IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 1 I.Injectable Electrolyte Products: Medication Name Vial Concentration Administration Compatibly Special Notes Calcium (Ca) 10% *Chloride 1 g/10 ml (10%) 1 ml =100 mg =0.68 mMol 1 ml = 27 mg Ca = 1.36 mEq Ca++ *Gluconate 1 g/10 ml (10%) 1 ml =100 mg =023mMol 1 ml = 9 mg Ca = 0.46 mEqCa For IV administration only Gluconate salt is less irritating, But contains less Ca per ml than Chloride salt D5W,NS,D5% NS D5% 1/2 NS, D5 % l/4 NS, D 10% NS,D10% 1/2 N , D10% 1/4 NS, SWFI In general , the dose ,concentration of infusion and rate of administration may be dependent on patient condition and specific institution Policy ECG monitoring is recommended for potassium infusions>10 mEq/hr In patients with renal dysfunction , slow administration rate or oral repletion is recommended Abbreviations: NaCl = sodium chloride , WFI = water for injections , PL = peripheral line; CL = central line Magnesium (Mg) Sulfate 10% 1 ml =100 m g = 0.8meq = 0.4 mMol 1 g =100 Mg2+ 8 mEq = 4 mMol Administration guidelines differ when used in obstetrical patients for tocolysis D5W,NS,D5% NS D5% 1/2 NS, D5 % l/4 NS, D 10% NS ,D10% 1/2 N , D10% 1/4 NS, LR , SWFI Phosphate (PO4) K PO4 :1 ml = 3 mMol PO4 = 4.4 mEq K Na PO4 : 1 ml = 3 mMol PO4 = 4 mEq Na Na PO4 (Glycophos®) : 1 ml = 1 mMol PO4 = 2 mEq Na 31 mg Elemental Phosphate = 1 Mmol Should be diluted before administration D5W,NS,D5% NS D5% 1/2 NS, D5 % l/4 NS, D 10% NS,D10% 1/2 N , D10% 1/4 NS, LR , SWFI Potassium (K) 15% KCL 1 ml = 2 mEq K = 149 mg KCl 1 ml = 2 mMol 1 mMol = 1 mEq Should be diluted before administration D5W,NS,D5 % NS D5% 1/2 NS, D5 % l/4 NS, D 10% NS, D10% 1/2 N , D10% 1/4 NS, LR , SWFI Sodium Bicarbonate 8.4% 1 ml = 84 mg NaHCO3 = 1 mEq Na and 1 mEq HCO3 1 mMol/ mL IV Push (for cardiac arrest) SWI (Direct I.V infusion) ,D5W, NS , D5% NS ,D5 1/2 NS, D5 ¼ NS ,D 10% NS, D10% 1/2 NS D 10% 1/4 NS, LR , SWFI Sodium chloride - 14.61% - 3% 146 mg/ mL , 2.5 mEq/ml, 2.5 mMol/ml 30 mg/ m L , 0.51 mEq/ mL ,0.5 mMoI / mL ≥3% solution central only D5W,NS,D5% NS D5% 1/2 NS, D5 % l/4 NS, D 10% NS ,D10% 1/2 N , D10% 1/4 NS, LR , SWFI Intravenous Preparation Guidelines New Najran General Hospital Pharmacy Department
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 2 2-Adult Electrolyte Infusion Guidelines - Ward Patients: Medication Name Calcium (Ca) Magnesium (Mg) Phosphate (PO4) Potassium (K) Cl Sodium Bicarbonate (HCO3) Sodium chloride( NaCl) Standard Conc. Chloride : IV Inf. 1g/50ml IV Push: 100mg/ml( undiluted) Gluco.: IV Inf. 1g/20 ml-50ml 2 gm/100 ml(20-50 mg/ml) IV Push: 100mg/ml( undiluted) IV Inf. : 1g/50ml (20 mg/ml) IV Push: 100 mg- 200 mg/ml K PO: IV Inf. : 15-30 mMol/ in 250 ml over 4 -6hr 10 mEq /100 ml 20mEq/250mL 40mEq/500 mL Continuous I.V infusion: 15 mg/mL (0.18 mEq/mL) 150 mEq/1000 mL I.V Push (for cardiac arrest) 1 mEq/mL (undiluted) ≥3% solution) central line only Maximum rate: 0.5 to meq /L/hr 100 ml/hr Infusion rate Chloride: 45-90mg/kg/hr (3-5 % solution) IV Push:50-100 mg/min Gluco. : 100 - 150 mg/min IV Inf. : over 30 min IV Push: 150 mg /min K PO: IV Inf. : 15 Mmol /hr (4 -6hr) 10 mEq/hr Continuous I.V infusion : 2-4 mEq /kg over 4-8 hrs. I.V Push (for cardiac arrest) 50 ml over 5-10 min. Maximum rate Chloride: 90mg/kg/hr IV Push: 100mg/min Gluco. : 200mg/min IV Inf. : 2 gm/hr IV Push: 150 mg /min: K PO: IV Inf. 15 Mmol /hr 10 mEq/hr Maximum concentration Chloride: 20 mg/ml IV Push: 100 mg/ml Gluco. : IV Inf. 50 mg/ml IV Push: 100mg/ml (intermittent) IV Inf. : 200 mg/ml IV Push: 200 mg/ml K PO: IV Inf. PL: 6.7 mMol/ in 100 ml 40 mEq/L Stability Ca Chloride and Ca Gluconate Stable for 24 hours at RT Don’t refrigerate solution D5% : 60 days at 0 0C NS :90 days at RT 24 hours 24 hours at RT in commonly used IV fluids (DSW, NS) 24 hrs Note: Undiluted hypertonic 8.4% HCO3 may be given by intravenous injection during cardiac arrest 24 hrs Medication Name Calcium (Ca) Magnesium (Mg) Phosphate (PO4) Potassium (K) Cl Sodium Bicarbonate (HCO3) Sodium chloride( NaCl) Standard Conc. Chloride : IV Inf. 1g/50ml IV Push: 100mg/ml( undiluted) Gluco.: IV Inf. 1g/20 ml-50 ml 2 gm/100 ml(20-50 mg/ml) IV Push: 100mg/ml undiluted) IV Inf. : 1g/50ml (20 mg/ml) IV Push: 100 mg- 200 mg/ml K PO : IV Inf. 15-30 mMol/ in 100 ml over 2 - 6hr Na PO: 0. 15-0.6mMol/mL in 100-250 ml of D5W or NS (same dilution as a source of Phosphate) 20 mEq /100 ml Continuous I.V infusion: 15 mg/mL (0.18 mEq/mL) 150 mEq/1000 mL I.V Push (for cardiac arrest) 1 mEq/mL (undiluted) ≥3% solution) central line only Maximum rate: 0.5 to meq /L/hr 100 ml/hr (3-5 % solution) Infusion rate Chloride :45-90mg/kg/hr IV Push:50-100 mg/min Gluco.: 100 - 150 mg/min IV Inf. : over 30 min IV Push: 150 mg /min K PO : IV Inf.2 -6hr Na PO: 4 -6hr PL = 10 mEq/hr CL = 20 mEq/hr Continuous I.V infusion : 2-4 mEq /kg over 4-8 hrs. I.V Push (for cardiac arrest) 50 ml over 5-10 min. Maximum rate Chloride : 90mg/kg/hr IV Push: 100mg/min Gluco.: 200mg/min IV Inf. : 2 gm/hr IV Push: 150 mg /min: K PO: IV Inf. 15mmol/hr Na PO: 15 mMol/hr PL = 10 mEq/hr CL = 40 mEq/hr Maximum concentration Chloride :20 mg/ml IV Push: 100 mg/ml Gluco.: .: IV Inf. 50 mg/ml IV Push: 100mg/ml(intermittent) IV Inf. : 200 mg/ml IV Push: 200 mg/ml K PO: IV Inf CL : 26.8 mMl/100 ml 15 mMol/ in 100 ml Na PO: -- PL = 10 mEq/100 ml CL=40 mEq / 100 ml 1-Adult Electrolyte Infusion Guidelines – ICU:
