurses trained
to administer
Definity®
IVP – A
Dilute with 60 ml of SWFI (without preservative).
Use continuous infusion for treatment of malignant hyperthermia.
Reversal of hyperthermia is usually achieved with a cumulative dose of
2.5mg/Kg. Change to oral when patient tolerating PO.
Protect from light. Stable for 6 hours.
Restricted to Infectious Disease Physicians only
Dilute in 50ml to 100ml NSS.
Dilute 1000mg in 250ml of NSS or D5W.
Dilute in NSS, D5W.
Do not exceed 6gm in 24 hours.
Reconstitute with Sterile Water; can give IM, IV, or SQ
Agitate solution for 10 seconds before each injection.
INF: over 30 min, IVP: over 5
minutes
IVP - Dilute in 5 ml NSS and inject over 5 minutes. For IV infusion, dilute
in 50 ml NSS and administer over 30min.
Dexamethasone
Decadron
IVP
INF
IVP: Over 2-3 min
INF: Doses > 10mg give as INF in
50ml NSS over 15 – 30 min.
For infusion, dilute in 50ml of D5W or NSS.
Dexmedetomidine
Precedex
INF
A
Loading dose (optional ) over 1020 minutes
Infusion 0.2 - 0.7 mcg/kg/hr, at
max rate of 1.4 mcg/kg/hr
Dexrazoxane
Totect
INF
Chemotherapy
trained nurses
Infuse IV over 1 to 2 hours in a
large caliber vein in an
extremity/area other than the one
affected by the extravasation.
Drug has no amnesic effect; therefore another sedative should be added
if pt is on a paralytic.
Can be discontinued anytime within 24 hours of initiation without weaning;
if longer, wean by reducing rate by 50% every 2 hours. Infusion for >
24hrs is not recommended.
Should be diluted in NSS to 4mcg/ml for infusion, and loading dose
should be mixed in 50 ml NSS.
Indicated for the treatment of anthracycline extravasation.
GENERIC NAME
INF - B
B
RATE
SPECIAL CONSIDERATIONS
Infusions on days 2 and 3 should start at the same hour (+/- 3 hours) as
on the first day.
Handle as cytotoxic.
Dextrose 50%
.
IVP
B
Over 10 min
Dose should be reduced by 50% in patients with creatinine clearance
values <40 mL/min.
Inject through running IV line.
Watch for phlebitis
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 7 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Diazepam
Valium
IVP
B
5 mg/min
Modify dose in renal and hepatic impairment
Digoxin
Lanoxin
IVP
B
Over 1-2 min
Digoxin Immune Fab
DigiFab
INF
A
1
Over 30 minutes. May be given as
IVP if cardiac arrest imminent.
Notify MD if pulse <60
Adjust for renal dysfunction
Should be reserved for patients who show signs of Digoxin toxicity. After
administration may cause falsely elevated serum Dig levels. Do not readminister digoxin until DigiFab eliminated – may take several days. No
filter needed with DigiFab. Mix each vial with 4 ml Sterile Water, then
dilute in 50ml of NSS.
Dihydroergotamine
D.H.E.
IVP
B
Over 2-3 min
Total weekly dose should not exceed 6 mg.
Monitor vital signs and observe for peripheral vasoconstriction.
Diltiazem
Cardizem
IVP/INF
A
1
Give loading dose
over 2 min.
Standard. 1mg/ml (125mg/125ml)
Infusion duration longer than 24hrs and infusion rates > 15mg/hr are not
recommended.
Dilute 125mg diltiazem in 100ml D5W or NSS (gives final concentration of
125mg/125ml 1mg/ml).
Should be used with continuous cardiac monitoring of EKG/BP.
Diphenhydramine
Benadryl
IVP
B
Over 2 to 3 minutes
Total dose 24-hour dosage should not exceed 400mg.
Avoid extravasation.
Reduce dosage in elderly or debilitated patients.
Dobutamine
Dobutrex
INF
A
1
2
B*
No evidence to support doses
greater than 40mcg/kg/min
May be titrated only in intensive care setting. Infusion device and flow
stop tubing required.
May administer unmonitored if rate is 5mcg/kg/min. or less.
If extravasation occurs, notify MD - Regitine injections into area as
antidote.
Standard concentration: 500mg/D5W 250ml**
B* - may be administered on non-monitored units at specific non-titrated
doses.
GENERIC NAME
RATE
SPECIAL CONSIDERATIONS
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 8 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Dopamine
Intropin
INF
A
1
2
B*
Doxycycline
Vibramycin
INF
C
Edrophonium
Tensilon
A
Enalaprilat
Vasotec
IVP
INF
IVP
B
Over 1 hour
100mg over 1 hour
200mg over 2 hrs
Over 15 to 30 seconds.
May use as infusion.
Over 5 min
IVP
A
Over 5 min
Do not exceed 150mg per 24 hours
GENERIC NAME
Ephedrine
RATE
SPECIAL CONSIDERATIONS
Standard concentration: 400mg/D5W 250ml**
May be titrated only in intensive care setting, 3 South or 5 West for postop carotid endarterectomy patients (may titrate only between 3 – 5
mcg/kg/min on 3 South and 5 West).
May administer unmonitored if rate is 5mcg/kg/min or less.
Infusion device and flow stop tubing required.
If extravasation occurs, notify MD - Regitine injections into area as
antidote.
Do not add to NaHCO3 or other alkaline solutions
B* - may be administered on non-monitored units at specific non-titrated
doses
Protect from light. Dilute in D5W to 100mg/150ml; 200mg/250ml.
Frequent blood pressure monitoring required.
Monitor BP and respiration every 15 minutes for 1 hour.
Epinephrine
Adrenalin
IVP
INF
A
IVP over 1 min
Infusion: no greater than
20mcg/min
Standard concentration 4mg/D5W 250ml**.
For infusion in critical care areas only.
