ISLHD Critical Care Division Critical Care IV Drug Protocols ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 1 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18% ISLHD Critical Care Division Medication Guidelines
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ISLHD Critical Care Division Medication Guidelines · NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose
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ISLHD Critical Care Division
Critical Care IV Drug Protocols
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 1 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
ISLHD
Critical Care Division
Medication Guidelines
ISLHD Critical Care Division
Critical Care IV Drug Protocols
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 2 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
DRUG & PRESENTATION CONTROL CLICK medication name for link
to administration guide –Australian Injectable Drug Handbook.
CRITICAL CARE PREFERRED ADMINISTRATION NOTES
ABATACEPT Link to AMH
ACETAZOLAMIDE Link to AMH
ACETYLCYSTEINE SEE ACETYLCYSTEINE WEIGHT BASED DOSAGE TABLES Link to AMH
ACICLOVIR Link to AMH
ADENOSINE Link to AMH
ADRENALINE (EPINEPHRINE)
1: 10,000 (1mg in 10mL) 1: 1,000 (1mg in 1mL) ADRENALINE-ANAPHYLAXIS
BOLUS: CARDIC ARREST ONLY
INFUSION: Add 6mg (6 x 1mL ampoules of 1:1000) to 100mL glucose 5% or NS Concentration: ~60microgram/mL
SEE ADRENALINE DOSAGE CHART
Link to AMH
AGALSIDASE ALPHA, BETA
Link to AMH
ALFENTANIL Link to AMH
ALTEPLASE 50mg
Pulmonary embolism: A total dose of 100mg should be administered over 2 hours (or 1.5mg/kg in patients <65kg).
Give 10mg bolus: After 10mg bolus give 90mg (or 1.5mg/kg in patients <65kg) diluted in 250 mL sodium chloride 0.9% over 2 hours.
MAXIMUM DOSE: 100mg For Massive/Sub-Massive Pulmonary Embolism: Administer 0.6mg/kg (max 50mg) over 15 mins.
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 3 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
DRUG & PRESENTATION CONTROL CLICK medication name for link
to administration guide –Australian Injectable Drug Handbook.
CRITICAL CARE PREFERRED ADMINISTRATION NOTES
AMINOPHYLLINE Link to AMH
AMIODARONE Usually administered by IV infusion via CVAD LOADING DOSE: For peripheral administration of a single loading dose of amiodarone:
o Add 150mg (3mL) to 100mL G5% (semirigid PVC Freeflex). Concentration≈ 1.5mg/mL OR
OR use weight based loading dose diluted in 250ml glucose 5% (max concentration 2mg/mL) via central venous catheter if possible, or a large peripheral vein
SEE AMIODARONELOADINGDOSE WEIGHT BASED LOADING DOSAGE TABLES Give via infusion device over a period of 20 minutes to 2 hours. Amiodarone should only ever be administered over shorter time periods in emergency situations. Infuse higher concentrations through a central venous access device (CVAD). In extreme clinical emergency amiodarone may be administered as a slow IV injection of 150mg-300mg in 10-20mL of glucose 5% over 1-2 minutes. Patients must be closely monitored CVAD A CVAD should be used if repeated administration or continuous infusions of amiodarone are required. For continuous infusion: CVAD administration Maximum concentration 6mg/mL Load 450mg (9mL) in 100mL glucose 5% (semirigid PVC Freeflex).
(concentration = 4.5mg/mL) Administer at 9mL per hour – or per weight based rate
SEE AMIODARONE CONTINUOUS INFUSION WEIGHT BASED DOSAGE TABLES
Link to AMH Amiodarone is adsorbed onto PVC and leaches plasticiser from PVC.For continuous infusions that will exceed 2 hours, the solution must be prepared in rigid PVC or non-PVC burettes =(semirigid PVC Freeflex Preferably use non-DEHP sets
It is recommended that an inline 0.22 micrometre filter is used with amiodarone infusions.
To minimise risk of thrombophlebitis associated with amiodarone avoid areas of flexure where it may be difficult to stabilise the peripheral intravenous cannula. Use the most appropriate cannula size for the vein as use of a peripheral intravenous cannula that is too large for the vein increases the risk of phlebitis(2).