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 3 II. Antimicrobial Drugs: IMPORTANT This guide is an aide memoire only, and should not replace your professional requirement to use manufactuer’s licensed information To inform your preparation and administration of medication. contact the hospital pharmacy for advice on any aspect of iv drugs. PREPARING A DOSE FROM A POWDER VIAL • If the dose to be given is the same as the vial dose, then unless otherwise indicated in the product leaflet, add the precise volume of correct diluent as stated, then draw up the entire vial contents once it is fully dissolved. Always dilute further if directed. • FRACTIONAL DOSES • If a fractional dose is to be taken from a powder vial, make up the solution by adding the precise volume of diluent as stated, then calculate the volume to draw out from the vial as follows: e.g. giving a 1000mg dose of benzylpenicillin from a 1.2g vial, 1000/1200 x (8+0.8) = 7.3ml. Therefore 8ml added to 1.2g vial and draw up 7.3ml, then dilute further to around 20ml (use at least 1000/1200 x 20 = 17ml) = 1000mg COMPATIBILITY Always administer each drug separately (but Metronidazole bags are compatible with Cefuroxime or Cefotaxime). ALWAYS FLUSH BEFORE, AFTER AND BETWEEN DRUGS. SINGLE-USE: Always use a freshly-prepared solution immediately, and use each vial ONCE ONLY, unless the vial specifically states that it is a multi-dose vial.
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 4 TABLE FOR PREPARATION AND ADMINISTRATION OF IV MEDICATION: Medication generic name Typical Adult dose and dose interval (assumes no renal/hepatic impairment) Displacement volume (to be taken into account for fractional doses) Suitable diluents for initial reconstitution of powder Suitable volume for diluting powder/final volume for bolus administration Speed of bolus injection (bolus often preferred if possible) Suitable fluid and volume for infusion Speed of infusion Stability Acyclovir 5-10mg/kg EVERY 8 HOURS 25 mg/ml NaCl 0.9% 10ml per 250mg then must dilute to at least 5mg/ml NOT FOR BOLUS ADMININSTRATIN 500mg/100ml NaCl 0.9% 60 minutes see IV medication stability Attachment Benzyl penicillin 600mg-3g (or can be higher) EVERY 4-6 HOURS 0.4ml/600mg Draw up entire vial contents for full dose WFI or NaCl 0.9% 4ml per 600mg DOSES >1.2g MUST BE GIVEN BY INFUSION At least 2 minutes per 600mg. Preferred 10ml per 600mg given over 5-10 minutes Doses over 1.2g must be infused NaCl 0.9% 50- 100ml 30-60 minutes Cefotaxime 1g EVERY 12 HOURS (though can be up to 12g daily in 3-4 doses) 0.5ml/1g vial Draw up entire vial contents for full dose WFI solution is strawcoloured (okay to reconstitute with Mini bagPlus) 1g vial– 4ml 2g vial– 10ml 3-5 minutes Acceptable, but bolus preferred
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 5 Medication generic name Typical Adult dose and dose interval (assumes no renal/hepatic impairment) Displacement volume (to be taken into account for fractional doses) Suitable diluents for initial reconstitution of powder Suitable volume for diluting powder/final volume for bolus administration Speed of bolus injection (bolus often preferred if possible) Suitable fluid and volume for infusion Speed of infusion Stability Ceftazidime (see leaflet for specific reconstitution guidance) 1g EVERY 8 HOURS or 2g EVERY 12 HOURS but can be up to 6g/day 0.55ml/500mg WFI or NaCl 0.9% 5ml/500mg 10ml/1- 2g 15ml/3g 3-5 minutes NaCl 0.9% 50- 100ml 20-60 minutes see IV medication stability Attachment Ceftriaxone (1g bolus ONLY) 1g EVERY 24 HOURS 0.5ml/1g WFI 10ml 2-4 minutes n/a n/a Ceftriaxone (2g infusion ONLY) 2g EVERY 24 HOURS 1.03ml/2g NaCl 0.9% 40ml - ALWAYS READ LEAFLET AS MAY VARY BY BRAND NOT FOR BOLUS ADMINISTRATION 40ml NaCl 0.9% added to vial and administer from vial via giving set 2g to be given over 30 minutes Cefuroxime 750mg-1.5g EVERY 8 HOURS (or can be inc to 6- hourly) 0.54ml/750mg WFI 6ml/750mg 15ml/1.5g 3-5 minutes NaCl 0.9% 50- 100ml 30 minutes Clarithromycin 500mg EVERY 12 HOURS reconstituted solution = 50mg/ml WFI 10ml/500mg then must dilute NOT FOR BOLUS ADMINISTRATION NaCl 0.9% 250ml 60 minutes Clindamycin Can be up to 3g divided into 2-4 doses daily n/a NOT FOR BOLUS ADMINISTRATION NaCl 0.9% Must not be more than 18mg/ml, e.g. 600mg in 50ml Minimum 10 minutes for every 300mg
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 6 Medication generic name Typical Adult dose and dose interval (assumes no renal/hepatic impairment) Displacement volume (to be taken into account for fractional doses) Suitable diluent for initial reconstitution of powder Suitable volume for diluting powder/final volume for bolus administration Speed of bolus injection (bolus often preferred if possible) Suitable fluid and volume for infusion Speed of infusion Stability Co-Amoxiclav (contains a penicillin) 1.2g EVERY EIGHT HOURS (can be increased to every 6 hours 0.5ml/600mg WFI 10ml per 600mg 3-4 minutes NaCl 0.9% 50ml per 600mg 30-40 minutes see IV medication stability Attachment Flucloxacillin 250mg-1g EVERY 6 HOURS (can be up to 2g every 6 hours) 0.2ml/250mg WFI 5ml per 250mg Bolus = 3-5 minutes (Doses of 2g must be given by infusion) (Doses of 2g must be infused) NaCl 0.9% 50- 100ml 20-60 minutes Gentamicin 3-4mg/kg daily in 8- hourly doses OR 5mg/kg EVERY 24 HOURS 3-5 minutes NaCl 0.9% Not more than 100ml No longer than 20 minutes Meropenem 500mg-1g EVERY 8 HOURS 0.4ml/500mg WFI 10ml per 500mg 5 minutes NaCl 0.9% 50- 200ml 15-30 minutes MethylPrednisolone Short courses of high dose (1g daily for 3 days) used for MS negligible add all of diluent ampoule Only doses up to 250mg suitable for bolus up to 250mg 5 minutes over 250mg NaCl 0.9% 100ml 30 minutes Metronidazole 500mg EVERY 8 HOURS n/a Ready-mixed n/a NOT FOR BOLUS ADMINISTRATION Ready-mixed 20 minutes Medication generic name Typical Adult dose and dose interval (assumes no renal/hepatic impairment) Displacement volume (to be taken into account for fractional doses) Suitable diluents for initial reconstitution of powder Suitable volume for diluting powder/final volume for bolus administration Speed of bolus injection (bolus often preferred if possible) Suitable fluid and volume for infusion Speed of infusion Stability