Usual initial infusion rate of 3-4 mcg/min – use flow stop tubing.
Epoetin alfa
IVP
B
Over 2-3 minutes
May also be given subcutaneously.
Eptifibatide
Procrit
Epogen
Integrilin
IVP/INF
A
1
Bolus over 1-2 min
Pre-mixed infusion of 75mg in 100ml.
Decrease infusion rates to 1mcg/kg/min for patients with serum creatinine
of 2 – 4, or CCl less than 50ml/min. No information for patients with
serum creatinine > 4.
Max bolus dose (180mcg/kg) for pts > 121kg: 22.6mg,
Max infusion rate for pts > 121kg: 15mg/hr
Ertapenem
Invanz
INF
B
Over 30 minutes
INF
C
Over 1 - 2 hours
Adjust dose for renal dysfunction
Mix 1gm in 50ml NSS
May give over 60 minutes if central line. Recommended dilution in NSS
(500mg/150ml; 1000mg/250ml).
Erythromycin
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 9 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Esmolol
Brevibloc
IVP/INF
A
Bolus – over 1 min
For infusion dilute 2.5 grams in 250 ml D5W.
Max conc 10 mg/ml
Ethacrynic acid
Edecrin
IVF
B
Infuse slowly IV over 20—30 minutes
through the tubing of a freely running
IV infusion or inject directly over
several minutes
Dilute with D5W or NSS for a 1mg/ml (50mg/50ml) concentration
Avoid in renal disease with GFR less than 10 ml/min due to ototoxicity
Factor VII Recombinant
NovoSeven
IVP
B
Over 2 to 5 minutes
Famotidine
Pepcid
IVP
INF
IVP – B
Restricted to Hematology/Oncology and CardioThoracic Surgeons. Order
MUST include indication. Should be used within 3 hrs of reconstitution.
For more details, refer to “NovoSeven Guidelines” under policy #0202800.
For doses > 20mg, dilute 40mg in 100ml NSS.
Adjust dose for renal dysfunction; CrCl < 50 ml/min: reduce recommended
Fenoldopam
Corlopam
INF
Fentanyl
Sublimaze
IVP
INF
GENERIC NAME
RATE
INF – C
A
1
IVP: 10mg/min
INF: doses > 20mg to be given
over 30min
Titrate dose by 0.5 to
0.1mcg/kg/min
Titrate dose to no greater than 1.6
mcg/kg/min
IVP – B
IVP: Over 2-3 minutes
Cautiously titrate dose for patient response.
If being used for Moderate Sedation refer to Moderate sedation policy for
further monitoring.
Over 1 to 2 hours
Administer 125mg in 100ml NSS over 1 hour; 150mg in 150ml NSS over
90 minutes; 250mg in 250ml NSS over 2 hours.
May administer test dose of 25mg/50ml NSS over 60 minutes prior to
start of therapeutic doses. Test dose not required.
Note: Doses of 250mg given over 60 min have been reported to be safe.
INF – B
Ferric Gluconate
Ferrlecit
INF
SPECIAL CONSIDERATIONS
B
dose by 50%
For use as in hypertensive crisis in renally compromised patients.
Dilute 10mg/NSS 250ml
Proven ineffective for prevention of Radio Contrast Induced Nephropathy.
Monitor BP every 15 min; only for short term use (up to 48 hrs)
Parenteral Iron Therapy Options; Am. J. Hematol. 76:74–78, 2004.
Fluconazole
Diflucan
INF
C
Not to exceed 200mg/hour
Adjust dose for patients with renal impairment. Dilute in NSS: 100 mg/50
ml; 200 mg/100 ml;
400 mg/200 ml.
Flumazenil
Romazicon
IVP
B
Over 15 seconds
No more than 3mg total dose should be given in any one hour. Repeat
treatment may be given no more than once every 20 min.
Watch for return sedation.
Folic Acid
INF
C
Over 30 minutes
Compatible with D5W, NSS, and LR; administer only through a freely
running IV infusion into a large vein
Dilute in 50ml of NSS or D5W.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 10 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Fomepizole
Antizol
INF
A
Over 30 minutes
Fosaprepitant
Emend
INF
B
Fosphenytoin
Cerebyx
IVP
INF
A
1
2
115mg: 15 minutes
150mg: 30 minutes
Maximum rate of infusion:
150mg PE/min
Furosemide
Lasix
IVP/INF
B
IVP: Over 1-2 minutes.
INF: 2-20mg/hr
For infusions mix 1mg/ml in NSS (100mg/100ml) – protect from light.
Ganciclovir
Cytovene
INF
B
Over 1 hour
Mix in 100ml D5W or NSS. Refrigerate. Use an in-line filter.
Handle as cytotoxic (chemo) agent.
Max conc 10 mg/ml
Dose must be individualized based upon patient’s infection, weight
(IBW or AdjBW), age, and renal status.
When drawing Peak level draw sample 30 minutes after completion
of infusion. Draw Trough levels 30 minutes before beginning
infusion.
Dilute in D5W: <150 mg/ 50 ml; 151-300mg/100 ml; >300 mg/150 ml.
May also be mixed in NSS.
For infusion, mix 10mg in 100ml or to conc. of 0.1mg/ml for smaller
doses. 1 unit = 1mg.
If the patient does not respond within 20 minutes, may repeat dose.
Should not exceed 2 units per dose.
Can give IM, IV, or SQ
Surgery: up to 0.1mg.
Reversal of neuromuscular blockade: 0.2mg for each 1mg neostigmine or
5mg pyridostigmine.
Antisectretory: 0.1 – 0.2mg every 4 to 8 hours. Maximum single dose
0.2mg. Maximum 24 hour dose 0.8mg.