AMPHOTERICIN B LIPOSOMAL
Reconstituted solution concentration is 4mg/mL Link to AMH Use the 5 micrometre filter supplied
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DRUG & PRESENTATION CONTROL CLICK medication name for link
to administration guide –Australian Injectable Drug Handbook.
CRITICAL CARE PREFERRED ADMINISTRATION NOTES
DAPTOMYCIN Link to AMH
DARBEPOETIN Link to AMH
DESMOPRESSIN Haemophilia A and von Willebrand's: Administer 0.4microg/kg in 50mL over 15-20 minutes. Platelet dysfunction: Administer 0.3microg/kg in 50mL NS over 30 minutes.
Link to AMH
DEXAMETHASONE Link to AMH
DEXMEDETOMIDINE NB prediluted vials 200microg/50mL now available
INFUSION: Add 200 mcg (2mL) to 48mL (4 mcg/mL) NS NB prediluted vials 200micrograms/50mL now available
SEE DEXMEDETOMIDINE WEIGHT BASED DOSAGE TABLE
Link to AMH
DIAZEPAM Link to AMH
DICLOXACILLIN No longer available as IV Link to AMH
DIGOXIN Link to AMH
DIGOXIN IMMUNE FAB
Dilute 40mg (1vial=40mg) to 40mL in NS to produce solution of concentration 1mg/mL
Dosage – see DIGIFAB product information SEE DIGOXIN IMMUNE FAB dosage table
Link to AMH
DOBUTAMINE INFUSION: Add 500mg (40mL of 12.5mg/mL solution) to 250mL G5% = 2mg/mL solution
SEE DOBUTAMINE WEIGHT BASED DOSAGE TABLES
Link to AMH
DROPERIDOL Link to AMH
ENOXAPARIN Link to AMH
EPHEDRINE Link to AMH
EPOPROSTENOL For use in dialysis see Dialysis guidelines Link to AMH
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 11 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
DRUG & PRESENTATION CONTROL CLICK medication name for link
to administration guide –Australian Injectable Drug Handbook.
CRITICAL CARE PREFERRED ADMINISTRATION NOTES
LINEZOLID Link to AMH
MAGNESIUM CHLORIDE See Critical Care Electrolyte Policy
MAGNESIUM SULPHATE Preloaded IV bags containing 20mmol Mg in 250mL NS ALSO Magnesium sulfate 8G/100mL preloaded bags available in Maternity for preeclampsia/eclampsia
See Critical Care Electrolyte Policy For Severe Pre-eclampsia and eclampsia patients use MATERNITY preloaded bag
containing 8G/100mL per policy:
See ISLHD Management of Hypertensive Disorders in Pregnancy and Postpartum
Link to AMH
MEROPENUM Link to AMH
METARAMINOL TARTATE
INFUSION: Add 50mg to 100mL compatible fluid solution = 0.5mg/mL titrate to effect.
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DRUG & PRESENTATION CONTROL CLICK medication name for link
to administration guide –Australian Injectable Drug Handbook.
CRITICAL CARE PREFERRED ADMINISTRATION NOTES
POTASSIUM CHLORIDE See Critical Care Electrolytes Policy Link to AMH
POTASSIUM DIHYDROGEN PHOSPHATE
See Critical Care Electrolytes Policy
PROCHLORPERAZINE
PROMETHAZINE Link to AMH
PROPOFOL Link to AMH
PROTAMINE Link to AMH
RANITIDINE Link to AMH
RASBURICASE Link to AMH
RIFAMPICIN Link to AMH
RITUXIMAB Link to AMH
ROCURONIUM
BOLUS: MO MUST be present. Maximum dose for nursing staff: 50mg. INFUSION: 10 ampoules 50mg/5ml into a 50ml syringe.
TOF: The infusion rate should be titrated against the number of twitches to a “train of four” stimulation using a Peripheral Nerve Stimulator. For ICU patients, generally, one twitch to the train of four should be present. The infusion rate of rocuronium is titrated to achieve this.
