Adult Surgical Critical C are IV Drip R eference S heet

Maintenance/Titration Precautions
Medication Classification Dilution Initial Dose Indication
Dose Contraindication
Alteplase  Side effects: Bleeding, Pulmonary embolism,
10mg/250m NS Maint: 1mg/hr Or 0.5mg/hr for Fat embolism, Angioedema
tPA
(Vasc Surg Fibrinolytic Or
Set Pump to EKOS to get
each bag on dual infusion.  Must be connected to the inner catheter of the
Dual infusion:  Catheter directed thrombolysis sheath for direct clot administration and not the
Only) Agent 5mg/250ml NS
correct dosing parameters
Dosage may be 1/2 or stopped sideport.
2 bags for low Fibrinogen level  Recommend Fibrinogen level Q6h. Goal
Fibrinogen >200

Amiodarone
Load: 150mg in  Has a long half-life; drug interactions may
Cordarone Load: 150mg over 10min  Tx of VT/VF/SVT
persist long after drug is discontinued,
100ml D5W Maint: 1mg/min x 6hrs Then,
– rapid loading infusion  Prophylaxis of frequently
Antiarrhythmic 0.5mg/min x 18hrs. monitor serum levels
Tx & prophylaxis of recurring VF and
VT/VF/SVT Group III Maint: 450mg in
1st Maint: 360mg in
May be continued at this rate for up  Hypotension, Arrhythmias, ARDS, Cardiac
250ml D5W to 2 – 3 weeks. hemodynamically unstable arrest, Cardiogenic shock, CHF, Hepatotoxicity
 Use 0.2 µ filter 200ml 1mg/min 6hr bag VT refractory to other therapy
 Contraindicated in 2nd or 3rd degree block

