Kentucky Children’s Hospital

Progressive Care Unit (PCU) Nurse’s Guide

Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Alprostadil Prostaglandin 0.01-0.4 mcg/kg/min 20 mcg/ml Apnea occurs in 10- Monitoring Parameters:
12% of neonates, Arterial pressure, respiratory
usually within the rate, heart rate, temperature,
first hour of therapy. pO2, monitor for gastric
Infusion rate should obstruction in pts on drip > 120
be slowed if fever or hrs
hypotension Adverse Effects:
develops. Hypotension, flushing,
Once therapeutic bradycardia, tachycardia, fever,
response is attained, cortical proliferation of long
gradually decrease bones, respiratory depression,
infusion rate to apnea
lowest effective
dose
Aminocaproic Antifibrinolytic; Intermittent dose: 30g/day 20mg/mL Single doses over Do not administer Monitoring Parameters:
acid Hemostatic agent 50-100mg/kg/dose every 6 or at least 15-60 undiluted drug. Serum CK, fibrinogen
hours 18g/m2/day minutes concentrations, BMP

Continuous Infusion: Adverse Effects:

33.3 mg/kg/hr (1g/m2/hr) Hypotension, bradycardia,
arrhythmia with rapid IV
infusion
Aminophylline Antiasthmatic, Loading dose: 900 mg/day 25 mg/ml Bolus: 0.36 Do not extravasate. Monitoring Parameters:
bronchodilator, 5.7 mg/kg (unless levels mg/kg/min (not to Do not administer Respiratory rate, heart rate,
respiratory dictate higher) exceed 25 IM serum theophyline levels,
stimulant, Continuous infusion: mg/min) arterial or capillary blood gases
theophyline 6 wks-1 year: 0.3-0.8 mg/kg/hr Monitor (if applicable); number and
derivative (age dependent) theophylline levels severity of apnea spells (apnea
1-9 yrs: 1 mg/kg/hr of prematurity)
9-12 yrs: 0.9 mg/kg/hr Asthma levels: 5- Adverse Effects: may cause
> 12 yrs: 0.63 mg/kg/hr 15mcg/ml dysrhythmias; GI upset, GE
reflux, diarrhea, n/v, abd pain,
Dosage should be adjusted to Neonatal apnea: 6- nervousness, agitation,
serum level measurements 12 mcg/ml dizziness, muscle cramp,
during the first 12-24 hrs tremor, tachycardia, PVC,
seizure

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Argatroban Anticoagulant Initial: 0.75 mcg/kg/min; titrate 1 mg/mL Do not mix with Monitoring Parameters:
0.1 – 0.25 mcg/kg/min per other medications aPTT, CBC, s/s bleeding
aPTT levels Adverse Effects: bleeding,
chest pain, dyspnea,
tachycardia, hypotension, fever
Arginine Urea Cycle UCD: 200-600 mg/kg load over 100 mg/mL 1 g/kg/hr (up to 60 Central line Monitoring Parameters:
Disorder (UCD) 90 minutes, followed by 8 g/hr) recommended Blood gas, BMP, ammonia and
treatment; mg/kg/hr Do not extravasate amino acid
Metabolic Adverse Effects: hypotension,
Alkalosis Alkalosis: flushing, hyperkalemia, GI
treatment 0.5 x [HCO3 – 24] x weight (kg) upset
Bumetanide Loop diuretic Initial dose: Maximum of 0.25 mg/mL IVP over 1-2 1 mg bumetanide Monitoring Parameters:
0.01 – 0.1 mg/kg/dose 10mg/day minutes approximately serum potassium, serum
equivalent to 40 mg sodium, blood pressure, blood
Continuous infusion: furosemide glucose, hepatic and renal
Initial dose of 5 mcg/kg/hr and function.
titrate to clinical effect to Adverse Effects: anorexia,
maximum of 200 mcg/kg/hr constipation, cramping,
diarrhea, blurred vision,
or dizziness, parathesias, vertigo,
muscle spasms, purpura,
Adult-sized patients: 0.9-1mg/hr photosensitivity, pruritus,
urticaria, rash

