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.

SEE ALTEPLASE DOSAGE CHART

Link to AMH

AMIKACIN Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

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

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 4 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

AMPICILLIN Link to AMH

ANIDULAFUNGIN Link to AMH

ATROPINE SULPHATE Link to AMH

AZITHROMYCIN Link to AMH

AZTREONAM Link to AMH

BENZTROPINE

(BENZATROPINE)

Link to AMH

BENZYPENICILLIN (BENZYLPENICILLIN)

Link to AMH

CALCIUM CHLORIDE See Critical Care Electrolytes Policy Link to AMH

CALCIUM FOLINATE Link to AMH

CALCIUM GLUCONATE See Critical Care Electrolyte Policy Link to AMH

CASPOFUNGIN Link to AMH

CEFALOTIN (CEPHALOTHIN) Link to AMH

CEFEPIME Link to AMH

CEFOTAXIME Link to AMH

CEFTAZIDIME Link to AMH

CEFTRIAXONE Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 5 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

CEFAZOLIN (CEPHAZOLIN) Link to AMH

CHLORPROMAZINE Link to AMH

CIPROFLOXACIN Link to AMH

CISATRACURIUM SEE CISATRACURIUM WEIGHT BASED DOSAGE TABLES Link to AMH

CLEVIDIPINE Do not dilute vial (vial = 0.5mg/mL clevidipine)

IV infusion, initially 1–2 mg/hour = 2 - 4mL /hour increase according to response by doubling the dose every 90 seconds, then, as

desired BP is reached, by smaller increments every 5–10 minutes. Maintenance, generally 4–6 mg/hour = 8-12mL/hour

Usual maximum 16 mg/hour. Up to 32 mg/hour has been used in severe hypertension.

Doses >500 mg/24 hours not recommended due to lipid content. Lipid content - 1 mL of clevidipine injection provides 0.2 g of lipid (2 kcal).

Link to AMH Do not use in patients who are allergic to

soybeans, soy products, eggs or egg products

CLINDAMYCIN Link to AMH

CLONAZEPAM Link to AMH

CLONIDINE Link to AMH

COLISTIN Link to AMH

CYCLIZINE Link to AMH

CYCLOSPORIN Link to AMH

DANAPAROID Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 6 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

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 Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 7 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

EPOETIN (ERYTHROPOETIN,EPO)

Link to AMH-Alpha Link to AMH-Beta

ERTAPENEM Link to AMH

ERYTHROMYCIN Link to AMH

ESMOLOL Link to AMH

FENTANYL

INFUSION: preloaded syringes available 1000 micrograms/50mL Shoalhaven ED: Contact pain service or ICU registrar for prescription of PCA

PCA procedure PCA analgesic agents

Link to AMH

FERRIC CARBOXYMALTOSE

Link to AMH

FLECAINIDE For Flecainide Drug Challenge for Brugada Syndrome – see procedure Link to AMH

FLUCLOXACILLIN Link to AMH

FLUCONAZOLE Link to AMH

FLUCYTOSINE Link to AMH

FLUMAZENIL Add 500 micrograms to 100mLs Link to AMH

FOLIC ACID Do not confuse with folinic acid

Link to AMH

FOLINIC ACID (CALCIUM FOLINATE)

Keep refrigerated

Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 8 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

FOSAPREPITANT Link to AMH

FOSCARNET Link to AMH

FUROSEMIDE (FRUSEMIDE) Link to AMH

GANCICLOVIR CYTOTOXIC: Strict handling precautions are required. Check your local guidelines Link to AMH

GENTAMICIN Link to AMH

GLUCAGON Link to AMH

GLUCOSE 50% 50ML

GLYCERYL TRINITRATE

INFUSION: Add 50 mg ampoule to 500mLs non-PVC bag (Freeflex) concentration≈ 100microg/mL).