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 15 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
DRUG & PRESENTATION CONTROL CLICK medication name for link
to administration guide –Australian Injectable Drug Handbook.
CRITICAL CARE PREFERRED ADMINISTRATION NOTES
SALBUTAMOL 500microgram in 1mL 5mg in 5mL (Ventolin Obstetric)
For bronchospasm: Add 5mg (5mL) to 500mL (concentration≈ 10microg/mL). More concentrated solution: 5mg/100mL ( 50microg/mL) can be used Initial dose 5microg/min. Maximum rate is 20 microgram/minute, except in patients with severe bronchospasm For premature labour: Add 5mg (5mL) to 100mL (concentration≈ 50microg/mL). Initial infusion rate 10microg/min. Start the infusion at 10 microgram/minute, and adjust according to the strength and frequency of contractions.
SEE SALBUTAMOL WEIGHT BASED DOSAGE TABLES
Link to AMH
SALCATONIN (SALMON CALCITONIN)
Link to AMH
SODIUM BICARBONATE 8.4% 1mmol in 1mL
See Critical Care Electrolytes Policy
SODIUM DIHYDROGEN PHOSPHATE
See Critical Care Electrolytes Policy
SODIUM NITROPRUSSIDE 50mg vial
INFUSION: Reconstitute vial with 2-3ml glucose 5%. Flask: Add 50mg to 500ml
Concentration: 100microg/ml Administer via peripheral line
Max dose: 500microg/min SEE SODIUM NITROPRUSSIDE WEIGHT BASED DOSAGE TABLES
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ACETYLCYSTEINE – ADULT : Using individual patient weight add volume (mLs) of acetylcysteine 200mg/mL stock solution from table to the indicated volume of IV
fluid and administer over the allocated time as outlined in each column. There are 3 infusions for a complete course.
ACETYLCYSTEINE DOSE FOR PARACETAMOL OVERDOSE (ADULT)
WEIGHT (kg)
INITIAL INFUSION SECOND INFUSION THIRD INFUSION Total dose
Add mLs of acetylcysteine 200mg/mL from table below (=150mg/kg) to 250mL of Glucose
5% and administer over 15 to 60 minutes
Add mLs of acetylcysteine 200mg/mL from table below (=50mg/kg) to 500mL of Glucose
5% and administer over 4 hours
Add mLs of acetylcysteine 200mg/mL from table below (=100mg/kg) to 1000mL of
Glucose 5% and administer over 16 hours
300mg/kg over 21 hours
mL of acetylcysteine 200mg/mL mL of acetylcysteine 200mg/mL mL of acetylcysteine 200mg/mL mL
50 38 13 25 75
55 41 14 28 83
60 45 15 30 90
65 49 16 33 98
70 53 18 35 105
75 57 19 38 113
80 60 20 40 120
85 64 21 43 128
90 68 23 45 135
95 71 24 48 143
100 75 25 50 150
105 79 26 53 158
110 83 28 55 165
115 86 29 58 173
120 90 30 60 180
130 98 33 65 195
140 105 35 70 210
150 113 38 75 225
Back to ACETYLCYSTEINE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 19 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
ACETYLCYSTEINE – CHILD <20kg
Using individual child weight add volume (mLs) of acetylcysteine 200mg/mL stock solution from table to the indicated volume of IV fluid and administer over the allocated time as outlined in each column. There are 3 infusions for a complete course.
