Pediatric Guidelines for IV Medication Administration

1 Pediatric Guidelines for IV Medication Administration NOTE: This is not a comprehensive Medication list. For items not listed, review standard Medication resources or consult the pharmacist. Version 9/28/2008 Barb Maas Pharm. D. 1 Approved For Drug ICU ED Telemetry Required Acute Care IVP IV Infusion Concent-ration Usual Dosing and Administration Comments Acetazolamide (Diamox ) X X X Dilute to MAX of 100 mg/mL 5-10 mg/kg/dose MR q 8 or 6 hrs. MAX dose: 25 mg/kg/dose up to 500 mg/dose MAX Rate: IVP over 1 minute. Monitor serum electrolytes Acetylcysteine (Acetadote ) X Bolus + infusion X Infusion only X 30 gm/1000 mL (30 mg/mL) Requires toxicology approval.

2 Bolus: 150mg/kg over 1 hr. Maintenance: See dosing protocol or contact pharmacy for weight-based protocol. When used in acetaminophen overdose, monitor serum acetaminophen concentrations; monitor LFTs. Bolus doses, monitor for hypotension, flushing, anaphylaxis Bolus doses must be completed in critical care areas only. Maintenance IV infusions may be continued or initiated in acute care areas. Acyclovir X X X Diluted to <5 mg/mL Infusion over 60-90 minutes. Dose: 5-20 mg/kg/dose q 8hrs. Patient should be well hydrated to prevent nephrotoxicity. Monitor urine output, Scr. Adenosine (Adenocard ) X X X See restriction . X 6 mg/2 mL. (3mg/ml) mg/kg up to 6 mg over 1-2 seconds followed by rapid NS flush. May increase dose by mg/kg q2 minutes up to 12 mg/dose every 1-2 mins till termination of arrhythmia to a MAX CUM dose of mg/kg/dose upto 30 mg.

3 > 50kg: 6mg, 12mg, 12mg Restriction: In acute care areas, doses must be administered by a physician.. Communication with the ICU team prior to adenosine Administration is required. An attending Hospitalist, Cardiologist, or ICU physician must be at the bedside. A continuous ECG rhythm strip must be obtained during dosing to monitor and document drug effects Albumin 5% (forhypovolemia, hypoalbuminemia X X X 5% (50 mg/mL) gm/kg/dose (10-20 mLs/kg/dose). Infusion over 30-60 minutes. In emergencies, may administer over 15 minutes. Adult MAX: 600mls/hr Rapid infusion may cause hypertension and pulmonary edema. Monitor vital signs and fluid balance. Use within 4 hours of opening vial. 60 micron filter/tubing supplied by pharmacy Albumin 25% (forhypoproteinemia w/ generalized edema) X X X 25% (250 mg/mL) gm/kg/dose (1-4 ms/kg/dose) Infusion as tolerated over 30-120 minutes.)

4 Adult MAX :180ml/hr Rapid infusion may cause hypertension & pulmonary edema. Monitor vital signs and fluid balance. Use within 4 hrs of opening. 60 micron filter/tubing supplied by pharmacy Alprostadil, PGE1 Prostin VR Pediatric ) X X X Contin-uous infusion Dilute 500 mcg in 50mls NS (10 mcg/ml) Initial: mcg/kg/min. Range: up to MAX Infuse via large vein. Monitor arterial pressure, RR, HR, oxygen saturation, temp. Amikacin (Amikin ) X X X Diluted to < 5 mg/mL 5-10mg/kg/dose q8hrs with NL renal function. Infusion: Over 30 minutes. Urine output, Serum creatinine, Peak and trough concentrations. Pediatric Guidelines for IV Medication Administration NOTE: This is not a comprehensive Medication list.

5 For items not listed, review standard Medication resources or consult the pharmacist. Version 9/28/2008 Barb Maas Pharm. D. 2 Approved For DrugDrD ICU ED Telemetry Required Acute Care IVP IV Infusion Concen- tration Usual Dosing and Administration Comments Amiodarone (Cordarone ) X X X Bolus in code only No infusion X X Bolus diluted to mg/mLin D5W Infusion 450 mg/ 250 mL in D5W BOLUS: PALS for pulseless VF/VT5 mg/kg (MAX 300 mg/dose) given over 5-10 minutes. - micron filter preferred . Flush post dose. For perfusing VF/VT 5 mg/kg over 20-60 min, MR X 3 Infusion: Initial dose of 5 mcg/kg/min, increase to desired effect to a MAX of 15 mcg/kg/min Central line preferred for concentrations exceeding 2 mg/mL. Dedicated filtered ( micron) line required.