 Side effects: Bleeding, CVA symptoms, CP,

Argatroban Direct
back pain, SOB
 Heparin induced
 Lower doses required with hepatic
Thrombin 50mg/50ml NS Maint: 0.5 – 1mcg/kg/min thrombocytopenia
impairment.
Inhibitor (HIT)
 Check PTT Q2h until 2 therapeutic, then daily.
Goal PTT 45-90.
Cisatracurium After effectively blocked,
3mcg/kg/min (skeletal
decrease to 1-2mcg/kg/min.
 Relax skeletal muscles during  To be ONLY used on mechanically
Nimbex muscle relaxation) mechanical ventilation,
Neuromuscular 200mg/200ml Monitor TOF twitches with a ventilated pt’s.
* Establish a baseline metabolized by a process that
Blocking agent NS, D5W
TOF prior to initiating
nerve stimulator Q1hr.  Has no analgesic properties.
Dose range: 0.5 – 10mcg/kg/min mostly bypasses the kidney and
this medication. liver.  Side effects: bradycardia, hypotension.
Average dose: 3mcg/kg/min
Clevidipine  Side effects: HA, N/V, tachycardia,
Antihypertensi Maint: 4 -6mg/hr
Cleviprex 25mg in 50ml
May dbl rate Q2min until goal  Hypertension or elevated MAP A-Fib, renal failure, elevated triglycerides
ve Ca Channel 50mg in 100ml 1 – 2 mg/hr
In lipids
achieved  Arterial vasodilating agent.  Obtain baseline Trig. Level, monitor Q48h
Blocker Max: 21mg/hr  Change bag & tubing Q12hrs
Alpha-2
Dexmedetomidine 0.2 Maint: 0.2 – 1.4 mcg/kg/hr
Adrenergic  Consider dose reduction for hepatic or renal
Precedex
Agonist
200mcg/50ml mcg/kg/hr  Sedation for mechanically impairment
NS Do Not Titrate infusion by increments ventilated and non-intubated pt’s
Bolus 0.1mcg/kg/hr Q15min  Bradycardia and Hypotension
Sedative
Diltiazem If no effect in 15min, bolus with  Short term use, Valsalva Maneuver 1st.
125mg(25ml) in
Cardizem Antihypertensive
100ml D5Wor
0.35mg/kg over 2min. Then, start  Temporary control of RVR in  May cause AVB, Hypotension, CHF,
Calcium Channel Bolus: 0.25mg/kg over 2min an infusion of 0.5-10mg/hr for A-Fib, A-Flutter, PSVT, Bradycardia, Flushing.
NS for 1:1
Blocker 24hr. HTN, Angina.  Contraindicated in Sick Sinus Syndrome or
solution
Max dose: 15mg/hr <24hrs AVB, 2nd or 3rd degree HB, AMI
 = Cardiac = Hypotension = Hypertension = ICP = Paralytic = Sedative =
Analgesic ψ = Use Central Line  = Use Micron Filter 1 of 6
Maintenance/Titration Precautions
Medication Classification Dilution Initial Dose Indication
Dose Contraindication
Dopamine Inotropic Premixed: 3mcg/kg/min Maint: 2 – 20mcg/kg/min  Hypotension  Use central line, may cause extravasation/
Intropin Adrenergic 800mg/250ml  Shock necrosis
Agonist D5W Titrate rate Q15min 
 Trauma Correct hypovolemia before starting
Ψ preferred  Septicemia  May cause HTN, Tachycardia, Ectopic beats
 Renal Failure
 CHF
Epinephrine Adrenergic 4 or 16mg in 0.01mcg/kg/min Maint: 0.01 – 1.0mcg/kg/min Side effects are rare: Arrhythmias, V-Fib,
Adrenalin Agonist Cardiac 250lml D5W Bronchospasms Palpitations, HA, N/V, CVA
Stimulant orNS Hypotension
Vasopressor Ψ preferred Bradycardia
Cardiac Arrest
Esmolol Anti-arrhythmic 2.5gm/250ml Load: 500mcg/kg/min Repeat loading dose of Hypotension, Bradycardia, Confusion,
Brevibloc Beta Blocker D5W or NS Over 1min Immediately 500mcg/kg/min after 4min if SVT Lightheadedness.
Group II start an infusion at necessary and increase the A-Fib/Flutter Contraindicated in Heart block, CHF, and
50mcg/kg/min infusion rate incrementally by Tachycardia Cardiogenic shock.
50mcg/kg/min after every bolus. HTN
Maint: 50 – 300mcg/kg/min
Fentanyl Analgesic 2500mcg/250ml Or Bolus: 25mcg Q5min till Maint: 50 – 200mcg/hr Analgesic effect, pain Respiratory depression or apnea, urinary
Sublimaze Opioid 2500mcg/50ml desired effect Call HO for rates >200mcg/hr Retention, N/V
Reversal with Narcan
Bolus: 0.35 – 1.5mcg/kg Maint: 0.5 – 3mcg/kg/hr
Q5min till desired effect

General Anesthetics 1000mg/100ml STICU: No bolus unless Maint STICU: 5mcg/kg/min - Thoracic pain, headaches, spinal Document Mental Status, Pain Scale, & I/S Efforts
Ketamine 2500mg/500ml ordered increase by 2.5mcg/kg/min to pain not responding well to Q1hr.
Ketamine 5000mg/500ml NSICU: 0.25mg/kg bolus MAX 15mcg/kg/min . common pain regimen. Physician must be present if IVP.
Hydrochloride NS
Rib fractures >3. Notify MD if noted decrease in respirations or I/S
Maint NSICU: 2mcg/kg/min – efforts < 500
(Non-Intubated)
increase
q15min by 1mcg/kg/min to MAX
15mcg/kg/min

