1: Critical Care Intravenous Infusion Drugs—Quick Mixing Guide

Section I Critical Care Intravenous Infusion Drugs—Quick Mixing Guide



ABCIXIMAB (REOPRO)




Bolus dose: Given IV push


Maintenance dose: Add required maintenance dose to 250 mL D5W



ALTEPLASE (ACTIVASE)




Add 100 mg alteplase to 100 mL sterile water or 50 mg alteplase to 50 mL sterile water


Final concentration: 1 mg/mL



AMINOPHYLLINE (THEOPHYLLINE) 500 MG IN 500 ML D5W




Premade solution




Theophylline 400 mg/500 mL or 800 mg/1000 mL


Final concentration: 1 mg/mL of aminophylline



AMIODARONE (CORDARONE)




Bolus dose: Add 150 mg to 100 mL D5W


Maintenance dose: Add 900 mg to 500 mL D5W in glass bottle


Final concentration: 1.8 mg/mL



ARGATROBAN (ACOVA) 250 MG IN 250 ML NS




Add 250 mg (2.5 mL) argatroban to 250 mL NS


Final concentration: 250 mg/250 mL (1 mg/mL)



ATRACURIUM (TRACRIUM) 250 MG (25 ML) IN 250 ML D5W




Add 250 mg (25 mL) atracurium to 225 mL D5W


Final concentration: 1 mg/mL



BIVALIRUDIN (ANGIOMAX) 250 MG (5 ML) IN 50 ML D5W




Add 250 mg (5 mL) bivalirudin to 50 mL D5W


Final concentration: 5 mg/mL



CISATRACURIUM (NIMBEX) 250 MG IN 250 ML D5W




Add 250 mg (25 × 5-mL vials) cisatracurium to 125 mL D5W


Final concentration: 1 mg/mL



CONIVAPTAN (VAPRISOL)




20 mg IV loading dose; 20-40 mg/day IV continuous infusion; maximum duration is 4 days


Final concentration 200 mg in 100 mL D5W (0.2 mg/mL) and 40 mg in 250 mL D5W (0.16 mg/mL)



DEXMEDETOMIDINE (PRECEDEX) 2 MG IN 50 ML NS




Add 2 mL Precedex to 48-mL NS minibag


Final concentration: 4 mcg/mL



DILTIAZEM (CARDIZEM) 125 MG IN 100 ML D5W




Add 125 mg (5 × 25-mg vials) diltiazem to 100 mL D5W or NS


Final concentration: 125 mg/125 mL (1 mg/mL)



DOBUTAMINE (DOBUTREX) 500 MG IN 250 ML D5W




Premade solution




Final concentration: 500 mg/250 mL (2 mg/mL)



DOPAMINE (INTROPIN) 400 MG IN 250 ML D5W




Premade solution




Final concentration: 400 mg/250 mL (1600 mcg/mL)



DROTRECOGIN ALFA (XIGRIS) (2 × 5 MG) 10 MG IN 100 ML NS




Add 10 mg (2 × 5 mg vials) to 100 mL NS


Final concentration: 10,000 mcg/100 mL (100 mcg/mL)



EPINEPHRINE (ADRENALIN) 1 MG IN 250 ML D5W OR NS




Add 1 mg (1 ampule) epinephrine to 250 mL D5W or NS


Final concentration: 1 mg/250 mL (4 mcg/mL)



EPTIFIBATIDE (INTEGRILIN) 75 MG IN 100-ML VIAL




Premade solution




Bolus dose: from 10-mL vial


Maintenance dose: from 75-mg/100-mL vial



ESMOLOL (BREVIBLOC) 2.5 G IN 250 ML D5W OR NS




Add 2.5 g (10 mL of 250-mg/mL vial) esmolol to 250 mL D5W or NS


Final concentration: 10 mg/mL



FENOLDOPAM (CORLOPAM) 10 MG IN 250 ML D5W OR NS




Add 10 mg (1 mL) fenoldopam to 250 mL D5W or NS


Final concentration: 40 mcg/mL



HALOPERIDOL (HALDOL) FOR RAPID TRANQUILIZATION




Available as 5-mg/mL vial for IV push



HEPARIN 25,000 UNITS IN 500 ML D5W




Premade solution




Final concentration: 25,000 units/500 mL (50 units/mL)



IBUTILIDE (CORVERT) 1 MG IN 50 ML D5W OR NS




Add 1 mg (10-mL vial) ibutilide to 50 mL D5W or NS


May also be given IV push over 10 minutes



IMMUNE GLOBULIN DOSES




See dosing chart



INAMRINONE (INOCOR) 500 MG IN 100 ML NS




Add 500 mg (5 × 100-mg ampules) inamrinone to 100 mL NS


Final concentration: 500 mg/200 mL (2.5 mg/mL)