Telemetry RNs can give when used with Neostigmine protocol
GENERIC NAME
RATE
See: CHEMOTHERAPY/BIOLOGICAL MEDICATIONS INTRAVENOUS
AND ORAL ADMINISTRATION GUIDELINES for more information
Gentamicin
Garamycin
Glucagon
Glycopyrrolate
Robinul
INF
C
Over 30 - 90 minutes
IVP
INF
B
IVP: Over 2-3 min
INF: 0.5-7mg/hr
IVP
A
1
2
Over 2 to 3 minutes
B (for Palliative
Care Use)
Granisetron
Kytril
IVP
INF
B
Over at least 30 seconds
(undiluted)
INF: over 15 min
SPECIAL CONSIDERATIONS
Mix in 100 ml of solution.
The dose increases from 10 to 15 mg/kg because the fomepizole induces
its own metabolism.
Restricted to use in chemotherapy patients only.
Mix to final conc. of 1mg/ml (i.e. 115mg/110ml)
PE= phenytoin equivalents
May be mixed in NSS or D5W. Dilute to 1.5 to 25mgPE/ml.
Patient must monitored for hypotension and cardiac arrhythmias
Give 30 min prior to initiation of chemotherapy.
May be diluted in 50ml of D5W or NSS.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 11 of 25
GENERIC NAME
Haloperidol lactate
.
BRAND
NAME
ROUTE
Haldol
IVP/INF
DESIGNATED
NURSING
STAFF
IVP – B
RATE
Over 2 to 3 minutes
Monitor for extra-pyramidal effects, hypotension.
Dilute with NSS to a concentration of 1mg/ml and administer over 2-3
minutes.
Flush before and after administration.
Available as 25,000 units/250 ml D5W.
Must use infusion device.
INF – A
Heparin sodium
SPECIAL CONSIDERATIONS
IVP/INF
B
IVP: over 2 to 3 minutes
INF: 500 – 1500 units/hr
Hetastarch
Hespan,
Hextend
INF
B
20ml/kg/hour
Hydralazine
Apresoline
IVP
B
over 2 to 4 minutes, not to exceed
5mg/min
Hydrocortisone
Solucortef
IVP/INF
B
Hydromorphone HCl
Dilaudid
IVP
INF
B
Over 3-5 minutes
INF: 250mg over 30 min
500mg over 1hour
Over 2 to 3 minutes
Ibutilide
Corvert
IVP/INF
A
1
Over 10 minutes
Onset of action 5 to 15 minutes.
Vital signs to be monitored every 15 minutes for 1 hour after each
administered dose.
For infusion dilute in NSS to 1mg/ml conc. (250mg/250ml, 500mg/500ml).
Reconstitute with bacteriostatic water for injection
Can be given as continuous infusion.
Reduce initial dose in renal and hepatic impairment and in geriatrics.
PCA concentration 0.2mg/ml. If compounding drip in IV bag use 1mg/ml
concentration.
Can cause life-threatening arrhythmias.
Should be monitored for four hours
Can be given undiluted or dilute in 50 ml D5W or NSS
Imipenen /Cilastatin
Primaxin
INF
C
Over 30 – 60 minutes
Adjust dose for patients with decreased renal function. Dilute in NSS;
250-500mg/100ml, 750 mg/150ml, 1000mg/250ml
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 12 of 25
GENERIC NAME
Immune Globulin
Infliximab
BRAND
NAME
ROUTE
IGIV,
Privigen
Gamimune,
Gammagard,
Venoglobulin,
Sandoglobulin
Carrimune
Polygam S/D
Gammagard
S/D
INF
Remicade
INF
DESIGNATED
NURSING
STAFF
RATE
B
See Policy 60.1.70
Regular Insulin
Intralipids
Vital signs every 15 minutes for 1 hour, then every 30 minutes for 1 hour,
then hourly thereafter if stable and after infusion is completed.
If side effects develop, reduce rate or interrupt the infusion until
symptoms subside. Restart the infusion at a more tolerable rate.
Possible systemic effects include urticaria, angioedema, rigors, emesis,
chills, fever, lethargy, chest tightness, and nausea. Anaphylactic reaction
may occur especially if highly allergic.
Venoglobilin does not need to be filtered.
Filter using Pall Microaggregate Blood filter to administration set (Orange
blood filter)
Polygam S/D and/or Gammagard S/D should be reserved for patients with
IgA deficiency
Over 2 hours
See: HEMOTHERAPY/BIOLOGICAL MEDICATIONS INTRAVENOUS AND
ORAL ADMINISTRATION GUIDELINES for more information
Insulin
SPECIAL CONSIDERATIONS
Infusion concentration ranges 0.4 - 4mg/ml.
Use in-line low-protein-binding filter.
Do not shake solution.
Begin administration within 3 hours of preparation.
Start slowly and increase rate if patient has no reaction.
Dilute to total volume of 250 ml NSS; reconstitute with 10 ml Sterile Water
INF
B
For insulin drip use 150 units of regular insulin in 150ml NSS (conc. of
1unit/ml).
Use infusion device with flow stop tubing.
INF
B
For cardiotoxicity of local anesthetics may repeat bolus every 3 – 5
minutes; continue infusion until hemodynamic stability is restored.
Iron Dextran
Infed
IVP/INF
B
IVP: may give undiluted over 1
minute or more (no greater than
50mg/min).
INF: over 2-6 hrs.
Iron Sucrose
Venofer
IVP/INF
B
IVP: 100-200mg slowly over 2 to 5
minutes
INF: over 1.5-4 hrs
* www.lipidrescue.org accessed 7/13/11
For treatment of Local Anesthetic cardiotoxicity*: 20%: 1.5 mL/kg over 1
minute, followed immediately by an infusion of 0.25 mL/kg/minute
(continue chest compressions - lipid must circulate). Repeat bolus every 3
– 5 minutes up to 3ml/kg until circulation is restored. Continue infusion
until hemodynamic stability is restored. Increase the infusion rate to 0.5
mL/kg/minute if BP declines.
Test dose of 25mg over 5 min –dilute test dose in 50ml NSS. No dilution
required, however can dilute in 500 ml of NSS for infusion. Use an
infusion device for infusion.
