Transcription of 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.
2 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. 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.
3 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.
4 > 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.)
5 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. 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.
6 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.
7 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.
8 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. 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.
9 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.
10 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.