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Calcium chloride Antidote for (Dose expressed in mg of 2 grams per IVP: 100 mg/mL IV push: Infusion through Monitoring Parameters:
hydrofluoric calcium chloride): dose 50-100 mg/min central line Heart rate, ECG during IV
acid, electrolyte Cardiac arrest in presence of IV infusion: 10-20 preferred- avoid administration, serum calcium,
supplement hyperkalemia or hypocalcemia: mg/mL IV infusion: 45- infusion into small phosphate, magnesium.
20 mg/kg; may repeat in 10 min 90 mg/kg over 1 veins in dorsum of Adverse Effects:
if necessary hour. hand or foot and Metallic taste, cardiac arrest
Hypocalcemia: 10-20 (0.6-1.2 mEq/kg scalp veins because (with rapid IV injection),
mg/kg/dose repeated Q4-6H if over 1 hour). of risk of hyperkalemia, hypertension,
needed extravasation. hypomagnesemia,
Hypocalcemia secondary to Infusion should be hypophosphatemia, milk-alkali
citrated blood transfusion: give stopped if patient syndrome, vasodilation,
0.45meq elemental calcium for complains of arrhythmias
each 100ml citrated blood discomfort.
transfused Must flush well
Tetany: 10mg/kg over 5-10 between sodium
min; may repeat after 6-8 hours bicarbonate to
or follow with an infusion with prevent
a max dose of 200 mg/kg/day precipitation.
Do not infuse with
phosphate
containing solutions

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Calcium Antidote for (Dose expressed in mg of 3g per dose 100 mg/mL IVP 10-20 seconds Infusion through Monitoring Parameters:
gluconate hydrofluoric calcium gluconate): 50 mg/mL central line Heart rate, ECG during IV
acid, electrolyte Cardiac arrest in presence of infusion preferred. Infusion administration, serum calcium,
supplement hyperkalemia or hypocalcemia: should be stopped if phosphate, magnesium.
60-100 mg/kg; may repeat in 10 patient complains of Adverse Effects:
min if necessary discomfort. Metallic taste, cardiac arrest
Hypocalcemia: 50-100 Must flush well (with rapid IV injection),
mg/kg/dose repeated Q4-6H if between sodium hyperkalemia, hypertension,
needed bicarbonate to hypomagnesemia,
Hypocalcemia secondary to prevent hypophosphatemia, milk-alkali
citrated blood transfusion: give precipitation. syndrome, vasodilation,
0.45meq elemental calcium for Do not infuse with arrhythmias
each 100ml citrated blood phosphate
transfused containing solutions
Tetany: 100-200 mg/kg over 5-
10 min; may repeat after 6 hours
or follow with an infusion with
a max dose of 500 mg/kg/day

Dobutamine Adrenergic Dose: 2-20 mcg/kg/min; titrate 40 8000 mcg/ml Correct Monitoring Parameters:
agonist 2 – 2.5 mcg/kg/min every 5 mcg/kg/min hypovolemia prior blood pressure, ECG, heart rate,
minutes to desired response. to initiation of electrolytes (potassium),
therapy. cardiac output.
Infiltration causes Adverse Effects: chest pain,
local inflammatory hypertension, HA,
changes or hypokalemia, injection site
extravasation may rxns, arrhythmias, eosinophilic
cause dermal myocarditis
necrosis