DO NOT FILTER.
Must have test dose prior to first infusion.
250mg can be diluted in 150ml NSS.
Doses of > 250mg should be diluted in 250-500 ml NSS or to a maximum
conc. of 2mg/ml
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 13 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Isoproterenol
Isuprel
INF
A
Titrate
Standard concentration:1mg/D5W 250ml (4mcg/ml)**.
Must use infusion device.
Ketorolac
Toradol
IVP
B
Over 2 to 3 minutes
Patients > 65yrs, or wt less than 50kg should receive 15mg q 6hrs prn
max dose of 60mg in 24 hours. Pharmacy to adjust dose per P&T.
Pts < 65yrs max dose 120mg/24 hrs.
5-day maximum treatment (all routes combined).
Labetalol
Normodyne
IVP/INF
A
1
2
B*
Titrate to effect
INF: 400mg/200ml NSS (2mg/ml).
Patient must be monitored according to Beta-blocker policy.
Use with caution in patients with bronchospastic disease.
*When given on Med-Surg must have been maintained on med prior to
current orders and unable to take PO.
Lacosamide
Vimpat
INF
B
Infuse over 60 minutes
Leucovorin
Leucovorin
IVP/INF/
ORAL
B
At least 3 minutes IV push
Mix with 50ml NSS
Adjust dose for severe renal impairment.
Controlled substance.
Mix in 100-500 ml D5W or NSS. Protect from light. Do not prime the
tubing. For doses > than 10 mg/m2 avoid reconstituting with benzyl
alcohol preservative. Start 6-24 hours after methotrexate. Maximum rate
160 mg/min.
Oral doses > 25 mg should not be given.
GENERIC NAME
RATE
15-120 minutes infusion
Levetiracetam
Keppra
INF
B
Over 15 minutes
Levofloxacin
Levaquin
INF
B
Levothyroxine
Synthroid
IVP
B
Over 60 minutes (90 min for 750
mg)
Over 2 to 3 minutes
Zyvox
IVP
INF
INF
A
1
B
Lidocaine
Linezolid
SPECIAL CONSIDERATIONS
Expiriation: 24 hours
Dilute 500mg in NSS 100ml.
Not to exceed 3000mg/day.
Reduce dose for renal dysfunction.
Dilute in D5W: 250mg/ 50ml; 500 mg/100 ml; 750 mg/150 ml
Dilute 200mcg with 5ml NSS without preservatives (conc =
100mcg/2.5ml).
IV dose is approximately ½ of the oral dose.
Over 2 minutes
Standard infusion: 2gm/250ml premixed
Over 30 to 120 minutes
Restricted to Infectious Disease Physicians only. Dilute in D5W:
600mg/300ml.
Lipids (See Intralipids)
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 14 of 25
GENERIC NAME
Lorazepam
BRAND
NAME
Ativan
ROUTE
IVP
INF
DESIGNATED
NURSING
STAFF
IVP – B
RATE
IVP: Over 2 to 3 minutes
INF: Titrate to effect
Dilute with equal amount of D5W or NSS prior to injection. If used for preop sedation, refer
to conscious sedation policy for further monitoring.
May be given as INF in critical care areas only; may be given on
general floors for hospice patients. Standard concentration
50mg/D5W 250ml. If needed may be concentrated to 1mg/ml (must
watch for precipitation).
Continuous infusion must be filtered.
Use only 10%-20% solutions for IVP.
Infusion must be on infusion device.
For infusion dilute in 50 ml.
Rapid administration may cause hypotension.
15% solutions or greater, must be infused through a final filter. 25%
solutions administered IVP must be drawn up through a filter needle. If
crystals are present, return to Pharmacy.
Dilute to a concentration of 10mg/ml.
Not recommend for use in patients with renal dysfunction, or elderly
patients.
If used as conscious sedation refer to conscious sedation policy.
Reduce dose for renal impairment.
Dilute in NSS 100ml. Can also mix in D5W.
Do not exceed 3gm/day for 3 days.
May be given as INF 1gm in 250ml D5W or NSS.
May cause phlebitis or sloughing if extravasation occurs.
Keep patient recumbent for 15 minutes to avoid postural hypotension.
Do not refrigerate
Dilute 250mg/100ml and 500mg/250ml D5W.
MD must give parameters.
Elderly patients are more likely to have an increased sensitivity to
methyldopa effects (e.g., orthostatic hypotension, sedation). Consider
alternative agent or reduced dose.
Dilute in 50ml NSS.
Methemoglobinemia: 1 to 2mg/kg over several minutes; may repeat in 1
hour if needed
Hypotension associated with cardiac surgery: 1.5 to 2mg/kg over 20 -60
minutes. May take 1 – 2 hours for effect
IVP recommended for emergency situations only
INF – A
Magnesium sulfate
IVP
INF
B
Up to 150 mg/min, may be
administered faster in emergent
situations.
Mannitol
INF
B
Over 30 to 90 minutes. For
elevated ICP give over 5 min.
Meperidine
Demerol
IVP
B
Over 2 to 3 minutes
Meropenem
Merrem
INF
C
Over 30 minutes
Methocarbamol
Robaxin
IVP/INF
A
Give IVP at a rate no greater than
300mg/min.
INF: 1gm over 1 hr
Methyldopa
Aldomet
INF
B
Over 60 min
INF
B
See usual adult dose
IVP
A
Over 2 to 3 minutes
Methylene Blue
Methylergonovine
Methergine
SPECIAL CONSIDERATIONS
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 15 of 25
GENERIC NAME
Methylprednisolone
Sodium Succinate
BRAND
NAME
ROUTE
Solumedrol
IVP/INF
DESIGNATED
NURSING
STAFF
B
RATE
IVP: Over 2 to 3 minutes
INF: Dilute in NSS. Infuse over
15—60 minutes. Large doses (e.g.,
>= 500 mg) should be
administered over at least 60-120
minutes
SPECIAL CONSIDERATIONS
High dose therapy for acute spinal cord injury: 30mg/kg IV over 15
minutes followed in 45 minutes by 23 hour infusion of 5.4mg/kg/hr.
