VUMC INTRAVENOUS MEDICATION …

1 VUMC INTRAVENOUS MEDICATION administration CHARTA pproved by Pharmacy and Therapeutics Committee, Revised October 2014*INFUSION CONCENTRATIONICUStep DownGen CareStandard (Std)Maximum (Max)Adenosine(Adenocard)AntiarrythmicXM D presentXMD presentXMD present6 mg / 2 mLInfusion not recommended AlbuminBlood Product DerivativeXXXNot for IV Push5% or 25%Alemtuzumab (Campath)Monoclonal AntibodyXXXNot for IV Push30 mg / 100 mLAlprostadil(Prostin VR)ProstaglandinXGRPeds:20 mcg/mLAlteplaseTissue Plasminogen Activator (t-PA)(Activase)ThrombolyticXXNo titration of infusion1 mg/mLAdult:100 mg / 100 mLPeds: 1 mg/mLAminocaproic Acid(Amicar)Hemostatic AgentXNot for IV PushAdult:20 Gm / 250 mLPeds: 20 mcg/mL* Refer to references such as Mosby s for additional information on administration and monitoring.

2 Alternate infusion rates permitted at provider discretion.** Central Line Preferred indicates that the MEDICATION is associated with venous irritation. Certain situations may require that the MEDICATION be administered peripherally (e g., emergency situations, waiting on central line placement, or very short duration of infusion planned). Infusion of these medications/solutions through a peripheral vein may lead to loss of vascular access or damage to the vein and/or surrounding tissue, resulting in chemical phlebitis and thrombus formation.

3 Other factors including vein size, infusion rate, catheter dwell time, catheter size and location also influence the risk of phlebitis. Monitor closely for signs and symptoms of infiltration and/or phlebitis if given peripherally. Guardrails*IV PUSH CONCENTRATIONDRUG DRUG CLASSAPPROVED FOR X = Approved for Level of Care IndicatedVUMC INTRAVENOUS MEDICATION administration CHARTA pproved by Pharmacy and Therapeutics Committee, Revised October 2014*INFUSION CONCENTRATIONICUStep DownGen CareStandard (Std)Maximum (Max)Guardrails*IV PUSH CONCENTRATIONDRUG DRUG CLASSAPPROVED FOR X = Approved for Level of Care IndicatedAmiodarone(Cordarone)Antiarryth micXXAdult areas only with no titration of infusionGRAdult for pulseless VT or VF.

4 300mg in 30mL NS or D5W **Central Line Preferred if conc > 2 mg/mLAdult:Bolus: 150 mg / D5W 100 mLInfusion:450 mg / 250 mL ( ) (Std)900 mg / 250 mL D5W (Max)Peds:Bolus: 2 mg/mLInfusion:2 mg/mL or 6 mg/mL **Central Line Preferred if conc > 2 mg/mLAntithymocyte Globulin-Rabbit (Thymoglobulin)ImmunosuppressantXXXGRNot for IV Push500mL (Std)May be dispensed in 250 mL for concentrated mg/mL (Max)ArgatrobanAnticoagulantXXXGR250 mg/250 mLAtropineAnticholinergicXXMD presentXMD present1 mg /10 mg/mLBasiliximab (Simulect)Monoclonal AntibodyXXXNot for IV Push20 mg/ 50 mLBivalirudin (Angiomax)AnticoagulantXXX250 mg/50 mLBlood Factor.

5 Anti-InhibitorCoagulantComplex(FEIBA -VH)Anti-hemophilic agentXXXD ependent on vial sizes used. N/AVUMC INTRAVENOUS MEDICATION administration CHARTA pproved by Pharmacy and Therapeutics Committee, Revised October 2014*INFUSION CONCENTRATIONICUStep DownGen CareStandard (Std)Maximum (Max)Guardrails*IV PUSH CONCENTRATIONDRUG DRUG CLASSAPPROVED FOR X = Approved for Level of Care IndicatedBlood Factor:fVIII/vonWillebrand factor complex, plasma derived(Humate P)Anti-hemophilic agentXXXD ependent on vial sizes used. N/ABlood Factor:Recombinant fIX(Benefix )Anti-hemophilic agentXXXD ependent on vial sizes used.

6 N/ABlood Factor:Recombinant fVIIa(NovoSeven RT)Anti-hemophilic agentXXX1000 mcg/mLFurther dilution not recommendedBlood Factor:Recombinant fVIII(Advate )Anti-hemophilic agentXXXD ependent on vial sizes used. N/ABlood Factor:Recombinant fVIII(Recombinate )Anti-hemophilic agentXXXD ependent on vial sizes used. N/ABumetanide (Bumex) mg/mLAdult:20 mg / 80 mg/mL (Std) mg/mL (for patients < 5 kg)Buprenorphine(Buprenex) mg/mLButorphenol (Stadol)OpioidXXX1 mg/mLCalcium Chloride(CaCl)ElectrolyteXXIntermittent infusion onlyXIntermittent infusion onlyGR1 gm / 10 mL**Central Line PreferredAdult:2 gm /100 mLDialysis specific conc:8 gm / 250mLPeds.

