medication administration policy

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Section II

Parenteral Medication Administration Guidelines

This section can be copied and kept for reference at bedside.Click a letter to quickly navigate the list: A B C D E F G H I J K L M N O P Q R S T U V W X Y ZMedication Generic - (Brand) ABCIXimab (Reopro) Antiplatelet IIb/IIIa How Supplied 2mg/ml 5 ml vial IV Push Conc / Rate Yes 2 mg/ml Give bolus over 1 minute SVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time Percutaneous Coronary Intervention: 0.25 mg/Kg bolus followed by 0.125 mcg/Kg/min infusion (up to max 10mcg/min = 7.2 mg) x 12 hours System Standard Concentration: 7.2 mg/ 250 ml NS (28.8 mcg/ml) AcetaZOLAMIDE (Diamox) Diuretic Acetylcysteine, Nacetylcysteine (Acetadote) 500 mg Vial Yes 100 mg/ml at max rate of 250 mg/min. NO IV Push Preferred ** Verify dose to be given. Discard vial after drawing up correct dose. ** May cause thrombophlebitis Caution with use in patients with asthma and/or history of bronchospasm Common adverse effects: rash, urticaria and pruritus Urticaria and pruritus may be treated with antihistamine (i.e. diphenhydramine) with physician order. Precautions / Comments Stability / Storage Limitations / Restrictions

Preprinted order set available Monitor Hgb/Hct, platelets, PT, PTT 6 hours after admin and 24 hrs after administration

Do not shake solution or transport via tube system. Administer in separate IV line 0.22 micron filter must be used in preparation!!

Reconstitute vial with sterile water only.

200 mg/ml 30 ml vial

Antidote acetaminophen overdose

Acetaminophen overdose: (Prescott Trial Protocol) Loading dose: 150 mg/kg IV over 60 minutes Maintenance dose: 50 mg/kg IV over 4 hours x 1 then 100 mg/kg IV over 16 hours Traditional dosing protocol may be used to dose IV rescue Loading Dose: 140mg/kg IV over 60minutes; Maintenance dose: 70mg/kg IV Q4h x 17 doses. N-acetylcysteine should continue until liver function improves!! Pediatric patients: recommended conc is 40 mg/ml to avoid hyponatremia and seizures.

Administer in separate IV line Solution may turn pink/lavender in color still ok to use

Acyclovir (Zovirax) Antiviral

5 mg/ml 10ml and 20 ml vials

NO

Up to 350 mg in 50 ml NS or D5W 351-700 mg in 100ml NS or D5W Infuse doses over at least 60 min. Max conc: 7 mg/ml

Renal tubular damage with infusions 7mg/ml Dose reduction recommended for CrCl < 50 ml/min

Do NOT refrigerate precipitate may form.

Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.

1

Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009

Section IIMedication Generic - (Brand) Adenosine (Adenocard) How Supplied 3 mg/ml 2 ml vial, 3 mg/ml 2 ml and 4 ml syringe IV Push Conc / Rate Yes, 6 mg rapidly over 2 seconds followed with saline flush. May then give 12mg 1-2 min later, followed by another 12 mg 1-2 min later if needed. NO

Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time IV Push Preferred Precautions / Comments Stability / Storage Limitations / Restrictions * See footnote Continuous ECG, BP monitoring recommended during administration

This section can be copied and kept for reference at bedside.

Dyspnea, flushing and heart-block (asystole) not uncommon with rapid resolution as half-life is only 10 seconds Reflex tachycardia may occur if given too slowly

Follow rapid IV push dose with 20 ml NS flush If given into IV line, use closest port to insertion site and follow with NS flush. Elevate extremity

Anti-arrhythmic

Albumin, Human Serum Plasma Expander Allopurinol (Aloprim) Xanthine oxidase inhibitor

5% - 250ml 25% - 50ml bottles

500mg/30 ml Vial

NO

Dose and rate of administration based upon patient condition. Recommended max rate of infusion: 5% at 10 ml/min 25% at 3 ml/min Intermittent Infusion 200-400mg/M/day (Max of 600mg) diluted in 100ml NS/D5W Give over 30 minutes

Administer with IV tubing provided by pharmacy.

Do not mix with other solutions Limited Indication: Hyperuricemia associated with chemotherapy Dose reduction recommended for CrCl < 20 ml/min Very short half-life necessitating continuous infusion administration Common side effects in adults include: flushing, nausea, abd cramps, tachycardia, hypotension, and edema. Monitor respiratory and cardiac status May cause thrombophlebitis recommend central line administration

If diluting 25% albumin, NS is preferred. D5W may be used for limited volumes. DO NOT dilute with sterile water! Stable only 10 hours after dilution at room temp Do NOT refrigerate Reconstitute vial with sterile water only! Further dilute with NS or D5W Stable x 24 hours at room temperature

Alprostadil (PGE1)

500 mcg/ml 1 ml vial

NO

Usual dose range for treatment of pulmonary hypertension: 1-150 nanograms/kg/min System Standard Concentration: 1000 mcg/100 ml NS (10 mcg/ml) System Concentrated Concentration: 2000 mcg/100 ml NS (20 mcg/ml) Max conc: 20 mcg/ml

* See footnote

Vasodilator/ Prostaglandin

Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.