INFLIXIMAB (REMICADE) 100 MG TO 900 MG IN 250 ML NS




Add 100 mg to 600 mg (calculate correct dose by weight in dosing charts) to total volume of 250 mL NS


Final concentration: 0.4 to 4 mg/mL



INSULIN 100 UNITS IN 250 ML NS




Add 100 units (1 mL) insulin to 250 mL NS


Final concentration: 100 units/250 mL (2 units/5 mL)


For intensive insulin protocols add 100 (1 mL) to 100 mL NS


Final concentration: 100 units/100 mL (1 unit/mL)



ISOPROTERENOL (ISUPREL) 1 MG IN 250 ML D5W




Add 1 mg (1 ampule) isoproterenol to 250 mL D5W


Final concentration: 1 mg/250 mL (4 mcg/mL)



LABETALOL (TRANDATE) 200 MG IN 200 ML NS




Add 200 mg (40 mL) labetalol to 160 mL NS


Final concentration: 200 mg/200 mL (1 mg/mL)



LEPIRUDIN (REFLUDAN) 100 MG IN 250 ML NS




Add 100 mg (2 mL) lepirudin to 250 mL NS


Final concentration: 0.4 mg/mL



LIDOCAINE 2 G IN 500 ML D5W




Premade solution




Final concentration: 2 g/500 mL (4 mg/mL)



LORAZEPAM (ATIVAN) 40 MG IN 500 ML D5W




Add 40 mg (10 mL) lorazepam to 500 mL D5W in glass bottle


Final concentration: 0.08 mg/mL



MAGNESIUM SULFATE (MGSO4)




Add 1 g magnesium sulfate to 50 mL NS or 2 g to 100 mL NS


Premixed doses 4% solution, 4 g/100 mL or 40 g/1000 mL (for eclampsia)


1-2 g (2-4 mL of 50% solution) diluted in 10 mL D5W may be given IV push for cardiac arrest


Final concentration: 1 g/50 mL (20 mg/mL)



MIDAZOLAM (VERSED) 125 MG IN 125 ML NS




Add 125 mg (25 mL of 5 mg/mL vials) midazolam to 100 mL NS


Final concentration: 1.0 mg/mL



MILRINONE (PRIMACOR) 20 MG IN 100 ML D5W




Premade solution




Final concentration: 0.2 mg/mL



NESIRITIDE (NATRECOR) 1.5 MG IN 250 ML D5W




Add 1.5 mg (5 mL) nesiritide to 250 mL D5W


Final concentration: 1.5 mg/250 mL (6 mcg/mL)



NICARDIPINE (CARDENE)




Add 1 ampule (25 mg/10 mL) to 240 mL of Dextrose 5% or NS resulting in 250 mL of solution


Final concentration: 0.1 mg/mL


A premixed 200 mL solution is also available containing 20 mg in NS or D5W


Final concentration: 0.1 mg/mL



NITROGLYCERIN 25 MG IN 250 ML D5W




Premade solution




Final concentration: 25 mg/250 mL (100 mcg/mL)



NITROPRUSSIDE (NIPRIDE) 50 MG IN 500 ML D5W




Add 50 mg (1 vial) nitroprusside to 500 mL D5W


Final concentration: 50 mg/500 mL (100 mcg/mL)



NOREPINEPHRINE (LEVOPHED) 4 MG IN 250 ML D5W OR NS WITH REGITINE 5 MG/250 ML




Add 4 mg (1 × 4-mg ampule) norepinephrine to 250 mL D5W or NS and add 5 mg Regitine (1 × 5–mg vial) to each 250-mL bag


Final concentration: norepinephrine 4 mg/250 mL (16 mcg/mL)



OCTREOTIDE (SANDOSTATIN) 1200 MCG IN 250 ML D5W OR NS




Add 1200 mcg (2.4 mL) Sandostatin to 250 mL D5W or NS


Final concentration: Sandostatin 4.8 mcg/mL



PANTOPRAZOLE (PROTONIX) 40–80 MG IN 100 ML D5W OR NS




Add 10 mL NS to each 40-mg vial and add contents to 90 mL NS


Final concentration: 40 mg/100 mL (0.4 mg/mL) or 80 mg/100 mL (0.8 mg/mL)