General Anesthetics 2500mg/500ml NSICU: 1 – 2 mg/kg bolus Maint: Increase as ordered by MD. Suppression of brain irritation or to Document Mental Status Q1hr; Pain Scale Q2hr
Ketamine Or Max: 100mcg/kg/min decrease ICP. Boluses may be administered by nursing with a
Ketamine 5000mg/500ml NS Analgesia for mechanically physician’s order.
Hydrochloride ventilated pt
(Intubated) STICU: Bolus 0.5mg/kg Maint STICU: 5mcg/kg/min -
every 5min 50mcg/kg/min
Increase rate 5mcg/kg/min every 5
min.
 Levothyroxine Synthetic T4 200mcg/500ml Load: 20mcg Bolus Maint: 10mcg/hr  Hypothyroidism  Side Effects: Palpitations, Tachycardia,
Hormone NS  Hormonal resuscitation for Arrhythmias, Hypertension, MI, low UOP.
deceased organ donors.

Maintenance/Titration Precautions
Medication Classification Dilution Initial Dose Indication
Dose Contraindication
Lidocaine Anti-arrhythmic Premixed: Load: 1 – 1.5mg/kg, up to Maint: 1 – 4mg/min  Tx of ventricular  Contraindicated in 1st, 2nd, 3rd degree heart
Xylocaine 2gms/250ml 3mg/kg total Or arrhythmia’s, VT, V-Fib, blocks w/o a pacemaker
D5W 20 – 50 mcg/kg/min WPSVT  Bradycardia, hypotension, wide QRS,
blurred vision, seizure
 Use cautiously in hepatic failure
Lorazepam Sedative hypnotic 12mg/60ml Sedation: Sedation:  Anxiety relief, sedation, tx  Monitor airway and for respiratory
Ativan Benzodiazepine 24mg/120ml Bolus: 1mg Q15min Maint: 0.5 – 5mg/hr. in seizures depression
Anticonvulsant D5W or NS Increase in 1mg/hr  Drug of choice on cirrhotic pt’s  Do not exceed 2mg/min IVP.
increments Q15min
Call HO for rate > 5mg/hr
 Change solution Q12hrs and tubing
Use 0.2 µ filter Bolus: 0.01 – 0.03mg/kg
Q15min till desired effect
Q24hrs.
Maint: 0.01 – 0.1mg/kg/hr .  Use cautiously in renal pt’s
 Reversal Agent: Romazicon
Seizure: Load: 4mg IV Seizures:
May repeat dose in 10 – 15min

Midazolam Sedative 50mg/50ml Bolus: 1mg Q5min till Maint: 0.5 – 10mg/hr  Conscious sedation or sedative  Airway obstruction, apnea, ataxia,
Versed Anesthesia D5W or NS desired effect Call HO for rate > 10mg/hr bradycardia, dysrhythmias, hypotension.
Increase by 1mg/hr Q5min  Reversal Agent: Romazicon

Bolus: 0.01 – 0.015mg/kg Maint: 0.02 – 0.1mcg/kg/hr

Q5min till desired effect
Milrinone Inotropic agent Premixed: Load: 50mcg/kg over Maint: 0.375 – 0.75mcg/kg/min  Short term mgmt of acute  Use caution in impaired renal function and
Primacore Vasodilator 20mg/100ml 10min decompensated heart hypotension
D5W Do not exceed a total dose of 1.13 failure  May increase ventricular response in A-
mg/kg/24hr. Flutter / A-Fib
Decrease dose 50% for renal
impairment
 Contraindicated in pt’s with severe aortic or
Infusion should not exceed 48hr pulmonary valvular disease
 May cause thrombocytopenia
Morphine Opioid Analgesic 100mg/100ml Bolus: 2mg Q10min till Maint: 1 – 10mg/hr  Analgesic effect, pain  Hypotension, respiratory depression, ileus,
Sedative NS desired effect Call HO for rate > 10mg/hr urinary retention, N/V
Vasodilator Increase by 1mg/hr Q5min
(preload) Bolus: 0.03mg/kg Q10min Maint: 0.01 – 0.2mg/kg/hr
till desired effect