2

Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009

Section IIMedication Generic - (Brand) Alteplase (Activase, TPA, Cathflo) How Supplied 100 mg/ 100 ml (1 mg/ml) vial & 2mg Cathflo vials IV Push Conc / Rate Yes, Up to 15 mg over 2 min. (7.5 mg/min)

Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time MI Greater than 67kg: 15 mg over 2 min, 50 mg over 30min, 35 mg over next 60min. MI - 67kg or Less: 15mg over 2min, followed by 0.75mg/kg over 30min, then 0.5mg/kg over 60min. Total dose not to exceed 100mg. Ischemic stroke: 0.9 mg/Kg up to max 90Kg - Give 10% as bolus over 1min, then remainder over 60min Pulmonary Embolism: 100 mg over 2 hours Peripheral Vascular Thrombolysis: Per Interventional Radiology/Interventional Cardiology. Preprinted order sets available. Catheter Clearing: Metro: Give 0.5 ml of 1 mg/ml alteplase and dwell x 60 min. If still occluded, aspirate alteplase, instill 1 ml of 1 mg/ml alteplase and dwell 60 min. If still occluded, aspirate alteplase, instill 2 ml of 1 mg/ml alteplase and dwell 60 min. When patency is restored, withdraw 5-10 ml and discard then flush with 10 ml NS. If catheter capacity is greater than volume of alteplase, then follow dose with NS to fill catheter volume. If patency is not restored after 2 ml dose, contact physician for further orders.(Metro Nursing Clinical Policy MN-11)

This section can be copied and kept for reference at bedside.Precautions / Comments Stability / Storage Limitations / Restrictions *See footnote for cardiopulmonary indications (i.e.: AMI, PE). Monitoring is at physician discretion for peripheral vascular indications. No restrictions for alteplase use for catheter clearance or administration of low doses per chest tube.

Thrombolytic medication: Monitor for bleeding. Minimize potential risks for bleeding: Establish all IVs prior to therapy. (Minimum of 2 peripheral IVs recommended in addition to thrombolytic infusion site.) Avoid unnecessary arterial/venous punctures, excessive blood sampling, or IM injections for at least 24 hr after d/cd (malnourished patients 48 hr). Apply pressure dressings to all puncture sites.

Reconstitution must be with sterile water. Conc 0.01-1 mg/ml stable 24 hours (if diluent is NS after reconstitution) Avoid shaking reconstituted solution. Do not transport via tube system. Administer via separate IV line.

*HIGH ALERT MEDICATION* Do not confuse with other thrombolytic medicines Thrombolytic

Amikacin (Amikin) Antibiotic/ Aminoglycoside

250 mg/ml 2 ml & 4 ml vials

NO

*Use 2 mg dose initially for hemodialysis catheters and fistulas * Dilute in 100 ml D5W or NS Max conc: 5mg/ml Infuse over 60 minutes

Aminoglycoside dosing and monitoring service available from pharmacy upon physician order. Monitor renal function.

Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication.

3

Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009

Section IIMedication Generic - (Brand) Aminocaproic Acid (Amicar) Hemostatic / Antifibrinolytic How Supplied 250 mg/ml 20 ml Vial IV Push Conc / Rate NO

Parenteral Medication Administration GuidelinesSVP or LVP Standard Diluent Max/Min Concentrations Recommended Infusion Time Intermittent infusion: Typically 1 Gm in 50 ml NS/D5W Infuse over 60 minutes. Continuous infusion: System Standard Concentration: 5 gm/250 ml NS (20 mg/ml) Usual dose range: 1 1.25 Gm/hr Cardiac Surgery: Loading dose: 10 gm/40 mL drawn up in a syringe & administered IV over 20 minutes. Maintenance Drip: 2 gm/hr (40mL/hr) during surgery. (10 gram/40 mL added to 150mL NS; total volume 200 mL). Precautions / Comments Stability / Storage Limitations / Restrictions

This section can be copied and kept for reference at bedside.

Hypotension, bradycardia, arrhythmia with too rapid infusion Recommended max dose: 30 Gm/24 hr

Expiration dating: 7 days refrigerated.

Aminophylline See

TheophyllineAmiodarone (Cordarone) 50 mg/ml 3 ml vial, ampule Yes, V. fib or Pulseless V-tach: Give 300 mg undiluted over 30 seconds. Follow with 20ml NS flush. May give 150 mg after 3 5 min if V.fib/pulseless Vtach persists Bolus: 150 mg / 100ml D5W (PVC) System Standard Conc: 450 mg / 250 ml D5W (Excel Bag) (1.8 mg/ml) System Concentrated conc: 600 mg/88 ml D5W (to

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