Dilute 1gm in 250ml NSS.
Do not confuse with Depomedrol
Metoclopramide
Reglan
IVP/INF
B
Over 2 to 3 minutes
INF: > 10mg over 15 min
If dose > 10mg dilute in 50 ml of solution and infuse over 15 min.
Reduce dose for patients with renal insufficiency.
Metoprolol
Lopressor
IVP
A
1
2
B*
Over 2 to 3 minutes
Patient must be monitored according to Beta-blocker policy.
Use with caution in patients with bronchospastic disease.
*When given on Med-Surg must have been maintained on med prior to
current orders and unable to take PO.
Metronidazole
Flagyl
INF
C
Over 60 minutes
Do not exceed 4gm/day. Available as premixed bag in NSS
500mg/100ml.
Do NOT refrigerate
Micafungin
Mycamine
INF
B
Over 1 hour
Midazolam
Versed
IVP
B
See comments
Dilute in 100ml NSS.
Protect from ligh.
Use lower dose in elderly patients. Refer to moderate sedation policy for
further monitoring.
For infusion, dilute 50mg in 100ml of NSS.
Must be in ICU/CVU for continuous infusion
For moderate sedation can only be given by nurses trained in the
administration of moderate sedation.
Milrinone
Primacor
IVP/INF
A
B*
1
2
Loading dose: over 10 minutes
IVP/INF
B
Over 2 to 3 minutes
INF
C
Morphine
Multivitamin
MVI
Over 2 to 3 minutes
Standard conc. - 200mcg/ml** (20mg/100ml). Use infusion device and
flow stop tubing.
Mix loading dose in 50ml to be given over 10 min.
Dose must be adjusted for renal function.
Compatible in D5W or NSS
*CAN ADMINISTER unmonitored ONLY IF GIVEN BEFORE ON A
MONITORED UNIT
Infusion: Use PCA on continuous infusion mode. Use flow-stop tubing.
If used as conscious sedation refer to conscious sedation policy.
PCA concentration 1mg/ml. If compounding drip in IV bag use 1mg/ml
concentration.
Must be diluted in at least 500 ml of solution
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 16 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Nalbuphine
Nubain
IVP
B
Over 2 to 3 minutes
Maximum dose 160mg over 24 hrs
Has partial antagonist properties and may cause withdrawal symptoms.
Naloxone
Narcan
IVP
INF
B
Over 2 to 3 minutes
Onset of action: 2 minutes; duration: 1 to 4 hours.
Infusion: 2mg/500ml administer at 0.4mg/hr, titrate to response.
If non-urgent reversal needed then administer Naloxone 0.4mg amp in
10cc saline; give 2ml IV push q 1 minute, titrating to avoid withdrawal,
seizures, pain.
Neostigmine
Prostigmin
IVP
A
1
2
Over 2 to 3 minutes
Nicardipine
Cardene
INF
A
Max rate 15mg/hr
5mg is normal maximum dose.
Must be on cardiac monitor if used for post-op ileus and have
Glycopyrrolate 0.4mg immediately available. See Neostigmine Post-op
ileus orders for monitoring requirements.
Concentration 0.1mg/ml (25mg/D5W 250ml)
For pts on oral nicardipine who can not tolerate PO meds (or in which PO
meds are contraindicated) initiate infusion based upon oral dose:
20mg PO q8h = 0.5mg/hr;
30mg PO q8h = 1.2mg/hr;
40mg POq8h = 2mg/hr.
GENERIC NAME
RATE
SPECIAL CONSIDERATIONS
Rapid BP reduction: 5mg/hr, rate may be increased by 2.5mg/hr q 5
minutes until desired BP achieved.
Max rate 15mg/hr.
Gradual BP reduction:
5mg/hr, rate may be increased by 2.5mg/hr q 15 minutes until desired BP
achieved. Max rate 15mg/hr.
Nitroglycerin
INF
A
1
Titrate
Nitroprusside
Nipride
INF
A
Titrate, but not to exceed
10 mcg/kg/min
Norepinephrine
Levophed
INF
A
Titrate.
Max recommended rate
30mcg/min
Infusion device and flow stop tubing required.
Standard concentration 25mg/D5W 250ml** (100mcg/ml) Premixed
solution. Maximum concentration 400mcg/ml.
Use non-PVC tubing
Standard infusion: 50mg/250ml D5W**
Infusion device and flow stop tubing required.
Protect from light.
Use with caution in patients with renal insufficiency.
Standard infusion: 8mg/250ml D5W (32mcg/ml)**
Avoid extravasation; must gradually taper doses
NovoSeven (see Factor
VII Recombinant)
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 17 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Octreotide
Sandostatin
INF
B
IV bolus: over 15-30 minutes.
Continuous infusion: usual dose
25mcg/hr
Ondansetron
Zofran
INF
IVP
B
INF: over 15 minutes beginning 30
min prior to chemo
IVP: Over 2 to 3 minutes
Orphenadrine
Norflex
IVP
A
Over 3 to 5 minutes
INF
C
Over 30 minutes
GENERIC NAME
Oxacillin
RATE
SPECIAL CONSIDERATIONS
Dilute 250mcg in 250ml D5W or NSS or 1mcg/ml concentration for
infusion.
Bolus 50mcg should be diluted in 50ml solution.
Do not use Sandostatin LAR® Depot intravenously.
For doses > 4mg, dilute in 50ml NSS.
Post-op NV: A single dose of 4 mg IV injected immediately prior to
anesthesia induction or once post-operatively if patient experiences
nausea/vomiting shortly after surgery. Per the manufacturer, repeat
dosing does not provide additional benefit to the patient.