6 Continuous BP/cardiac monitoring, thyroid function, LFTs, and pulmonary function should be monitored frequently. Ampicillin X X X slow X Dilute to <20 mg/mL IVP: not to exceed 10 mg/kg/minute. Infusion: over 15-30 minutes Dosing: 100-400 mg/kg/day divided every 6 hrs. MAX 12 gm/day Adjust with renal dysfunction. Ampicillin/ Sulbactam (Unasyn ) X X X slow X Dilute to <30 mg/mL =(amp 20 mg/ sulb 10 mg) IVP: not to exceed 15 mg/kg/minute (amp/sulb) Infusion: Over 15-30 minutes >1 month: 150-225 mg/kg/day (amp/sulb) divided every 6 hrs Children: 150-300 mg/kg/day (amp/sulb) divided every 6 hrs. (non-meningitic doses) (MAX dose: 12 gm ampisulb/day) Unsayn: Each unasyn=1mg apicillin + sulbactam. With prolonged therapy, monitor hematologic, renal and hepatic function.

7 Observe for change in bowel frequency. Atropine X X X MD available X mg/mL; 1 mg/mL IV Push: given over 1 minute Dosing: mg/kg (MIN mg) Child: up to mg, MRx1 Adolescent: up to 1 mg, MRx 1 Please see reference for dosing for specific indications. Monitor vital signs and EKG; monitor for side effects including dry mouth, dizziness and palpitations. Azithromycin (Zithromax ) X X X Dilute to 2 mg/mL Infusion:MAX concentration of 2 mg/mL over 1 hr Dosing: 5-10 mg/kg/day as q 24 h (MAX 500 mg) Single dose regimen: 30mg/kg X 1 (MAX 1500mg) For specific indications, please consult pedi reference for recommendations. Monitor for pain at infusion site, LFTs, WBC and infection. Aztreonam (Azactam ) X X X X Dilute to < 20 mg/mL IVP: over 3-5 min Infusion: Over 20 minutes Dosing: >1 month-90-120 mg/kg/day div q 8h or q 6 h.

8 CF: 50 mg/kg/dose q 6 hrs MAX 8 gm/day Adjust dosing with renal dysfunction. Pediatric Guidelines for IV Medication Administration NOTE: This is not a comprehensive Medication list. For items not listed, review standard Medication resources or consult the pharmacist. Version 9/28/2008 Barb Maas Pharm. D. 3 Approved For Drug ICU ED Telemetry Required Acute Care IVP IV Infusion Concen-tration Usual Dosing and Administration Comments Bumetanide (Bumex ) X X X X mg/mL mg/kg/dose up to 4 mg q 6-24 hrs (MAX dose is 10 mg/day, 20 mg/day w/ RF)) IV Push: over 1-2 minutes MAX 1mg/min Monitor blood pressure, serum electrolytes and renal function.

9 Caffeine Citrate (Cafcit) For apnea X X X 20 mg/mL citrate salt (=10 mg/mL caffeine base) Loading: 10-20 mg/kg citrate salt infused over 30 minutes Maintenance: 5 mg/kg/day as citrate salt once daily starting 24 hours after bolus doseinfused over 10 minutes Clarify if dosing is as citrate salt or caffeine base. Must be specified on Medication order. May dilute in D5W Monitor heart rate, number and severity of apnea spells, and serum caffeine levels Caffeine sodium benzoate For spinal headache X X X Dilute to mg/mL Adults: 500 mgs as a single dosediluted with 1000 mL NS and infused over 1 hour, followed by 1000 mL NS over 1 hour. Not to be administered in neonates(benzoates). Monitor heart rate. calcium chloride X Slow IVP X IVP In code only w/MD present.

10 No infusion. X Slow IVP X 1 gm/ 10 mL vial Recommend use only in symptomatic hypocalcemia Bolus: 10-20 mg/kg/dose up to 1gm over a minimum of 10 minutes. Infusion: Do not exceed 45-90 mg/kg given over 1 hour Central Line preferred unless emergency Administration . Do not administer or or use scalp, small hand or foot veins for IV Administration since severe necrosis may occur. Monitor serum calcium (ionized calcium is recommended), heart rate and EKG. Do not infuse calcium chloride in same IV line as phosphate-containing solutions . calcium Gluconate X Slow IVP X Slow IVP only. Slow IVP in code w/ MD present. Infusion OK X Slow IVP X 1 gm/50 mL =20 mg/mL 200-500 mg/kg/DAY as continuous infusion or in 4 divided doses Acute::Usual 100mg/kg or 1gm MAX 3gm over 10 minutes Non-Acute: Usual 50-100mg/kg not to exceed 2gm over no less than 60 minutes.