Neostigmine Central Nervous  Pseudo-obstruction of  Monitor for Atrioventricular block,

Neostigmine System Agent 10mg/100ml NS Maint: 0.4 – 0.8 mg/hr intestines (Non-FDA approved Bradyarrhythmia, Decreased LOC,
Methylsulfate use) Seizure, Hypotension, N/V
Cholinesterase Re-evaluate use in 12hrs  MD must be present at bedside for start of
Inhibitor
infusion
 Keep Atropine at bedside
Nesiritide Natriuretic Peptide 1.5mg/250ml Load: 2mcg/kg over 1min Maint: 0.01mcg/kg/min  Acutely decompensated  Hypotension, HA, dizziness
Natrecor D5W or NS May be cautiously increased to max heart failure  Use cautiously in renally impaired pts.
of 0.03mcg/kg/min
Increase in increments of 0.005
mcg/kg/min no faster than Q3hrs

= Cardiac = = = ICP = Paralytic = = Analgesic ψ = Use  = Use Micron Filter 3 of 6

Hypotension Hypertension Sedative Central Line
 Maintenance/Titration Precautions
Medication Classification Dilution Initial Dose Indication
Dose Contraindications
Nicardipine  Contraindicated in hypotension, 2nd & 3rd
Cardene Maint: 3 – 15mg/hr degree HB, bradycardia, and advanced
Ca Channel Blocker 25mg/250ml
5mg/hr
Increase by 2.5mg/hr Q5 – 15min.  Short-term management aortic stenosis
Antihypertensive D5W or NS When desired BP is achieved, of Hypertension  May increase frequency, duration &
reduce to 3mg/hr intensity of angina, CHF
 Change PIV site q12hrs
Nitroglycerin  Treatment of HTN, Angina.  Requires use of non-polyvinylchloride
Nitro-bid Vasodilator
Premixed: Maint: 5 – 200mcg/min
 Coronary artery vasodilator
tubing preventing 80% loss of effect
Nitrostat Antianginal
100mg/250ml 5mcg/min Or
 CHF  Do not use in uncorrected hypovolemia,
D5W 0.1 – 5.0 mcg/kg/min cerebral hemorrhage, or closed head
 Pulmonary edema injury
Norepinephrine 4 - 16 - 32mg  Correct hypovolemia prior to use
Levophed 250ml D5W
Inotropic  Hypotension  Requires a central line
Maint: 0.01 – 1.0mcg/kg/min
Adrenergic  Septic Shock  Risk of extravasation/necrosis
Ψ Preferred  Side effects (rare): bradycardia, CP, ↓CO

Pentobarbital  To be only used in mechanically

Nembutol ventilated pts.
Follow with 5mg/kg/hr x3 hrs.  Side effect of respiratory depression,
Barbiturate
2500mg/500ml
Maint: 1.5 – 2.5mg/kg/hr  Sustained elevated ICP’s that are tachycardia, drowsiness, hypothermia
Sedative-Hypnotic 10mg/kg over 30min Bolus: 5mg/kg if serum level < uncontrolled with other
Anticonvulsant
NS
3mg/dl. medications and treatments.
 Hypotension after bolus
Titrate for burst suppression  Keep MAP > 70
 Reduce dose for renal or hepatic
impairments