Patient should be in a supine position for administration and for 10 min
thereafter.
Adjust dose for severe renal impairment.
Max dose 12 gm/day.
Dilute in NSS: 1 gm/50 ml; >1 gm/100 ml. Can also mix in D5W.
Oxymorphone
Numoprhan
IVP
B
Over 2 to 5 minutes
Oxytocin
Pitocin
INF
A
Response dependant
Palonosetron
Aloxi
IVP
INF
B
IVP: Over 30 seconds 30 min
before chemotherapy
Pamidronate
Aredia
C
Over 2 to 24 hours
Dilute in 500ml of NSS or D5W.
Not compatible with calcium containing IV solutions or ringer’s solution.
To allow time for full effect, wait 7 days before retreatment;
Pancuronium
Pavulon
A
IVP: Over 2 to 3 minutes
INF:
0.06-0.1mg/kg/hr
Patient must be mechanically ventilated.
Use proper sedative regimen
IVP/INF
Mix 40 units in 1000ml of NSS, LR, or D5W.
Use of oxytocin during pregnancy can precipitate uterine contractions and
abortion.
Black box warning:
oxytocin is not indicated for elective induction of labor (Prod Info
PITOCIN(R) intravenous solution, 2004).
Restricted to use in chemotherapy patients only.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 18 of 25
GENERIC NAME
Pantoprazole
BRAND
NAME
ROUTE
Protonix
INF/IVP
Papaverine
Paricalcitol
Zemplar
Penicillin - G
DESIGNATED
NURSING
STAFF
B (IVP and
Infusion)
C (Infusion
only)
RATE
IVP: Over 2 minutes
INF: Over 15 minutes or as a
continuous infusion
SPECIAL CONSIDERATIONS
IVP: mix in 10ml NSS
Bolus: Dilute 80mg in 100ml NSS.
Infusion: 80mg in 500ml NSS.
May be used as INF for patients with GI bleed. Doses for GI bleed
80mg/day or as continuous infusion of 8mg/hr – preceded by an 80mg
bolus dose.
May give undiluted or mixed with equal volume of sterile water for
injection.
Monitor BP frequently
IVP
A
Over 2 to 3 minutes
IVP
B
Over 2 to 3 minutes
Give during dialysis.
INF
C
Over 1 to 2 hours
May give as continuous infusion. Mix in NSS: 1MU / 50 ml; 2-3 MU /100
ml; 4-7 MU / 150 ml
>8 MU / 250 ml. Can also mix in D5W.
Dilute to 50-250ml of D5W. Must infuse over at least 1 hour. Patient
should be lying flat during infusion. BP should be taken immediately prior
to infusion, every 15 minutes during infusion, every 30 minutes for the first
hour following infusion and then every 4 hours.
Pentamadine
Pentam
INF
C
Over 1-2 hrs
Pentazocine
Talwin
IVP
B
Over 5 to 6 minutes
Total dose should not exceed 360mg/ day.
Has partial opiate antagonist properties and may cause withdrawal
symptoms.
IVP
B
Not to exceed 60mg/min
Total daily dose should not exceed 600 mg.
Phenobarbital
Phentolamine
Regitine
IVP
B
Over 2 to 3 minutes
Also use intradermally for catecholamine extravasation – see
extravasation procedure for more information.
Phenylephrine
Neosynephrine
IVP/INF
A
IVP: Over 30 to 60 seconds
INF: Titrate
For IVP: Dilute 10mg (1ml) in 9ml Sterile Water for injection (final conc.
1mg/ml).
INF: 50mg/D5W 250ml** (200mcg/ml), can be mixed in NSS. Light
protect
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 19 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Phenytoin
Dilantin
IVP/INF
B
50mg/minute
Doses of 750mg or greater placed in 250ml NSS and infused over
one hour.
If the peripheral IV route is used, the nurse must monitor and document
the condition of the IV site every 10 minutes during the entire infusion.
Doses less than 750mg may give as slow IVP, or mixed in NSS, not
to exceed 50mg/minute and given through 150ml NSS infusing at
50ml/hr. Give IVP via injection port of tubing closest to the patient. Flush
before and after administration with at least 20ml NSS. Infusion must be
filtered.
Not compatible with Dextrose.
For IV use ONLY
Phosphate
Potassium
Phosphate
And/or
Sodium
Phosphate
Antilirium
INF
B
Recommend over 6 hours.
IVP
A
Over 1 to 3 minutes
Caution: too rapid infusion may lead to rapid decrease in serum calcium.
Consider potassium/sodium content when infusing – may need to adjust
infusion time.
Infuse via infusion device with flow stop tubing.
Suggest dilution in D5W
Atropine and resuscitation equipment should be available; frequently
monitor BP, RR, pulse, and neurological status during administration.
Do not administer rapidly. Rapid administration may lead to bradycardia,
increased salivation (which may lead to respiratory distress), or seizures
Phytonadione
Vitamin K
Aquamephyton
INF
B
Not faster than 1mg/minute
Piperacillin/Tazobactam
Polymyxin-B
Zosyn
INF
INF
C
C
Over 30 minutes
Over 60 to 90 minutes
INF
B
Max rate of 10mEq/hr (may be up
to 20mEq/hr under specific
situations – see Potassium
Replacement guidelines for more
information).
GENERIC NAME
Physostigmine
Potassium Acetate
RATE
SPECIAL CONSIDERATIONS
Dose will be diluted in 50 ml of D5W or NSS to be run over 20 to 30 min.
Can cause decrease in blood pressure, diaphoresis and transient flushing
Do BPs pre-infusion, during and post infusion
Protect from light
Adjust dose for renal insufficiency. Mix in D5W 50ml.
Dilute 500,000 units in 500 ml of D5W or to a concentration of 1,667
units/mL. Total daily dose should not exceed 2 million or 25,000 units/kg.
