CTICU

Medication Administration:

Medication Administration Policy

Medication Administration using EMAR and Barcode Scanning

Intravenous (I.V.) Fluids and Medication Administration

ICU Sedation/ Neuromuscular

BIS and Train of Four

Lexi-Drugs MAR

Orientation Manual

Drug Books

Pharmacy/ Unit Pharmacist

Daily 0900

BID 0900, 1700

TID 0900, 1300 1700

Q6H 0000,06001200, 1800

Q8H 0000, 0800 1600

Q12H 0900, 2100

0000, 1200

AC 0800, 12001700

QHS 2100

Inotrope: +/- FORCE of myocardial contraction

Chronotrope: +/- RATE of myocardial contraction

Vasoactive: causes either vaso-constriction or dilation

Antiarrhythmics: restores normal rhythm and conduction, prevents harmful or lethal arrhythmias.

Paralytic: prevents skeletal muscle contraction

Sedative: calms nervous excitement

Agonist: Stimulates response

Antagonist: Inhibits response

Wean: to decrease a medication within ordered parameters; MAY NOT go back up

Titrate: to increase/decrease a medication to meet an ordered parameter

• Alpha 1: Vasoconstriction

• Alpha 2: Vasodilitation & Decreased chronotrope

• Beta 1: Positive inotrope & Positive chronotrope

• Beta 2: Vasodilitation & Bronchodilation

INOTROPES

800mg/ 250ml D5W

Typical dose: 1-5mcg/kg/min

Increases HR, CO, BP & Renal Perfusion

Action determined by dose

ADR: Dysrhythmias, Tachycardia, Angina, HTN

Administer via central line

DO NOT TITRATE!!

1gm/250ml D5W

Typical dose 2.5-20 mcg/kg/min

Beta 1 agonist

Increases HR & CO

ADR: Tachycardia, Dysrhythmias, Hypo &/or HTN, Headache

Administer via central line

DO NOT TITRATE!!

20mg/100ml D5W

Typical dose: 0.125-0.75 mcg/kg/min

Increases CO & Decreases pulmonary artery pressures

Phosphodiesterase inhibitor, systemic & pulmonary

vasodilator

ADR: Hypotension, Dysrhythmias

Caution in patients with renal dysfunction

Administer via central line (preferred)

DO NOT TITRATE!!

8mg/250ml NS

Typical dose: 0.01-0.06 mcg/kg/min

Increases CO, HR & BP

Beta agonist (alpha agonist at higher doses)

Adverse SE: dysrhythmias, tachycardia, HTN, hyperglycemia,

hypokalemia, decreased peripheral perfusion at higher doses

Administer via central line only

WEAN BY PROVIDER ORDER ONLY!!!

DO NOT TITRATE!!

VASOPRESSORS

16mg/250ml NS

Typical dose 0.05-0.4 mcg/kg/min

Increase BP & Increase Cardiac Contractility(titrate 0.01 mcg/kg/min every 5 min)

Alpha 1 and Beta 1 Agonist

ADR: vasoconstriction, dysrhythmias

Administer via central line only

50 units/50ml NS

Typical dose 0.02-0.04 units/min

Vasoconstrictor, Synthetic form of ADH

ADR: Coronary and mesenteric vasoconstriction, decreased

UOP

Central line preferred

• 80mg/250ml NS

• Typical dose 0.5-10 mcg/kg/min

• (titrate 0.25-0.5 mcg/kg/min every 5 min)

• Alpha 1 agonist

• Adverse SE: HTN, Reflex bradycardia, Decreased UOP

• Administer via central line

VASODILATORS

• 40mg/200ml (premixed)

• Typical Dose 5-15 mg/hr (max of 20 mg/hr)

• Decrease BP and SVR, used in preop aortic surgeries(titrate 2.5-5 mg every 10-15 min)

• Arterial dilator

• Adverse SE: hypotension, Headache, tachycardia ,Nausea &

Vomiting, Phlebitis

• Administer via central or peripheral line

• 100mg/250ml (pre-mixed)

• Typical dose 10-200 mcg/min

(titrate 10 mcg every 5 min)