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Dopamine/ Adrenergic Initial: 5-10 mcg/kg/min 50 6400 mcg/ml Do not infuse Monitoring Parameters:
Dopastat, Intropin agonist Maintenance: mcg/kg/min through an umbilical EKG, heart rate, CVP, MAP,
2-10 mcg/kg/min; increase 2 – artery catheter. urine output, if pulmonary
2.5 mcg/kg/min every 5 minutes artery catheter is in place
to desired response Extravasation causes monitor CI, PECP, SVR, RAP,
tissue necrosis. PVR
Adverse Effects: anxiety, HA,
injection site rxns, ectopic
heartbeats, widened QRS
complex, ventricular
arrhythmias
Doxapram Respiratory Initial: 2.5-3 mg/kg load 2.5 mg/kg/hr 2 mg/mL Infuse bolus over Do not extravasate Monitoring Parameters:
stimulant Continuous: 1 mg/kg/hr 15-30 minutes Pulse oximetry, ABG, blood
pressure, heart rate, apnea
epidoses (number, duration,
severity)
Adverse Effects: Flushing, GI
upset, hypertension, pruritis
Fentanyl citrate/ Analgesic, Dose: 0.5-4 mcg/kg followed 50-100 50 mcg/ml IVP over 3-5 Chest wall rigidity Monitoring Parameters:
Sublimaze narcotic, general by continuous infusion of 1-5 mcg/kg/dose minutes related to high doses Respiratory rate, blood
anesthetic, mcg/kg/hr until desired effect for anesthesia (>5mcg/kg, slow and rapid escalation pressure, heart rate, O2
opioid IVP 5-10 minutes) to moderate doses- saturations, bowel sounds,
may be reversed abdominal distention.
with naloxone Adverse Effects: asthenia,
confusion, urinary retention,
arrhythmias, chest pain, apnea,
circulatory depression,
tachyphylaxis

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Furosemide Antihypertensive Edema initial, 1 mg/kg/dose; up 200 mg 10 mg/ml 0.5 mg/kg/min Transient and Monitoring Parameters:
diuretic to 2 mg/kg/dose every 6 hours (not to exceed 4 permanent serum potassium, serum
mg/min) ototoxicity has been sodium, blood pressure, blood
Continuous infusion: initial associated with glucose, hepatic and renal
0.05-0.1 mg/kg/hour; titrate administration rates function.
dosage to clinical effect up to > 4 mg/min or 0.5 Adverse Effects: anorexia,
0.4 mg/kg/hr mg/kg/min constipation, cramping,
diarrhea, blurred vision,
dizziness, parathesias, vertigo,
muscle spasms, purpura,
photosensitivity, pruritus,
urticaria, rash
Heparin Anticoagulant Neonates and children < 1 yr: 100 mg/mL Adjust per Pediatric Monitoring Parameters:
loading dose = 75 units/kg over Heparin Protocol APTT, platelet count, signs of
10 minutes with initial drip at bleeding, hemoglobin,
28 units/kg/hr; adjust to APTT hematocrit
Adverse Effects:
Children > 1 yr: loading dose = Hemorrhage,
75 units/kg with initial drip at thrombocytopenia, fever,
20 units/kg/hr; adjust APTT headache, chills, n/v, elevated
liver enzymes
Insulin, Regular Antidiabetic Diabetic ketoacidosis: 0.1 100 units/ml Optimal rate of Monitoring Parameters:
agent unit/kg/hour (range: 0.05-0.2 decrease is 80-100 Urine sugar and acetone, blood
unit/kg/hour depending upon mg/dl/hour sugar, serum electrolytes,
rate of decrease in serum (decreasing serum hemoglobin A1C
glucose) glucose too rapidly Adverse Effects:
may lead to cerebral Palpitations, tachycardia,
edema) fatigue, hypoglycemia,
hypokalemia
Only Regular
Insulin can be given
intravenously

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Magnesium Electrolyte Hypomagnesium: 2000 mg 200 mg/mL Monitoring Parameters:
sulfate supplement Neonates: Serum magnesium, deep tendon
25-50 mg/kg/dose (0.2-0.4 reflexes, respiratory rate
meq/kg/dose) Q8-12H Adverse Effects:
Children: Hypotension, diarrhea,
25-50 mg/kg/dose (0.2-0.4 hypermagnesia, abdominal
meq/kg/dose) Q4-6H cramps, gas formation, muscle
weakness
Management of seizures and
hypertension: Adverse effects are related to
20-100 mg/kg/dose Q4-6H serum concentration:
>3 mg/dl: depressed CNS,
Treatment of Torsades de blocked peripheral
Pointes VT: neuromuscular transmission
25-50 mg/kg/dose (not to leading to anticonvulsant
exceed 2gm/dose) effects
>5 mg/dl: depressed deep
Bronchodilation (asthma): tendon reflexes, flushing,
25 mg/kg/dose (max 2gm) as a somnolence
single dose; 30-70 mg/kg over >12 mg/dl: respiratory
20 minutes has been given paralysis, complete heart block