Phenylephrine 10 – 80mg/
Neo-Synephrine Vasopressor 250ml D5W or Maint: 50 – 200mcg/min  Side effects: tachycardia, HTN, MI, SAH.
Inotropic NS Or  Hypotension  Risk of extravasation/necrosis.
Adrenergic agonist 0.5 – 1mcg/kg/min  Hepatic dosing required.
Ψ Only
Propofol  To be only used in mechanically
Diprivan Maint: 5 – 50mcg/kg/min ventilated pts.
500mg/50ml 5mcg/kg/min  Sedation for a
Sedative Or
Titrate to effect 10min
mechanically ventilated  May cause apnea, O2 desaturation,
Call MD for dose >50mcg/kg/min hypotension, bradycardia, clonic mvmt,
Anesthesia 1000mg/100ml Bolus: 0.5mg/kg Q5min till ICU patient
green urine
Premixed desired effect
Max: 70mcg/kg/min  Change tubing Q12hrs
 Monitor triglyceride levels prior to
dose and Q72hrs, Daily R>40ml/hr
 Sodium  Hypertensive crisis  Side effects: Hypotension, ischemic
Nitroprusside  Reduces peripheral resistance injuries, death, cyanide toxicity
Antihypertensive  Increases ICP and CO2 retention
Nipride 100mg/250ml Maint: 0.3 – 10mcg/kg/min by a direct action on both veins
Coronary/Peripheral D5W
0.3 – 1.5mcg/kg/min
Titrate to effect Q3 to 5min and arterioles. Has greater effect  Monitor cyanide levels if used for > 3
on DBP days. (1st sign is decreased O2 sats)
Vasodilator
 Reduces preload and afterload in  Cover bag with foil to protect from light
heart failure  Risk of extravasation/necrosis.
= Cardiac = Hypotension = Hypertension = ICP = Paralytic = Sedative = Analgesic ψ = Use Central Line  = Use Micron Filter 4
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 Medication Classification Dilution Initial Dose Maintenance/Titration Indication Precautions
Dose Contraindications
Vasopressin 40unit/40ml
Pitressin ADH D5W or NS 0.04 units/min Maint: 0.04 units/min  Septic shock resistant to  Angina, arrhythmias, decreased
Vasopressor Or catecholamine cardiac output, myocardial ischemia,
2.4 units/hr
Septic Shock Dose Ψ preferred vasopressors MI.

Not to exceed 6 units/hr

Vecuronium Neuromuscular 50units/50ml NS Load: 0.08 – 0.1mg/kg Maint: 0.5 – 1.6mcg/kg/min  Muscle relaxation for intubation  To be used only on mechanically
Norcuron blocker non- or D5W Or or process ventilated pt’s.
polarizing 8 – 10mg 5mg/hr  Lung compliance  Use cautiously with hepatic disease
Establish a baseline TOF Evaluate effectiveness by
during mechanical  Pt must be sedated first.
ventilation
with the nerve stimulator monitoring TOF twitches with the
prior to initiating this nerve stimulator.
medication
= Cardiac = Hypotension = Hypertension = ICP = Paralytic = Sedative = Analgesic ψ = Use Central Line  = Use Micron
Filter

Central and peripheral iv access standards

 Filter Guidelines Osmolarity Common ICU Vesicants
Amiodarone, Digibind, Dilantin, Central line use 3% Sodium Epinephrine Phenytoin
0.22 Micron Lorazepam recommended for fluids Alteplase Esmolol Piperacillin
with an osmolarity of Calcium Chloride Lorazepam Potassium >0.3mEq/ml
1.2 Micron TPN over 600mOsml/liter Calcium Gluconate Mannitol >15% Promethazine
and with fluids with a Dextrose >10% Metronidazole Rocuronium
5.0 Micron Mannitol pH < 5 or > 9 Diazepam Midazolam Sodium Bicarb
(Required if > Dobutamine Norepinephrine TPN
170-260 Micron Platelets, Cryo 900mOsml/liter) Dopamine Phenobarbital Vancomycin
For infiltration, recommend use of Phentolamine Mesylate (Regitine).
5 – 10mg in 10ml Saline: Inject ½ into infiltrated IV line and give remainder
210 Micron PRBC, FFP SC around site. Must be administered within 12hrs of extravasation.