• Vasodilator

• Decrease BP and myocardial oxygen demand, prevent

arterial vasospasm, decreases preload, dilates coronaries

• Adverse SE: hypotension, Headache, Nausea

• Administer via central or peripheral line

• 25mg/50ml bottle

• Decreases MAP, SVR, and PVR

• Minimal negative inotropic effect

• Dosing: 1-2mg/hr initially. **Immediate Onset**

• Titration: Double dose every 90 seconds to achieve MAP

goal. Usual dose 4-8 mg/hr. Max dose 32 mg/hr

• SE: Headache, hypotension, reflex tachycardia, N/V

• Run Alone and Change Tubing every 12H- Lipid based

Calcium Channel Blocker

ANTIARRHYTHMICS

• Increases refractory time, *monitor for QT prolongation

• Bolus: 150mg over 10-15 minutes

• Gtt: 900mg/500ml D5W

(1mg/min for 6 hours then 0.5mg/min for 18 hours)

• SE: Bradycardia, Heart Block, Hypotension, Pulmonary

Fibrosis, Dysrhythmias

• Monitor thyroid and LFTs in long term use

• IV infusion, oral route

• Infusion: 2gm/500ml D5W

• IV bolus 1gm

• Typical dose 1-5mg/min

• Used to control VT, VF

• SE: Hypotension, Heart Block, Neurotoxicity, Monitor

Lidocaine Levels

• IV bolus or IV infusion

ANALGESICS, SEDATIVES & PARALYTICS

• 200 mg/ 100 ml NS

• Paralytic, Neuromuscular blockade

• Acetylcholine Antagonist

• Immediate onset, 25 min half life

• ENSURE ADEQUATE SEDATION & ANALGESIA, monitor

TOF hourly, ensure eye lubrication & proper pressure ulcer

prophylaxis.

• 400 mcg/ 100 ml NS

• Typical dose: 0.1- 1 mcg/kg/min

• Titrate by 0.1 mcg q 15 min

• Sedative, ETOH/ Benzodiazipine withdrawal

• Alpha 2 agonist, Anxiolytic & Analgesic

• 2 hour half life

• SE: Hypotension & Bradycardia

• Patient will remain arousable, No respiratory depression

• 50 mcg/ 1 mL PCA

• Analgesic

• Potent Opiate Agonist

• Immediate onset

• SE: Respiratory depression, constipation, nausea & vomiting,

itching

• Tolerance develops over time

• 1000mg/ 100mL

• Sedative

• Increases GABA receptor strength

• Typical dose: 10-60mcg/kg/min Immediate onset; 30-60

minute half life

• SE: Respiratory depression, Hypotension, Nausea &

Vomiting, Bradycardia, Infection

• Airway Protection Required!!!!

ANTICOAGULATION

• 25000 units/ 250 mL

• Used for DVT &PE prophylaxis, Thromboprophylaxis in

Cardiac and Thoracic Sx.

• Dosage : r/t to ptt goal for patient

• Contraindications: Uncontrollable bleeding,

thrombocytopenia or hx of HIT, hypersensitivity to heparin

or pork.

• SE: Bleeding, False LFT results

• Only anticoagulant with a antidote

• 50 mg/ 5mL

• Dose: 1.5mg per 100 units of Heparin

• Neutralizes Heparin

• Forms inactive salt when in contact with Heparin

• Immediate onset; 2 hour half life

• SE: Bleeding, Pulmonary Edema, Hypotension

Follow the 8 RIGHTS of Medication Administration

Patient, Medicine, Time, Dose, Route, Response, Reason, Documentation

If you don’t know a medication….LOOK IT UP!

Check compatibility of medications infusing together.

Use aseptic technique…scrub the hub for 15 seconds.

Flush lines before and after administration of IV medications.

Never flush lines that have continuous IV medications infusing.

Pharmacy mixed bags are good for 96 hr when spiked; Nurse mixed bags are good for 24H; Bags from outside vendors are good for 96H.

IV tubing for intermittent infusions are good for 24H; continuous Infusions for 96H; lipid based infusions for 12H.

Cap changes are q96H unless it is a lipid based infusion which is q12h. Be sure to wear a mask during cap changes.

Time, date and initial your lines.

Link your IV medications to a line.

Document your volumes appropriately in the I/O’s.

PERFORM DRIP CHECKS with every handoff and when hanging new bags.