Milrinone/ Phosphodiesterase Dose: 0.2 -1 mcg/kg/min Max dose in 400 mcg/ml Furosemide is Monitoring Parameters:
Primacor enzyme inhibitor adults is 1.13 incompatible with Blood pressure, heart rate,
mg/kg/day milrinone cardiac output, CI, SVR, PVR,
(not CVP, EKG, platelet count,
established in serum potassium, renal
children) function, clinical signs and
symptoms of CHF
Adverse effects: ventricular
arrhythmias, chest pain, HA

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Morphine Analgesic Dose: 0.05-0.2 mg/kg/dose q2- Suggested: 5 mg/ml 5 minutes Hypotension and Monitoring Parameters:
narcotic, opioid 4h prn Infant: 2 mg chest wall rigidity respiratory and cardio status, O2
1-6 yo: 4 mg may occur with saturation, pain relief, level of
Continuous infusion: 10-500 7-12 yo: 8 mg rapid administration sedation
mcg/kg/hour >12 yo: 10mg Adverse Effects: hypotension,
Respiratory pruritis, vomiting, constipation,
depression is somnolence, dizziness,
reversible with respiratory depression. Use
naloxone with caution and at lower doses
in infants and neonates less than
3 months because they are more
susceptible to respiratory
depression. Abrupt dc may
cause withdrawal.
Naloxone Antidote for Opiate intoxification: 2 mg Injection: 1 Naloxone has been Monitoring Parameters:
narcotic agonists 0.01 - 0.1 mg/kg, repeat every mg/mL used to increase Respiratory rate, heart rate,
2-3 min if needed blood pressure in pts blood pressure
If continuous infusion is Continuous with septic shock Adverse Effects:
required, calculate the initial Infusion: 4 Hypertension, hypotension,
dosage/hour based on the mcg/mL tachycardia, ventricular
effective intermittent dose used arrhythmias, nausea, vomiting,
and duration of adequate increased diaphoresis
response seen; titrate dose; a
range of 2.5-160mcg/kg/hr has
been reported.
Narcotic induced pruritis: initial
2 mcg/kg/hour; may increase by
0.5 mcg/kg/hour every few
hours if pruritis continues

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Octreotide Antisecretory Diarrhea: 1 mcg/kg bolus then 10 mcg/mL 15-30 minutes Allow to warm to Monitoring Parameters:
agent, continuous infusion of 1 room temperature Blood sugar, thyroid function
Somatostatin mcg/kg/hour (can use undiluted (IVP over 3 before test, fluid and electrolyte
analog, GI bleed: 1-2 mcg/kg bolus in emergent minutes in administration balance
antidiarrheal then continuous infusion of 1-2 situations) emergent Adverse Effects:
mcg/kg/hour situations) Hyperglycemia, nausea,
Chylothorax: 0.3 - 10 hypoglycemia, diarrhea,
mcg/kg/hour hypothyroidism, Abdominal
Titrate to response discomfort, Constipation,
Flatulence, Pancreatitis,
dizziness, headache
Pantoprazole Proton pump 1 mg/kg bolus, then 0.1 80 mg 4 mg/mL bolus Over 15 minutes Monitoring Parameters: GI
inhibitor mg/kg/hr 0.8 mg/mL bleeding, s/s GERD
infusion Adverse Effects: HA, GI upset
Potassium Electrolyte 0.25 mEq/kg/dose; repeat as 10 mEq 0.2 mEq/ml 0.25 mEq/kg/hour Maximum Monitoring Parameters:
chloride supplement needed based on lab values (max 10 recommended Serum potassium, glucose,
mEq/hour) concentration for chloride, pH, urine output (if
PIV is 80 mEq/L. indicated)
Maximum Adverse Effects:
recommended hyperkalemia, nausea,
concentration for vomiting, diarrhea, pain at
central line is 150 injection site
mEq/L.
Sodium Alkalinizing 1-2 mEq/kg 50 mEq Child: 1 mEq/mL 10 mEq/minute Do not extravasate Monitoring Parameters:
bicarbonate agent; Infant: 0.5 ABG, BMP
Electrolyte mEq/mL Adverse Effects:
supplement hypernatremia, hypocalcemia,
metabolic alkalosis,

