MassGeneral Hospital for Children NICU/PICU Pediatric ...

MassGeneral Hospital for ChildrenNICU/PICU

Pediatric Medication Administration ProcessManual

For Syringe Pumps

1st edition

Copyright 2006

MassGeneral Hospital for Children

MassGeneral Hospital for Children NICU/PICU

Pediatric Medication Administration Process Manual For Syringe Pumps

1st edition

Editor in Chief

Nat Sims, MD

Physician Advisor Partners Health Care Biomedical Engineering

Massachusetts General Hospital

Contributing Editors

Kathryn A. Beauchamp, RN, MSN, CCRN Clinical Nurse Specialist

Pediatric Intensive Care Unit MassGeneral Hospital for Children

Boston, MA

Gayle Fishman, RN, BSN, MBA Consultant

Health Systems Redesign, Inc.

Daniel Kohane, MD, PhD Staff Attending Pediatric Intensive Care Unit MassGeneral Hospital for Children

Boston, MA

Brenda Miller, RN, MSN Nurse Manager

Pediatric Intensive Care Unit and Pediatric Outpatient MassGeneral Hospital for Children

Boston, MA

Erasmo A. Mitrano, RPh, M.A. Pharmacy Operations Specialist

Massachusetts General Hospital Department of Pharmacy Boston, MA

Lisa Morlitz, PharmD Clinical Pharmacist

WakeMed Cary Hospital Cary, NC

Ellen Kinnealey, RN, BSN Advanced Infusion System Specialist

Massachusetts General Hospital Department of Biomedical Engineering

Lois Finstein Parker, RPh Senior Attending Pharmacist



Disclaimer: © 2006 The General Hospital Corporation (d/b/a Massachusetts General Hospital) All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system, without written permission from the copyright owner. Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in any particular situation remains the professional responsibility of the practitioner.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently utilized drug.

Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his/her clinical practice.


Editor in Chief

Nat Sims, MD Physician Advisor

Partners Health Care Biomedical Engineering Massachusetts General Hospital

Contributing Editors

Kathryn A. Beauchamp, RN, MSN, CCRN Clinical Nurse Specialist

Pediatric Intensive Care Unit MassGeneral Hospital for Children

Boston, MA

Gayle Fishman, RN, BSN, MBA Consultant

Health Systems Redesign, Inc.

Daniel Kohane, MD, PhD Staff Attending Pediatric Intensive Care Unit MassGeneral Hospital for Children

Boston, MA

Brenda Miller, RN, MSN Nurse Manager

Pediatric Intensive Care Unit and Pediatric Outpatient MassGeneral Hospital for Children

Boston, MA

Erasmo A. Mitrano, RPh, M.A. Pharmacy Operations Specialist


Lisa Morlitz, PharmD Clinical Pharmacist

WakeMed Cary Hospital Cary, NC

Ellen Kinnealey, RN, BSN Advanced Infusion System Specialist

Massachusetts General Hospital Department of Biomedical Engineering

Lois Finstein Parker, RPh Senior Attending Pharmacist




Pediatric Medication Administration Process Manual for Syringe Infusion Pumps

Continuous Infusions

This manual describes a drug library that provides: y Mixing guidelines and flow rates for each drug and

concentration y IV administration guidelines for each drug y Starting dose; loading dose and continuous dose by drug y Usual and maximum dosing by drug y Pump flow rates by drug concentration, dose rate and patient

weight y Color Zones which assists the clinician in choosing the

best concentration for most effective flow rate* 1. Green – indicates flow rate at 0.3 mL/hr or higher 2. Yellow – indicates flow rate between 0.1 and 0.3

mL/hr may be initiated in an emergency (please page pharmacy)

3. Red – indicates flow rate <0.3 mL/hr or >20 mL/hr *Flow rates of at least 0.3mL/hr provide optimal titration Definition of Terms: “Soft Min”: Soft Minimum Refers to the recommended minimum dose “Soft Max”: Soft Maximum Refers to the recommended maximum dose Sources: References: Albany Medical Center; Dayton Children's Hospital; Eggleston Children’s Hospital, Atlanta; Minneapolis Children's Hospital; Children's Medical Center of Dallas; Yale - New Haven Children’s Hospital; MGH - Lexi-Comp's Clinical Reference Library MGH Development Team: Pharmacy; Nursing; Smart Infusion Pump Learning Lab, sponsored by the Sims Lab; Pediatrics; Biomedical Engineering