Meds with Osmolarity > 600mOsml/L Meds with pH < 5 Meds with pH > 9
Sulfamethoxazole TPN Ciprofloxacin (3.3-4.6) Minocycline (2-2.8) Dobutamine (3.5) Acyclovir (10.5-11.6) Pantoprazole(9-10)
3% Sodium Chloride Iron Dextran Nicardipine (3.5) Octreotide (3.9-4.5) Milrinone (3.2-4) Ganciclovir (11) Phenytoin (12)
Potassium Chloride >0.3mEq/ml Dextrose 10% Dopamine (3.3) Ondansetron (3-3.4) Doxycycline (1.8-3.3) Sulfamethoxazole (10)
Linezolid (4.8) Vancomycin (2.5-4.5)

S.Rechkemmer RN
Disclosure: This guide is to assist in maintaining safe limits for the administration of IV medications for all patients. Current UHS policies always supersedes any dosages or rates within this list. In addition, patient history and
functionality of organs must be taken into consideration with use of any medication..

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 Rapid Sequence intubation Medications
Sedatives
Action Dosage Avg Doses STICU Precaution
Midazolam HCL Short acting benzodiazepine 0.1 mg/kg IV over 30 sec; allow 5mg/1ml Vial  Hypotension
CNS for amnesia prior to 2 min to take effect; repeat dose  ½ dose for liver or renal disease.
procedure q2-5min. 2-6 mg IVP
Versed Max 10mg after repeat doses.
Propofol Short acting hypnotic; decreases 1.5-2.5mg/kg IV 1000mg/100ml Bottle  Hypotension
intraocular pressure & ICP Dose 1mg/kg  Hyperlipidemia (prolonged use)
50-150mg IVP (5-15ml)  Decreases CPP
Diprivan
Ketamine Produces dissociative anesthesia; 0.5-2.0 mg/kg 50mg/1ml Vial  Increases intracranial pressure,
promotes sympathetic nervous intraocular pressure, and BP/HR
Ketalar stimulation 50-100mg IVP
Etomidate Short acting hypnotic for 0.15-0.3mg/kg IV over 30- 40mg/20ml Vial  Can cause prolonged suppression of
induction of anesthesia. 60sec; repeat dose q3-5min endogenous cortisol and aldosterone
Cerebroprotective. 20-40mg IVP production.
Amidate  Hypotension
Paralytics Always sedate the pt before paralyzing
Action Dosage Avg Doses STICU Precaution
Succinylcholine Short acting neuromuscular 1.5mg/kg IV (max 150mg) 200mg/10ml Vial  Increases intraocular pressure
Chloride blockade, depolarizing agent – Onset 1-2min  Hyperkalemia
relaxes muscles & opens the Duration 4-6min 100mg IVP  Do not give in Spinal Injuries causes
Anectine larynx. neuron degeneration causing deficits to
be irreversible.
Rocuronium Neuromuscular blockade, non- 0.6-1.2mg/kg IV 50mg/5ml Vial  Pulmonary hypertension
Bromide depolarizing Onset 1min
Duration 30min 70 – 100mg
Zemuron
Vecuronium Neuromuscular blockade, non- 0.1mg/kg IV 10mg Powder Vial/mix w/  Use cautiously with hepatic disease.
depolarizing Onset 2-3min 10ml NS  Malignant hyperthermia
Norcuron Duration 25-40min.
10-20mg IVP
Analgesia
Action Dosage Avg Doses STICU Precaution
Fentanyl Opioid analgesic, mitigates 1-3mcg/kg IV 100mcg/2ml Ampule  Hypotension
physiologic increase in
sympathetic tone (ICP 100-200mcg IVP
Sublimaze fluctuations) associated with
intubation
Other
Lidocaine Suppresses the cough/gag reflex 1-1.5mg/kg IV 2% 100mg/5ml Syringe  Bradyarrythmia
during intubation which increases  Heart block
ICP 100mg IVP
Atropine For vagal response (heart rate < 60) 0.02mg/kg 1mg/10ml Syringe  Tachyarrythmia
During intubation ½ to 1 amp  Increased Intraocular pressure
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