SEE GLYCERYL TRINITRATE DOSAGE TABLES

Link to AMH

GLYCOPYRROLATE Link to AMH

GRANISETRON Link to AMH

HALOPERIDOL Check product formulation Link to AMH

HEPARIN SODIUM 5000 units in 5mL

Intravenous Heparin policy

Link to AMH

HYDRALAZINE Link to AMH

HYDROCORTISONE Link to AMH

HYDROMORPHONE PCA procedure PCA analgesic agents

Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 9 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

HYDROXYCOBALAMIN Link to AMH

HYOSCINE –N -BUBR Link to AMH

HYOSCINE HYDROBROMIDE

Link to AMH

ILOPROST SAS product - Special Access Scheme drug - paperwork must be completed

Link to AMH

IMIPENUM-CILASTATIN Link to AMH

IMMUNOGLOBULIN Human CMV, Normal IM, Normal IV

Link to AMH

INFIXAMAB (INFLIXIMAB)

Link to AMH

INSULIN NEUTRAL “Actrapid HM” “Novorapid” 100 units/mL

Continuous Subcutaneous Insulin Infusion Guidelines – Shoalhaven Hospital Group only business rule

Add 50 units to 50mL NS. Concentration 1 unit/mL. Titrate to prescribed BGL

Emergency Care Institute: treatment of Diabetic Ketoacidosis (DKA) See Guidelines-for-the-Management-of-adult-patients-with-DKA-in-the-ED April

2017

Link to AMH Refrigerate vials.

.

IRON CARBOXYMALTOSE Same as FERRIC CARBOXYMALTOSE Link to AMH

IRON POLYMALTOSE COMPLEX 100mg/2mL (elemental iron)

Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 10 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

IRON SUCROSE 100mg/5mL

Link to AMH

ISOPRENALINE 200microgram/ml, 1mg/5ml

INFUSION: Add 2mg (10mL) to 100mL of G5% or NS Concentration: 20microgram/mL

SEE ISOPRENALINE DOSAGE TABLE

Link to AMH

KETAMINE 200mg/2ml (Controlled drug) PCA Opioid withdrawal

Ketamine infusion for adult with acute or chronic non malignant pain PCA procedure

PCA analgesic agents Shoalhaven ED: Contact pain service or ICU registrar for prescription of PCA

Link to AMH

KETOROLAC Link to AMH

LABETALOL SAS product - Special Access Scheme Drug SAS paperwork must be completed

Link to AMH

LACOSAMIDE Link to AMH

LENOGRASTIM (rHuG-CSF) Link to AMH

LEVETIRACETAM Link to AMH

LEVOSIMENDAN SAS product - Special Access Scheme Drug SAS paperwork must be completed

Dilute 25 mg (10 mL) to 500 mL with glucose 5% to make a concentration of 50 microgram/mL

SEE LEVOSIMENDAN WEIGHT BASED DOSAGE TABLES

Link to AMH

LIGNOCAINE (LIDOCAINE)

Link to AMH

LINCOMYCIN Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

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.

Higher concentration can be used up to 1mg/mL

Link to AMH

METHYLPREDNISOLONE SODIUM SUCCINATE

Link to AMH

METOCLOPRAMIDE Link to AMH

METOPROLOL Link to AMH

METRONIDAZOLE Link to AMH

MIDAZOLAM 50mg/10mL 5mg in 5mL

Link to AMH

MILRINONE Link to AMH

MIVACURIUM Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 12 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

MORPHINE SULPHATE 10mg/mL 15mg/mL 30mg/mL 50mg/50mL (in safe)

ED: Contact pain service or ICU registrar for prescription of PCA PCA procedure

PCA analgesic agents

Link to AMH

MOXIFLOXACIN Link to AMH

MYCOPHENOLATE Link to AMH

NALOXONE 400microg/mL

50-200microg titrated to clinical effect every 2-3 minutes up to 2mg NaloxoneforOpioidOverdose

Link to AMH

NATALIZUMAB Link to AMH

NEOSTIGMINE Link to AMH

NIMODIPINE 10mg/50mL

Link to AMH

NORADRENALINE ACID TARTRATE (NOREPINEPHRINE) 4mg base in 4mL (1:1000)