PHENYLEPHRINE (NEO-SYNEPHRINE) 10 MG IN 250 ML D5W




Add 10 mg (1 ampule) phenylephrine to 250 mL D5W


Final concentration: 10 mg/250 mL (40 mcg/mL)



POTASSIUM CHLORIDE (KCL)




Based on serum potassium levels: 20–60 mEq/day is usual


Typical doses based on serum levels:


3.1-3.4 mmol/L give 20 mEq every 2 hr × 2 doses


2.5-3 mmol/L give 20 mEq every 2 hr × 3 doses


Less than 2.5 mmol/L give 20 mEq every 2 hr × 4 doses


1. Max: 200 mEq/day and rarely up to 400 mEq/day with extreme caution.

2. Max infusion rate: 10 mEq/hr; in severe hypokalemia (K < 2.0), 20-40 mEq/hr with extreme caution and infusion pump

Final concentration: 10 mEq/100 mL (central line) or 40 mEq/500 mL (peripheral)


PROCAINAMIDE (PRONESTYL) 1 G IN 250 ML D5W OR NS




Add 1 g (1 vial) Pronestyl to 250 mL D5W or NS


Final concentration: 1 g/250 mL (4 mg/mL)



PROPOFOL (DIPRIVAN) 500 MG/50 ML OR 1 G/100 ML EMULSION




Premade solution




Final concentration: 10 mg/mL



RETEPLASE (RETAVASE) 20-UNIT KIT




Add 10 mL sterile water to 10 units Retavase with kit provided


Repeat for second 10-unit dose



TENECTEPLASE (TNKASE)




Add 10 mL sterile water to 50 mg TNKase


Final concentration: 5 mg/mL



TIROFIBAN (AGGRASTAT) 12.5 MG IN 250 ML D5W OR NS




A premixed solution 100 mL or 250 mL container,


Final concentration: 50 mcg/mL or 0.05 mg/mL



VASOPRESSIN (PITRESSIN SYNTHETIC) 250 UNITS IN 250 ML




Add 250 units (12.5 mL of 20 units/mL) vasopressin to 250 mL D5W or NS


Final concentration: 250 units/250 mL (1 unit/mL)



Quick Reference Infusion Drug Compatibility and Incompatibility Chart






















































Drug Compatibility Incompatibility
Abciximab Unknown or no information Unknown or no information
Alteplase

Dextrose 5%


Lidocaine


Metoprolol


Propranolol

Dobutamine


Dopamine

Aminophylline

Allopurinol


Amphotericin B


Bretylium


Ceftazidime


Cimetidine


Cladribine


Diltiazem


Dopamine


Doxorubicin


Enalaprilat


Esmolol


Etoposide


Famotidine


Filgrastim


Fluconazole


Foscarnet


Gatifloxacin


Gemcitabine


Granisetron


Heparin


Inamrinone (Inocor)


Labetalol


Lidocaine


Linezolid


Meropenem


Morphine


Nitroglycerin


Paclitaxel


Pancuronium


Piperacillin


Potassium chloride


Propofol


Ranitidine


Remifentanil


Sargramostim


Tacrolimus


Vecuronium

Amiodarone


Atracurium


Chlorpromazine (Thorazine)


Ciprofloxacin


Clindamycin


Codeine


Dobutamine


Hydralazine


Hydroxyzine (Vistaril)


Insulin


Isoproterenol


Meperidine (Demerol)


Norepinephrine


Ondansetron (Zofran)


Prochlorperazine (Compazine)


Phenytoin (Dilantin)


Promethazine (Phenergan)


Verapamil

Amiodarone

Amikacin


Bretylium


Clindamycin


Dobutamine


Doxycycline


Erythromycin


Esmolol


Gentamicin


Insulin


Isoproterenol


Labetalol


Lidocaine


Metaraminol


Metronidazole


Midazolam


Morphine


Nitroglycerin


Norepinephrine


Penicillin G


Phentolamine


Phenylephrine


Potassium chloride


Procainamide


Tobramycin


Vancomycin

Aminophylline


Cefazolin


Heparin


Sodium bicarbonate

Argatroban Unknown or no information Unknown or no information
Atracurium

Bretylium


Cefazolin


Cefuroxime


Cimetidine


Dobutamine


Dopamine


Epinephrine


Esmolol


Etomidate


Fentanyl


Gentamicin


Heparin


Hydrocortisone


Isoproterenol


Lidocaine


Lorazepam


Midazolam


Milrinone


Morphine


Nitroglycerin


Procainamide


Ranitidine


Sodium nitroprusside


Trimethoprim/sulfa


Vancomycin

Aminophylline


Diazepam


Propofol


Thiopental

Bivalirudin

Dexamethasone


Digoxin


Diphenhydramine


Dobutamine


Dopamine


Epinephrine


Eptifibatide


Esmolol


Furosemide


Heparin


Hydrocortisone


Lidocaine


Meperidine


Methylprednisolone


Midazolam


Morphine


Nitroglycerin


Potassium chloride


Sodium bicarbonate


Tirofiban


Verapamil

[including Y-site]