Large Volume Parenteral:
Central line: dilute to a maximum concentration of 25mEq/100ml.
Peripheral line: maximum concentration 10mEq/100ml
Small Volume Parenteral:
Central Line: 20mEq/100ml
Peripheral Line: 10mEq/100ml
See Potassium Replacement guidelines for more information.
No concentrated Potassium vials will be dispensed or stored outside the
Pharmacy.
Infuse via infusion device.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 20 of 25
GENERIC NAME
BRAND
NAME
Potassium Chloride
ROUTE
INF
DESIGNATED
NURSING
STAFF
B
RATE
Max rate of 10mEq/hr (may be up
to 20mEq/hr under specific
situations – see Potassium
Replacement guidelines for more
information).
SPECIAL CONSIDERATIONS
Large Volume Parenteral (> 250ml):
Peripheral Line: The maximum concentration of potassium permitted to be
infused via a peripheral line is 0.1mEq/ml (i.e. 10mEq/100ml), including
peripheral parenteral nutrition, at a rate not to exceed 10mEq/hr.
Central Line: The maximum concentration of potassium permitted to be
infused via a central line is 0.25mEq/ml (i.e .25mEq/100ml)(including
parenteral nutrition) at a rate not to exceed 20mEq/hr*.
Small Volume Parenteral (up to 250ml):
All orders for small volume parenterals for Potassium Chloride replacement
will be dispensed as individual bags containing 10mEq (i.e. an order for
Potassium Chloride 30mEq/300ml D5W would be dispensed as 3 X
10mEq/100ml Sterile Water).
Peripheral Line: The maximum allowable IVPB concentration for peripheral
vein administration will be 0.1mEq/ml (10 mEq/100 ml) to be administered via
“Y” site to a running primary IV at a rate not to exceed 10mEq/hr.
Central Line:The maximum allowable IVPB concentration for central line
administration will be 0.2mEq/ml (10mEq/50 ml) at a rate not to exceed
20mEq/hr*.
See Potassium Replacement guidelines for more information.
No concentrated Potassium vials will be dispensed or stored outside the
Pharmacy.
Infuse via infusion device.
*Patient must be on a cardiac monitor in order to receive potassium at a rate
higher than 10mEq/hr.
Pralidoxime
Protopam
INF
A
Procainamide
Pronestyl
IVP/INF
A
1
Prochlorperazine
Compazine
IVP
B
Over 15-30 min., Do not exceed
200mg/min
IVP: Not to exceed 50mg/min
every 5 min until effect or 1000mg
given
Loading dose: 1gm over at least 20
min
Over 2 to 3 minutes
Dilute 1 to 2 gm in 100 ml
Loading dose: 1000mg in 100ml D5W
Standard infusion: 2gm/500ml D5W.
Infusion device and flow stop tubing is required.
Dilute each 5mg in 9ml of NSS
Dose not to exceed 40 mg/day.
Dose to be adjusted to 5mg in patients greater than 65yrs per P&T.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 21 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Propofol
Diprivan
IVP/INF
A
IVP: Over 2 to 3 minutes.
Must change bottle and tubing every 12 hours.
Patient must be mechanically ventilated if receiving as infusion.
Refer to conscious sedation policy for use in procedures.
Lipid suspension – may lead to hypertriglyceridemia. Contains 1Kcal/ml
of lipids.
Not recommended for use greater than 48 hours.
Propranolol
Inderal
IVP
B*
1mg/min
Patient must be monitored according to Beta-blocker policy.
*When given on Med-Surg must have been maintained on med prior to
current orders and unable to take PO.
Use with caution in patients with bronchospastic disease.
IVP
INF
B
IVP: over 1-3 min.
INF: over 15 min for small bag or
300mg/hr.
Dilute in an equal volume of NSS prior to IVP.
For infusion, 50mg can be diluted in 50ml and 250mg in 250ml of
No more than 50 mg should be
administered in a 10-minute period
Use 1mg protamine for every 100 units unfractionated heparin (dose
needs to be adjusted based on length of time heparin was stopped).
Use 1mg protamine for every 1mg enoxaparin.
For neuromuscular blockade reversal.
GENERIC NAME
Protamine
RATE
SPECIAL CONSIDERATIONS
D5W or NSS.
Pyridostigmine
Mestinon
IVP
A
Over 2 to 3 minutes
Pyridoxine
B6
IVP
INF
B
No greater than 50mg/minute.
IVP: May give undiluted.
INF: May be added to IV fluids.
Quinidine gluconate
Quinupristin/Dalfopristin
Synercid
INF
INF
A
C
16mg/minute
Over 60 minutes
Rasburicase
Elitek
INF
B
Over 30 minutes
Over 1 hour or 16mg/minute
Mix in 250 ml D5W (can administer in 100 ml D5W if administered via a
central line).
Restricted to Infectious Disease Physicians only
Reconstitute only with the diluent provided
Mix with 0.9% sterile sodium chloride for injection to achieve a final
volume of 50 ml.
Remifentanil
Ultiva
INF
Anesthesia
Only
Variable
[Larson LA, Pui CH, Tumor Lysis Syndrome. In UpToDate, Savarese D
(Ed), UpToDate, Waltham, MA, 2011, accessed 2/14/11]
Ordering of remifentanil is restricted to Anesthesia only. Mix 2 mg in
100ml NSS.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 22 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Retavase
Reteplase
IVP
A
Over 2 minutes
Caution: Thrombolytic!
Incompatible with heparin
Do not shake
For DVT/PAO recommend Alteplase
RhO(D) Immune
Globulin
WinRho
IVP
B
Over 3 to 5 minutes
Rifampin
Rifadin
INF
C
Scopolamine
IVP
B
Over 30 minutes
(Over 3 hrs if in 500 ml)
Over 2 to 3 minutes
Dilute with NSS. Do not shake.
5 International Units = 1mcg
Administer separately from other IV fluids.