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 7 Piperacilli/ Tazobactm (Contains A Penicillin) 4.5g EVERY 8 HOURS 0.7ml/1g (3.15ml/4.5g) WFI or NaCl 0.9% 20ml per 4.5g vial NOT FOR BOLUS ADMINISTRATION NaCl 0.9% 50- 100ml 30 minutes see IV medication stability Attachment Tigecycline Maintenance dose 50mg (see SPC for first dose) Add 5.3ml of diluent to create a concentration of 10mg/ml NaCl 0.9% 5.3ml per 50mg then draw up 5ml and add to bag NOT FOR BOLUS ADMINISTRATION NaCl 0.9% 100ml 30-60 minutes Vancomycin 500mg EVERY 6 HOURS or 1g EVERY 12 HOURS Draw up entire vial contents for full dose WFI 20ml per 1g then dilute further NOT FOR BOLUS ADMINISTRATION NaCl 0.9% not more than 5mg/ml e.g. give 1g in 250ml Give over not less than 60 minutes and at least 10mg per minute, e.g. give 1g over 2hours
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 8 III. Crash Cart Drug Dilution DRUG DILUENT VOLUMEANDDOSAGE GUIDELINES ADULTS PEDIATRICS INFANTS ADENOSINE 6 mg/2 ml 100mcg/kg/dose 6mg, then 12mg IV / 2 second (max 12mg/dose) 0.1 mg/kg, 0.2mg/kg IV/ 2 second 0.05 mg/kg, 0.1 mg/kg IV/ 2 second UNDILUTED UNDILUTED UNDILUTED ADRENALINE 1:10,000 0.01mg/kg/dose 1 mg Q5min IV 12 mg/h cont. infusion 0.01 mg/kg Q5min IV As peds. 1MG IN 10 ML NS 12 MG IN 50 ML D5W 5 ML NS 12 MG IN 50ML D5W 2 ML NS 12 MG IN 50 ML D5W AMIODARONE 150 mg/ 3ml Compatible with D5W, NS 300 mg I.V. Push, dilute to 20 ml D5W, may repeat 150 mg in 3-5 mins 5 mg/kg (max 300 mg/dose) rapid I.V. bolus or I.O. May repeat to max. 15mg/kg/day No available indication LD IN 20 ML D5W : 150 mg over 10 minutes (15 mg/min). Do not exceed a rate of 30 mg/min MD 4 MG/ ML D5W: 0.5 mg/min or 16.6 mL/hr (0.278 mL/min) of 1.8 mg/mL solution for 18 hours LD IN 10 ML D5W IV Bolus over 10-15 minutes MD 4 MG/ML D5W IV Interment (5-15 mcg/kg/min). NA ATROPINE 1mg/ ml/Syringe 0.6-1mg IV PRN (max 2.4mg) 0.01-0.03 mg/kg/dose IV 0.1 mg /dose (max 0.8 mg) As peds. May be given Undiluted over 1 min But may dilute desired dose in at least 10 mL of NS IN 5 ML NS IN 2 ML NS
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 9 DRUG DILUENT VOLUME AND DOSAGE GUIDELINES ADULTS PEDIATRICS INFANTS D50W 50% 25 g/50 ml 25g IV PRN 0.5 g/kg (1 ml/kg) IV dilute 1:1 0.5 g/kg/(1 ml/kg) IV dilute 1:4 UNDILUTED max: 0.5 gm/kg/min DILUTE 1:1 WITH WATER DILUTE 1:4 WITH WATER DOBUTAMINE 250 mg/5 ml 2.5-20mcg/kg/min 2.5-15 mcg/kg/min As peds. 500 MG IN 100 ML D5W Adjust to fluid requirements of the patient. 