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 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Tacrolimus Immunosuppress 0.01-0.06 mg/kg/day continuous 0.02 mEq/mL Polyvinyl chloride- Monitoring Parameters: Daily
ant infusion free tubing required tacrolimus levels, BMP,
to minimize drug magnesium, LFTs, CBC, blood
absorption. pressure
Adverse Effects: hypertension,
hyperglycemia, hyperkalemia
hypomagensium, tremor,
edema, headache,
nephrotoxicity
Valproic acid Antiepileptic; Status epilepticus: 100 25-50 mg/ml Bolus: 3-6 Maintenance doses Monitoring Parameters:
used for mg/kg/day mg/kg/min should be Monitor for seizure activity,
treatment of loading dose: 20-40 mg/kg determined based on LFT, ammonia, CBC
refractory clinical response and Adverse Effects:
migraines continuous infusion: 1-2 total serum Drowsiness, irritability,
valproate confusion, restlessness,
mg/kg/hour (max of 6
concentrations (50- headache, ataxia,
mg/kg/hour)
100 mg/L) hyperammonemia, nausea,
vomiting, diarrhea, tremor

Page 10 of 11
 Kentucky Children’s Hospital
Progressive Care Unit (PCU) Nurse’s Guide
Intravenous Drip and Intravenous Medication List
– Approved for RN Administration Updated: 11/2013

GENERIC/ THERAPEUTIC TYPICAL CHILD DOSE MAXIMUM MAXIMUM MAXIMUM RATE ADMINISTRATION ADVERSE EFFECTS/COMMENTS
BRAND NAME CATEGORY CHILD DOSE CONCENTRATION OF CONSIDERATIONS MONITORING PARAMETERS
ADMINISTRATION
Vasopressin Antidiuretic Diabetes insipidus: 0.5 1 unit/ml Extravasation may Monitoring Parameters:
hormone analog, milliunits/kg/hour; double cause tissue MAP, fluid intake and output,
hormone dosage as needed every 30 min necrosis. urine specific gravity, urine and
to max of 10 milliunit/kg/hour serum osmolality, serum and
After hemorrhage urine sodium, hemoglobin and
GI hemorrhage: 2 has been controlled hematocrit (GI bleeding)
milliunits/kg/min; titrate 1 for 12 hours, Adverse Effects:
milliunit/kg/min every 20-30 gradually taper Circumoral pallor (with high
minutes to max of 10 dosage over next 24- doses), hypertension,
milliunits/kg/min 48 hours. bradycardia, arrhythmias,
venous thrombosis,
Vasodilatory shock: 0.3 vasoconstriction, distal limb
milliunits/kg/min; titrate 0.1-0.2 ischemia, tremor, wheezing,
bronchoconstriction,
milliunits/kg/min every 20-30
diaphoresis
minutes to max of 2
milliunit/kg/min

 If the medication is not approved for administration and alternative routes of administration are not available, approval for this individual
situation must be obtained through collaboration with pharmacy and the patient care manager

Updated: November 20, 2013

Developed by: Brian Gardner, PharmD, Karen Garlitz, PharmD, BCPS
Approved by: Brian Gardner, PharmD
Contact person for revisions: Brian Gardner ([email protected])

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