INFUSION: Add 4mg to 100ml G5% Concentration: 40microgram/mL

Titrate to clinical effect as per MO order See NORADRENALINE DOSAGE CHART

Link to AMH

OCTREOTIDE Check product formulation Link to AMH

ONDANSETRON Link to AMH

OXYTOCIN Link to AMH

PALONOSETRON Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 13 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

PAMIDRONATE Link to AMH

PANCURONIUM Link to AMH

PANTOPRAZOLE Link to AMH

PARACETAMOL Link to AMH

PARECOXIB Link to AMH

PARENTERAL NUTRITION TPN

PENICILLIN G (BENZLPENICILLIN)

Link to AMH

PENTAMIDINE Link to AMH

PHENOBARBITONE Link to AMH

PHENYLEPHRINE Link to AMH

PHENYTOIN 100mg/2mL; 250mg/5mL

Link to AMH

PHYTOMENADIONE

(VITAMIN K)

Link to AMH

PIPERICILLIN WITH TAZOBACTAM

Link to AMH

POTASSIUM ACETATE See Critical Care Electrolytes Policy

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 14 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

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.

Link to AMH

ROPIVACAINE Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

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

Link to AMH

SOTALOL Link to AMH

SUXAMETHONIUM

Link to AMH

TACROLIMUS Link to AMH

TEICOPLANIN Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 16 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

TENECTEPLASE 50mg vial

SEE TENECTEPLASE WEIGHT AND AGE BASED TABLE High Risk and STEMI Patient Transfer

Link to AMH

TERBUTALINE Link to AMH

TERLIPRESSIN Link to AMH

THIAMINE Link to AMH

THIOPENTONE

SODIUM 500mg ampoule

Link to AMH

TIGECYCLINE Link to AMH

TIROFIBAN 12.5mg/50mL

INFUSION: Add 12.5mg (50mL) to 200ml NS or G5%.(withdraw 50mL from a 250mL bag)

SEE TIROFIBAN WEIGHT BASED DOSAGE TABLES

Link to AMH

TOBRAMYCIN Link to AMH

TPN

TRACE ELEMENTS

TRAMADOL PCA procedure PCA analgesic agents

Link to AMH

TRANEXAMIC ACID Link to AMH

TRIMETHOPRIM WITH SULFAMETHOXAZOLE

Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 17 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

TROPISETRON Link to AMH

URIKINASE SAS scheme

Link to AMH

VALPROATE SODIUM Link to AMH

VANCOMYCIN Link to AMH

VASOPRESSIN

(ARGIPRESSIN)

INFUSION: Add 60 units (3 x 20 unit vials) to 60mL of G5% or NS. = 1unit /mL

SEE VASOPRESSIN WEIGHT BASED TABLE

Link to AMH used as add on therapy in vasodilatory

septic shock – off licence use

VECURONIUM Link to AMH

VERAPAMIL Link to AMH

VITAMINS MULTI CERNEVIT

VITAMIN K Link to AMH

VORICONAZOLE Link to AMH

ZOLENDRONIC ACID Link to AMH

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 18 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 – 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

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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.

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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

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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

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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

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 23 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%

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

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 24 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%

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)

Central infusion rate Concentration of

solution 4.5mg/mL (mL/hour)

50 750 6.9 55 825 7.6 60 900 8.3 65 975 9 70 1050 9.7 75 1125 10.4 80 1200 11.1 85 1200 11.1 90 1200 11.1 95 1200 11.1

100 1200 11.1 110 1200 11.1 120 1200 11.1 125 1200 11.1 130 1200 11.1 140 1200 11.1 150 1200 11.1

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 25 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%

CISATRACURIUM

WEIGHT (kg) CISATRACURIUM Dose Required microg/kg/min

1 1.5 2 2.5 3

Flow Rate mLs/hr for 2mg/mL undiluted vial 50 1.5 2.25 3 3.75 4.5 60 1.8 2.7 3.6 4.5 5.4 70 2.1 3.15 4.2 5.25 6.3 80 2.4 3.6 4.8 6 7.2 90 2.7 4.05 5.4 6.75 8.1