7 100 mg/mL**Central Line PreferredVUMC INTRAVENOUS MEDICATION administration CHARTA pproved by Pharmacy and Therapeutics Committee, Revised October 2014*INFUSION CONCENTRATIONICUStep DownGen CareStandard (Std)Maximum (Max)Guardrails*IV PUSH CONCENTRATIONDRUG DRUG CLASSAPPROVED FOR X = Approved for Level of Care IndicatedCalcium GluconateElectrolyteXXXGR1 gm / 10 mL1 gm / 50mLDialysis specific conc:6 gm /100 mLChlorproMAZINE(Thorazine)Antipsychotic XXXNot for IV Push25 mg in 100 mL (Std)Cisatracurium(Nimbex)HIGH ALERT MEDICATIONN euromuscular BlockerXGR2 mg / mLAdult:200 mg / 250 mL (Std)400 mg / 250 mL (Max)Peds: 1 mg / mL2 mg / mLCMV INTRAVENOUS Immune Globulin (Cytogam)Blood Product DerivativeXXXNot for IV PushCycloSPORINE(SandIMMUNE)Immunosuppre ssantX XXGRNot for IV PushAdult:Dose diluted in 250 mL glass (Std)Dose diluted in 100 mL glass (Max)Peds.

8 Mg / mLDexamethasone (Decadron)CorticosteroidXXX4 mg/mL10 mg/mL15 mg/mLDexmedetomidine (Precedex)SedativeX400 mcg /100mLAdult:400 mcg/100 mL (Std,Max)Peds: 4 mcg/mLVUMC INTRAVENOUS MEDICATION administration CHARTA pproved by Pharmacy and Therapeutics Committee, Revised October 2014*INFUSION CONCENTRATIONICUStep DownGen CareStandard (Std)Maximum (Max)Guardrails*IV PUSH CONCENTRATIONDRUG DRUG CLASSAPPROVED FOR X = Approved for Level of Care IndicatedDextrose in WaterNutrition TherapyXXX50% (Max)Adult:5% (Std)10% (Std)20% (Max) - **Central Line PreferredPeds:5% (Std)10% (Std) - Maximum given peripherally with Calcium - Maximum given peripherally without Calcium additiveAbove - Central Line PreferredNote: Above standards to not apply to dextrose in TPND iazepam(Valium)BenzodiazepineXXNo titration of infusionXIntermittent Dosing OnlyGR5 mg/mL5 mg/50 mL (Std)10 mg/50 mL (Max)Digoxin(Lanoxin)HIGH ALERT MEDICATIOND ouble Check RequiredMiscellaneousXXAdult areas onlyXAdult areas onlyAdult:250 mcg/mLPeds.

9 10 mcg/mL, 100 mcg/mLDihydroergotamine(DHE 45)AntimigraineXXX1mg/mLDiltiazem (Cardizem)CalciumChannelBlockerXXNo titration of infusionGR5 mg/mL100 mg/100 mL (Std, Max)VUMC INTRAVENOUS MEDICATION administration CHARTA pproved by Pharmacy and Therapeutics Committee, Revised October 2014*INFUSION CONCENTRATIONICUStep DownGen CareStandard (Std)Maximum (Max)Guardrails*IV PUSH CONCENTRATIONDRUG DRUG CLASSAPPROVED FOR X = Approved for Level of Care IndicatedDiphenhydrAMINE(Benadryl)Antihi stamineXXX50 mg/mLDOBUT amine(Dobutrex)Adrenergic agonistXXNo titration of infusionGRAdult: 250 mg/250 mL (Std)1000 mg/250 mL (Max)Peds: 5 kg800 mcg/mL1600 mcg/mL (Std)3200 mcg/mL>5 kg1600 mcg/mL (Std)3200 mcg/mLDOP amine(Intropin)Adrenergic agonistXXNo titration of infusionException: 7T3 kidney &/or pancreas transplants may receive in 1st 24hrs post-op while on 1:1 RN careGRAdult: 400 mg/250 mL (Std)1600 mg/250 mL (Max)Peds.

10 5 kg800 mcg/mL1600 mcg/mL (Std)3200 mcg/mL>5 kg1600 mcg/mL (Std)3200 mcg/mL6400 mcg/mL**Central Line PreferredDroperidol (Inapsine) mg/mLEnalaprilat(Vasotec)ACE InhibitorXXAdult areas onlyXAdult areas onlyAdult: mg/mLPeds:25 mcg/mLVUMC INTRAVENOUS MEDICATION administration CHARTA pproved by Pharmacy and Therapeutics Committee, Revised October 2014*INFUSION CONCENTRATIONICUStep DownGen CareStandard (Std)Maximum (Max)Guardrails*IV PUSH CONCENTRATIONDRUG DRUG CLASSAPPROVED FOR X = Approved for Level of Care IndicatedEPINEPH rine(Adrenalin)Adrenergic agonistXGR1:10,000( mg/mL)1:1,000(1 mg/mL)Central Line PreferredAdult: 4 mg/250 mL (Std)8 mg/250 mL (Max)Adult Emergency Dept Only: 1 mg/1000 mL (not prepared by the pharmacy.)