Alteplase (tPA)


Amiodarone hydrochloride


Amphotericin B


Chlorpromazine hydrochloride


Diazepam


Prochlorperazine


Reteplase (rtPA)


Streptokinase


Vancomycin hydrochloride

Cisatracurium

[via Y-site]


Alfentanil


Amikacin


Aztreonam


Bretylium


Bumetanide


Buprenorphine


Butorphanol


Calcium gluconate


Ceftriaxone


Chlorpromazine


Cimetidine


Ciprofloxacin


Clindamycin


Dexamethasone


Digoxin


Diphenhydramine


Dobutamine


Dopamine


Doxycycline


Droperidol


Enalaprilat


Epinephrine


Esmolol


Famotidine


Fentanyl


Fluconazole


Gatifloxacin


Gentamicin


Haloperidol


Hydrocortisone


Hydromorphone


Hydroxyzine


Imipenem/cilastatin


Inamrinone


Isoproterenol


Ketorolac


Lidocaine


Linezolid


Lorazepam


Magnesium sulfate


Mannitol


Meperidine


Metoclopramide


Metronidazole


Midazolam


Minocycline


Morphine


Nalbuphine


Nitroglycerin


Norepinephrine


Ofloxacin


Ondansetron


Phenylephrine


Potassium chloride


Procainamide


Prochlorperazine


Promethazine


Ranitidine


Remifentanil


Sufentanil


Theophylline


Ticarcillin


Tobramycin


Vancomycin


Zidovudine

Acyclovir


Aminophylline


Amphotericin B


Ampicillin


Ampicillin/sulbactam


Cefazolin


Cefotaxime


Cefotetan


Cefoxitin


Ceftazidime


Cefuroxime


Diazepam


Diprivan


Furosemide


Ganciclovir


Heparin


Ketorolac


Methylprednisolone


Nitroprusside


Piperacillin


Thiopental


Ticarcillin/clavulanate


Trimethoprim/sulfa


Zosyn

Conivaptan None

LR & NS


Dilute only with D5W.


Do not mix or


administer with other IV fluids or medications.

Dexmedetomidine

Atracurium besylate


Atropine sulfate


Fentanyl citrate


Glycopyrrolate bromide


20% Mannitol


Midazolam


Mivacurium chloride


Morphine sulfate


Normal saline

 Blood: serum or plasma
Diltiazem

Aminophylline


Albumin


Amikacin


Amphotericin B


Aztreonam


Bretylium


Bumetanide


Cefazolin


Cefotaxime


Cefoxitin


Ceftazidime


Ceftriaxone


Cefuroxime


Cimetidine


Ciprofloxacin


Clindamycin


Digoxin


Dobutamine


Dopamine


Doxycycline


Epinephrine


Erythromycin


Esmolol


Fentanyl


Fluconazole


Gentamicin


Heparin


Hetastarch


Hydromorphone


Imipenem/cilastatin


Insulin


Labetalol


Lidocaine


Lorazepam


Meperidine


Metoclopramide


Metronidazole


Midazolam


Milrinone


Morphine


Multivitamins


Nicardipine


Oxacillin


Penicillin G


Pentamidine


Piperacillin


Potassium chloride


Potassium phosphate


Ranitidine


Nitroglycerin


Nitroprusside


Norepinephrine


Theophylline


Ticarcillin/clavulanate


Tobramycin


Trimethoprim/sulfa


Vancomycin


Vecuronium

Acetazolamide


Acyclovir


Aminophylline


Ampicillin


Diazepam


Hydrocortisone


Insulin


Lasix


Methylprednisolone


Phenytoin


Procainamide


Rifampin


Sodium bicarbonate


Thiopental

Dobutamine

Amiodarone


Atracurium


Aztreonam


Bretylium


Cladribine


Calcium chloride


Calcium gluconate


Ciprofloxacin


Cisatracurium


Diazepam


Diltiazem


Docetaxel


Dopamine


Doxorubicin


Enalaprilat


Epinephrine


Etoposide


Famotidine

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Jun 4, 2016 | Posted by in CRITICAL CARE | Comments Off on 1: Critical Care Intravenous Infusion Drugs—Quick Mixing Guide

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