100 3 4.5 6 7.5 9 110 3.3 4.95 6.6 8.25 9.9 120 3.6 5.4 7.2 9 10.8 130 3.9 5.85 7.8 9.75 11.7 140 4.2 6.3 8.4 10.5 12.6 150 4.5 6.75 9 11.25 13.5

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 26 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%

DEXMEDETOMIDINE

INFUSION: Add 200 mcg (2mL) to 48mL (4 mcg/mL) NS

WEIGHT (kg)

DEXMEDETOMIDINE Dose Required microg/kg/hour

0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Flow Rate mLs/hr for 4 microg/mL 40 2 3 4 5 6 7 8 9 10 50 2.5 3.75 5 6.25 7.5 8.75 10 11.25 12.5 60 3 4.5 6 7.5 9 10.5 12 13.5 15 70 3.5 5.25 7 8.75 10.5 12.25 14 15.75 17.5 80 4 6 8 10 12 14 16 18 20 90 4.5 6.75 9 11.25 13.5 15.75 18 20.25 22.5

100 5 7.5 10 12.5 15 17.5 20 22.5 25 110 5.5 8.25 11 13.75 16.5 19.25 22 24.75 27.5 120 6 9 12 15 18 21 24 27 30 130 6.5 9.75 13 16.25 19.5 22.75 26 29.25 32.5 140 7 10.5 14 17.5 21 24.5 28 31.5 35 150 7.5 11.25 15 18.75 22.5 26.25 30 33.75 37.5

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 27 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%

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

WEIGHT (kg) Serum Digoxin Concentration in ng/mL

1 2 4 8 12 16 20

(No. of Vials to be administered)

40 0.5 1 1.5 3 5 6.5 8

60 0.5 1 2.5 5 7 9.5 12

70 1 1.5 3 5.5 8.5 11 14

80 1 1.5 3 6.5 9.5 13 16

90 1 2 3.5 7 11 14.5 18

100 1 2 4 8 12 16 20

110 1 2 4.5 9 13 17.5 22

120 1 2.5 5 9.5 14.5 19 24

130 1.5 2.5 5 10.5 15.5 21 26

140 1.5 3 5.5 11 17 22.5 28

150 1.5 3 6 12 18 24 30

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 28 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%

DOBUTAMINE

INFUSION: Add 500mg (40mL) to 250ml 5% Dextrose. ~ 2mg/mL solution

Titrate to clinical effect as per MO order

DOBUTAMINE Dose required on microg/kg/min

WEIGHT (kg) 2.5 5 7.5 10

DOBUTAMINE Infusion rate (mL/hour) using 2mg/ml solution (500mg/250mL G5%)

30 2.3 4.5 6.8 9

40 3 6 9 12

50 3.8 7.5 11.3 15

60 4.5 9 13.5 18

70 5.3 10.5 15.8 21

80 6 12 18 24

90 6.8 13.5 20.3 27

100 7.5 15 22.5 30

110 8.3 16.5 24.8 33

120 9 18 27 36

130 9.8 19.5 29.3 39

140 10.5 21 31.5 42

150 11.3 22.5 33.8 45

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 29 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%

Glyceryl Trinitrate GTN

INFUSION: Add 50 mg ampoule to 500mLs non-PVC bag (Freeflex) concentration≈ 100microg/mL).

Titrate to clinical effect as per MO order

GLYCERYL TRINITRATE 50mg/500ml INFUSION concentration≈ 100microg/mL

Dose (microg/min)

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Infusion rate (mL/hr)

3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 30 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%

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

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 31 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%

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

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 32 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%

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

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 33 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%

SALBUTAMOL

Add 5mg (5mL) to 500mL NS (concentration≈ 10microg/mL). Initial dose 5microg/min.