ACETYLCYSTEINE DOSE FOR PARACETAMOL OVERDOSE (CHILD <20KG)
INITIAL INFUSION SECOND INFUSION THIRD INFUSION TOTAL DOSE
add volume (mLs) of acetylcysteine 200mg/mL stock solution (= 150mg/kg) to 3mL/kg of
Glucose 5% administer over 15 to 60 minutes
add volume (mLs) of acetylcysteine 200mg/mL stock solution (=50mg/kg) in 7mL/kg of Glucose 5% administer over 4
hours
add volume (mLs) of acetylcysteine 200mg/mL stock solution (=100mg/kg) in
14mL/kg of Glucose 5% administer over 16 hours
300mg/kg over 21 hours
WEIGHT (kg)
5 3.75mL acetylcysteine in 15mL G5% 1.25mL acetylcysteine in 35mL G5% 2.5mL acetylcysteine in 70 mL G5% 7.5mL
10 7.5mL acetylcysteine in 30mL G5% 2.5mL acetylcysteine in 70 mL G5% 5mL acetylcysteine in 140 mL G5% 15mL
15 11.25mL acetylcysteine in 45 mL G5% 3.75mL acetylcysteine in 105 mL G5% 7.5mL acetylcysteine in 210 mL G5% 22.5mL
Back to ACETYLCYSTEINE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 20 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
ACETYLCYSTEINE – CHILD 20-40kg
Using individual child weight add volume (mLs) of acetylcysteine 200mg/mL stock solution from table to the indicated volume of IV fluid and administer over the allocated time as outlined in each column. There are 3 infusions for a complete course.
Back to ACETYLCYSTEINE
ACETYLCYSTEINE DOSE FOR PARACETAMOL OVERDOSE (CHILD 20 - 40 KG)
INITIAL INFUSION SECOND INFUSION THIRD INFUSION TOTAL DOSE
Add volume of acetylcysteine solution from table below (150mg/kg) to 100mL of Glucose
5% administer over 15 to 60 minutes
Add volume of acetylcysteine solution from table below (50mg/kg) to 250mL of Glucose
5% administer over 4 hours
Add volume of acetylcysteine solution from table below (100mg/kg) to 500mL of
Glucose 5% administer over 16 hours
300mg/kg over 21 hours
WEIGHT (kg)
mL of acetylcysteine 200mg/mL mL of acetylcysteine 200mg/mL mL of acetylcysteine 200mg/mL
20 15 5 10 30
25 18.75 6.25 12.5 37.5
30 22.5 7.5 15 45
35 26.25 8.75 17.5 52.5
40 30 10 20 60
ISLHD Critical Care Division
Critical Care IV Drug Protocols
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 21 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
ADRENALINE
INFUSION: Add 6mg (6 x 1mL ampoules of 1:1000) to 100mL glucose 5% or NS. Concentration: ~60microgram/mL N.B. Should be given through dedicated C.V.C. line when infusion necessary.
Use of medial or distal CVC port preferable Do not use if the solution contains a precipitate or is brown.
Titrate to clinical effect as per MO order
ADRENALINE 60microg/mL
Body WEIGHT (kg)
50 60 70 80 90 100 120
DOSE (microg/kg/min)
Flow Rate (mL/hr)
0.02 1 1.2 1.4 1.6 1.8 2 2.4
0.05 2.5 3 3.5 4 4.5 5 6
0.1 5 6 7 8 9 10 12
0.2 10 12 14 16 18 20 24
0.3 15 18 21 24 27 30 36
0.4 20 24 28 32 36 40 48
0.5 25 30 35 40 45 50 60
0.6 30 36 42 48 54 60 72
0.7 35 42 49 56 63 70 84
0.8 40 48 56 64 72 80 96
0.9 45 54 63 72 81 90 108
1.0 50 60 70 80 90 100 120
Back to ADRENALINE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 22 of 39 NS=sodium chloride 0.9% G5%=glucose 5% in water Hartmann’s=Lactated Ringers G/S=glucose in sodium chloride G4%NS/5=glucose 4% in sodium chloride 0.18%
ALTEPLASE
WEIGHT
(KG) BOLUS DOSE (mg)
OVER 1-2 MINS INTERMITTENT INFUSION
(mg) OVER 2 HOURS TOTAL DOSE
(mg)
FOR MASSIVE/SUB-MASSIVE PE 0.6mg/kg (max 50mg)
OVER 15 MINS
40 10 50 60 24
45 10 57.5 67.5 27
50 10 65 75 30
55 10 72.5 82.5 33
60 10 80 90 36
65 10 87.5 97.5 39
70 10 90 100 42
75 10 90 100 45
80 10 90 100 48
85kg or
greater 10 90 100 50
Back to ALTEPLASE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
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AMIODARONE – LOADING DOSE
Peripheral infusion
o Add 150mg (3mL) to 100mL G5% (semirigid PVC Freeflex). Concentration≈ 1.5mg/mL o Give via infusion device over a period of 20 minutes to 2 hours.