500 MG IN 100 ML D5W 500 MG IN 100 ML D5W DOPAMINE 200 mg/5 ml 5-20mcg/kg/min 2-20 mcg/kg/min As peds. 400 MG IN 100 ML NS 400 MG IN 100 ML NS 400 MG IN 100 ML NS FUROSEMIDE 20 mg/2 ml 40mg IV 1 mg/kg/dose As peds. DILUTE IN 10 ML NS May be given undiluted DILUTE IN 5 ML NS DILUTE IN 2 ML NS LIDOCAINE 1% Syringe 1-1.5mg/kg/dose 1-4mg/min IV infusion (0.014 to 0.057 mg/kg/min). Should not exceed 200 to 300 mg/hr As adults As peds. LD UNDILUTED LD UNDILUTED UNDILUTED MGSO410% 2g/20ml 1-2g IV over 2 min 25-50mg/kg IV over 2 min As peds DILUTE IN 10 ML D5W Must be diluted to a concentration of 20% (200 mg/mL) or less for IV administration. D5W or NS are the most common diluents. DILUTE IN 5 ML D5W DILUTE IN 2 ML D5W NITROGLYCERIN 1 mg/ml NORADRENALINE 4MG/4ML 0.1-0.5mcg/kg/min IV infusion 0.1-2mcg/kg/min IV/IO infusion As peds. Must be diluted in 250 to 1,000 mL of D5W or D5NS and given as an infusion. 4 mg (4 mL) in 1 L of diluent equals 4 mcg/mL.3.6 MG IN 100 ML D5 3.6 MG IN 100 ML D5W 3.6 MG IN 100 ML D5W
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 10 DRUG DILUENT VOLUME AND DOSAGE GUIDELINES ADULTS PEDIATRICS INFANTS PROPRANOLOL 0.5 to 1 mg over 1 minute, repeated as needed up to a total dose of 0.1 mg/kg 0.01-0.01 mg/kg/dose 0.01 to 0.1 mg/kg/dose over 10 minutes. Maximum dose is 3 mg 0.01-0.01 mg/kg/dose Maximum dose is 1 mg for infants May be given undiluted Further dilution of each 1 mg in 10 mL D5W or NS DILUTE 1MG/10 ML NS DILUTE 1 MG/10 ML NS Procainamide 1000mg/10ml 1-6mg/min IV infusion Loading dose: 0.2 to 1 Gm (100 mg/mL). 100 mg every 5 minutes or 20 mg every 1 minute may be given as an infusion until arrhythmia is suppressed or 500 mg is administered 20-80mcg/kg/min IV infusion (max 2g/24h) 2 to 5 mg/kg of body weight. Do not exceed 100 mg/dose. Repeat as indicated every 10 to 30 minutes. Maximum dose in 24 hours is 30 mg/kg or 2 Gm. An alternate dose regimen is 2 to 6 mg/kg as a loading dose given over 5 minutes; follow with a maintenance infusion of 20 to 80 mcg/kg/min to control arrhythmias. Supraventricular tachycardia (SVT), atrial flutter, VT with pulse: AHA recommends 15 mg/kg over 30 to 60 minutes. 20-50mcg/kg/min Dilute each 100 mg with 5 to 10 mL of D5W IV injection: Dilute each 100 mg with 5 to 10 mL of D5W. Infusion: Add 1 Gm of procainamide to 50, 250, or 500 mL of D5W. Yields 20 mg/mL, 4 mg/mL, or 2 mg/mL respectively. 20 mg/mL should only be used as a loading dose. 2 and 4 mg/mL dilutions may be used for loading or maintenance based on fluid restrictions Add a calculated loading dose (2 to 5 mg/kg) to a minimum of 10 mL D5W for each 100 mg or fraction thereof. More diluent may be used based on size of child and fluid restriction. SODIUM BICARBONATE 50mmol IV stat & PRN (ABG) 1-2mmol/kg IV PRN As peds. 1 MMOL/ML 0.5 MMOL/ML 0.5 MMOL/ML
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 11 IV. Intravenous Admixture A:
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 12 B:
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 13 Intravenous Medications Stability Attachment
IPP MM-005 (2) Attachment-B Pharmacy Department - Intravenous Preparation Guidelines-2020 14 Intravenous Compatibility Chart