SALBUTAMOL DOSAGE

microg/min

(for 5mg in 500mL infusion)

SALBUTAMOL INFUSION RATE:

mL/hr

2.5 15

5 30

10 60

12.5 75

15 90

17.5 105

20 120

Add 5mg to 100mL NS infusion (Concentration ~ 50microg/mL)

SALBUTAMOL DOSAGE

microg/min

(for 5mg in 100mL infusion)

SALBUTAMOL INFUSION RATE:

mL/hr

2.5 3

5 6

10 12

12.5 15

15 18

17.5 21

20 24

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 34 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%

SODIUM NITROPRUSSIDE

INFUSION: Reconstitute vial with 2-3ml glucose 5%. Flask: Add 50mg to 500ml

Concentration: 100microg/ml Administer via peripheral line

Max dose: 500microg/min

SODIUM NITROPRUSSIDE 100microg/mL INFUSION RATE BY WEIGHT PERIPHERAL LINE

WEIGHT (KG) INFUSION RATE (ML/HOUR) 100MICROG/ML PERIPHERAL LINE

0.5mcg/kg/min 1 mcg/kg/min 2 mcg/kg/min 3 mcg/kg/min 5 mcg/kg/min 7 mcg/kg/min 10 mcg/kg/min

40 12 24 48 72 120

Use More

Concentrated Solutions

50 15 30 60 90 150

60 18 36 72 108 70 21 42 84 126

80 24 48 96 144

90 27 54 108 162

100 30 60 120 180

Back to SODIUMNITROPRUSSIDE

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 35 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%

TENECTEPLASE

Tenecteplase weight and age adjusted dose.

PATIENT AGE 18 -74 years 75 years and over

WEIGHT(kg) Dose (mg) Volume(mL) Dose (mg) Volume (mL)

Less than 60 30 6 15 3

60-69 35 7 17.5 3.5

70-79 40 8 20 4

80-89 45 9 22.5 4.5

90kg and above 50 10 25 5

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

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 36 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%

TIROFIBAN

Dose adjustment table by weight –Note – patients with severe renal insufficiency require dose decrease

TIROFIBAN 50 microg/mL INFUSION RATES

WEIGHT(Kg) 30 minute Loading Dose 30 minute Loading Dose Maintenance Dose

Infusion Rate (mL/hr) Volume to be infused (mL) Infusion rate (mL/hr)

30-37 16 8 4

38-45 20 10 5

46-54 24 12 6

55-62 28 14 7

63-70 32 16 8

71-79 36 18 9

80-87 40 20 10

88-95 44 22 11

96-104 48 24 12

105-112 52 26 13

113-120 56 28 14

121-128 60 30 15

129-137 64 32 16

138-145 68 34 17

146-153 72 36 18

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 37 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%

VASOPRESSIN

INFUSION: Add 60 units (3 x 20 unit vials) 57mL of G5% or NS. = 1 unit /mL

VASOPRESSIN 60 UNITS IN 60mLs = 1 unit/mL

Dosage (units/min) Infusion Rate (mL/hr)

0.01 0.6

0.02 1.2

0.03 1.8

0.04 2.4

0.1 6

0.2 12

0.3 18

0.4 24

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ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 38 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%

Revision & Approval History

Date Revision No. Author Approval

July 2017 3

DT17/102995

J Hilditch – Director of Pharmacy

J Theodosiou - Pharmacist SDMH

Approval for publishing granted by Critical Care Medication Guidelines Working Party – 24 July 2018

Next Revision Due June 2019

April 2018 4

Broken Links to AMH have been corrected

J Hilditch – Director of Pharmacy

J Theodosiou - Pharmacist SDMH

M Farrah – Acting Director Pharmacy SDMH

Approval for release – Shanyn King – Co-Director Critical Care Division -

5 April 2018

June 2018 5 J Hilditch – Director of Pharmacy

J Theodosiou - Pharmacist SDMH

M Farrah – Acting Director Pharmacy SDMH

Approval for release –

Shanyn King – Co-Director Critical Care

14 June 2018

Approved ISLHD DTC June 2018

ISLHD Critical Care Division

Critical Care IV Drug Protocols

ISLHD DOC 188 REV: 5 Trim: DT17/142456 June 2018 Page 39 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%