Or use weight based dose as below: Use a central venous catheter if possible, or a large peripheral vein
o Load appropriate dose per table in 250mL Glucose 5% (semirigid PVC Freeflex) (maximum concentration 2mg/ml) o administer dose over 20 minutes to 2 hours
WEIGHT AMIODARONE
LOADING DOSE 5mg/kg
Dose in mg
50 250
55 275
60 300
65 325
70 350
75 375
80 400
85 425
90 450
95 475
100 500
Back to AMIODARONE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
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AMIODARONE – CONTINUOUS INFUSION CVAD
For continuous infusion: CVAD administration
Load 450mg in 100mL 5% glucose (concentration = 4.5mg/mL)
Note: maximum concentration 6mg/mL
Administer at 9mL per hour – or per weight based rate as per table
WEIGHT (kg) AMIODARONE Dose for 24 hours = 15mg/kg (mg)
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DIGOXIN IMMUNE FAB
Dilute each 40mg (1 vial = 40mg) to 40mL IN SODIUM CHLORIDE 0.9% to produce solution of concentration 1mg/mL DOSAGE TABLE FOR FULL NEUTRALISATION DOSE OF DIGIFAB BASED ON PATIENT’S WEIGHT AND KNOWN SERUM DIGOXIN CONCENTRATION Note: product recommendation is to administer ½ the calculated full neutralisation dose initially followed by monitoring for 6-12 hours – see product information
DIGIFAB Full neutralisation dose for ADULTS based on known serum digoxin concentration
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ISOPRENALINE
INFUSION: Add 2mg (10mL) to 100mL of NS or G5% Concentration: 20microgram/mL
Titrate to clinical effect as per MO order Starting rate: 1.5mL/hour
Maximum rate: 15mL/hour
ISOPRENALINE 20microg/mL
Dose (microg/minute) Infusion Rate (mL/hour)
0.5 1.5
1 3
2 6
3 9
4 12
5 15
Back to ISOPRENALINE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
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LEVOSIMENDAN
Dilute 25 mg (10 mL) to 500 mL with glucose 5% to make a concentration of 50 microgram/mL.
Dosage & administration: Shoalhaven ICU does not usually use a loading dose.
Usually start at a dose of 0.1microg/kg/minute for 30 – 60 minutes. If the initial infusion rate is tolerated the rate may be increased to 0.2 microg/kg/minute. Infuse for a total of 24 hours.
LEVOSIMENDAN 50microg/mL
WEIGHT (kg) Running rate in mL/hr
0.1microg/kg/min 0.2 microg/kg/min
40 4.8 9.6
50 6 12
60 7.2 14.4
70 8.4 16.8
80 9.6 19.2
90 10.8 21.6
100 12 24
110 13.2 26.4
120 14.4 28.8
130 15.6 31.2
140 16.8 33.6
150 18 36
Back to LEVOSIMENDAN
ISLHD Critical Care Division
Critical Care IV Drug Protocols
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NORADRENALINE
Add 4mg to 100ml G5% Concentration: 40microgram/mL
Titrate to clinical effect as per MO order
NORADRENALINE 4mg/100mL INFUSION
Concentration≈ 40microg/mL
Dose (microg/minute) Infusion Rate (mL/hr)
2 3
4 6
6 9
8 12
10 15
Back to NORADRENALINE ACID TARTRATE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
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Directions: 1. Accurately determine patients weight 2. Tightly attach prefilled syringe to the vial adaptor 3. Penetrate vial with vial adapter (prefilled syringe attached) 4. Slowly inject water for injection into vial to avoid foaming 5. Reconstitute contents of vial by swirling gently to reconstitute – do not shake 6. Withdraw required dose 7. Administer dose IV over 10seconds
Back to TENECTEPLASE
ISLHD Critical Care Division
Critical Care IV Drug Protocols
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TIROFIBAN
Dose adjustment table by weight –Note – patients with severe renal insufficiency require dose decrease