May cause intravascular hemolysis (IVH) watch for back pain, shaking
chills, fever, discolored urine or hematuria. Contact prescriber for any of
the above. Monitor closely for at least 8 hours after administering.
Mix in minimum of 100 ml NSS. Can also be mixed in 500 ml NSS. NSS
diluent is preferred due to extended product stability in NSS.
Dilute with equal volume of sterile water for injection
Sodium acetate
INF
C
Over at least 2 hours
Must be added to a large volume IV solution
Sodium bicarbonate
IVP/INF
B
Over 5 to10 minutes
Incompatible with TPN solutions
Flush IV line before and after administration
Sodium Chloride 3%
INF
A
1
2
GENERIC NAME
RATE
Succinylcholine
Anectine
IVP/INF
A
IVP: Over 10 to 30 seconds
Sulfamethoxazole –
Trimethoprim
Bactrim
INF
C
Over 60 to 90 minutes.
INF
C
Over 5 minutes
INF
C
Over 60 minutes
Thiamine (B1)
Tigecycline
Tygacil
SPECIAL CONSIDERATIONS
Administration via a central line preferred; may be administered via a
peripheral line in emergent situations for a limited time. Rates of
hypertonic sodium chloride infusions should not exceed 1 mEq/kg/hr.
Monitor serum sodium closely.
For INF: add to 250- 1000 ml of D5W or NSS.
Patient MUST BE mechanically ventilated and sedated.
Adjust dose for renal impairment.
Dose depends on infection. Mix in D5W.
Dilute each 5ml in 125 ml D5W (75 ml in fluid restricted pts)
Add to 50ml of compatible solution
Dilute in NSS 100ml.
Restricted to Infectious Disease Physicians only.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 23 of 25
DESIGNATED
NURSING
STAFF
BRAND
NAME
ROUTE
Tobramycin
Nebcin
INF
C
Over 30 – 90min
Torsemide
Demadex
IVP
B
Over 2 minutes
Valproate Sodium
Depacon
INF
B
Over 60 minutes; may be given as
fast as over 5 to 10 minutes
Dilute dose in 50ml of NSS
INF
C
Doses < = 1gm to be infused over
60 minutes; doses 1gm to 1500mg
over 90 minutes. 2gm should be
infused over 3 hrs
Dose must be adjusted for renal insufficiency.
Mix in NSS: 500mg/150 ml; 501-1250mg/250ml; 1251 – 1500mg/300 ml;
> 1500mg/500ml. Concentrations above 5mg/ml are not recommended.
In fluid restricted patients a concentration of 10mg/ml may be used (see
package insert for details).
GENERIC NAME
Vancomycin
RATE
Vasopressin
Pitressin
IVP/INF
A
Vecuronium
Norcuron
IVP
INF
A
IVP: Over 2 to 3 minutes
IVP
A
1
2
Over 2 to 3 minutes
Give over 5 min in elderly patients.
Verapamil HCl
SPECIAL CONSIDERATIONS
Dose must be individualized based upon patient’s infection, weight,
age, and renal status.
When drawing Peak level draw sample 30 minutes after completion of
infusion. Draw Trough levels 30 minutes before beginning infusion.
Dilute in D5W: <150 mg/ 50 ml; 151-300mg/100 ml; >300 mg/150 ml.
May also be mixed in NSS.
No dilution necessary if given as a slow IV injection
Standard infusion: 150 units/250ml D5W
(0.6 units/ml). Can also mix in NSS
Must use an infusion device with flow stop tubing.
Patient MUST BE mechanically ventilated and sedated.
Standard concentration 0.5mg/ml (50mg/100ml total volume) D5W or
NSS
Use IBW when calculating the dose.
Vitramin K (see
Phytonadione)
Voriconazole
V-Fend
INF
B
Infuse over 1 to 2 hours (max rate
of 3 mg/kg/hr)
In patients with CCl < 50ml/min intravenous voriconazole should be
avoided.
Dilute in D5W to a concentration no greater than 5mg/ml. Restricted to
Infectious Disease Physicians only
Zoledronic Acid
Zometa
INF
B
Infuse over 15 minutes
Dilute in 100ml NSS. Single doses should not exceed 4 mg and the duration of
the infusion should be no less than 15 minutes.
Monitor renal function.
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 24 of 25
References:
Drugs Facts and Comparisons, Facts and Comparisons, St. Louis, Mo. 2002.
MICROMEDEX® Healthcare Series: MICROMEDEX, Greenwood Village, Colorado
Handbook of Critical Drug Therapy, 2nd Edition, 1998, Williams & Wilkins, Baltimore, MD
Handbook of Evidenced-Based Critical Care, 2001, Springer-Verlag, NY.
2005 Intravenous Medication, 21st edition, Mosby, St. Louis, Mo.
2000 Handbook of Emergency Cardiovascular Care for Healthcare Providers, American Heart Association,
Pharmacotherapy, 5th edition, McGraw-Hill, NY, 1999
Gold Standard, Inc. Clinical Pharmacology [database online]. Available at: http://www.clinicalpharmacology.com. Accessed: 5/12/13
Larson LA, Pui CH, Tumor Lysis Syndrome. In UpToDate, Savarese D (Ed), UpToDate, Waltham, MA, 2011, accessed 2/14/11
DESIGNATED NURSING STAFF:
ROUTE ABBREVIATIONS
A = Critical Care RNs
IVP = IV Push
B = All RNs
INF = IV Infusion
C = All RNs and LPN
IVP/INF = IV Push or IV Infusion
1 = Telemetry Class 1 (PCCU – 5W, MPCU – 5S, Observation – 3N, Neuro 3S)
2 = Telemetry Class 2 (Respiratory – 5N, Oncology – 4N, Bariatric Surg – 4W, Renal – 5E, Rehab – 3E)
** = See Standard Concentrations of Cardiovascular Medications for further dilution information
1/2015
Page 25 of 25

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