Pediatric Medication Administration Process Manual for Syringe Pumps

Instructions

MGH recommends that each hospital create its drug library based on individual practice (refer to Drug Library Development Process) Establish the formulary, standard concentrations and default starting doses along with minimum and maximum dosing. Using any spread sheet application; build the flow table as follows:

1. List a range of weights in a column, in ascending order 2. List a range of drug dosing across a row – begin with the “Soft

Min” and end with the “Soft Max” 3. In the first cell (lowest weight and Soft Min), write the formula

that multiplies the weight value x Soft Min value x Drug Concentration per milliliter. The value that appears is the rate delivered to the patient.

4. Extend this formula to the rest of the table 5. Apply conditional formatting to set the colors to the following values:

Red (0.09 to 19.9); Yellow (0.09 to 0.3) and Green (0.3 to 19.9). It is important to use this order in the conditional formatting)

a. Green – indicates flow rate at 0.3 mL/hr or higher b. Yellow – indicates flow rate between 0.1 and 0.3

mL/hr may be initiated in an emergency (please page pharmacy)

c. Red – indicates flow rate <0.3 mL/hr or >20 mL/hr *Flow rates of at least 0.3mL/hr provide optimal titration

6. Remove all trailing zeros 7. If the flow rates, given the standard dosing procedure in the

hospital do not fall within the majority of green flow rates, it is necessary to create another concentration for your drug library


NEONATAL / PEDIATRIC ALPROSTADIL-Ductus

Neonatal/Pediatric Alprostadil IV Dosing and Preparation Guidelines Concentration Provided Starting Dose

Continuous Infusion: 0.05-0.1mcg/kg/minute Usual/ Maximum Dose

10mcg/mL in D5W

Usual: 0.01-0.4mcg/kg/minute Maximum: 0.4mcg/kg/minute

ALPROSTADIL 10MCG/mL (DUCTUS)

INGREDIENTS QUANTITY FOR 1

SYRINGE Alprostadil 500mcg/mL

1mL

D5W

49mL

To make 50 mL: 1. Using a 1mL syringe, draw up 1mL from an Alprostadil 500mcg/mL vial. 2. Using a 60mL syringe, draw up 49mL of D5W. 3. Add the 1mL of Alprostadil to the 49mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date


Flow Rate as function of Drug Concentration, Dose Rate, Patient Weight

"ALPROSTADIL 10 MCG/mL" INDICATION: DUCTUS September-05

Dose rate in mcg/kg/minuteSoft Min Soft Max

Weight 0.01 0.05 0.1 0.15 0.2 0.3 0.40.5 kg 0.03 0.15 0.3 0.45 0.6 0.9 1.21.5 kg 0.09 0.45 0.9 1.35 1.8 2.7 3.63 kg 0.18 0.9 1.8 2.7 3.6 5.4 7.2

6 kg 0.4 1.8 3.6 5.4 7.2 10.8 14.4

Pump flow rate (mL/hr)

Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (risk fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range


NEONATAL / PEDIATRIC ALPROSTADIL-Liver

Neonatal/Pediatric Alprostadil IV Dosing and Preparation Guidelines Concentration Provided Starting Dose

Continuous infusion: 0.1-0.6mcg/kg/hour Usual/ Maximum Dose

10mcg/mL in D5W

Maximum: Please consult the liver transplant team for additional dosing information.

ALPROSTADIL 10MCG/mL (LIVER)


SYRINGE Alprostadil 500mcg/mL

1mL

D5W

49mL

To make 50 mL: 1. Using a 1mL syringe, draw up 1mL from an Alprostadil 500mcg/mL vial. 2. Using a 60mL syringe, draw up 49mL of D5W. 3. Add the 1mL of Alprostadil to the 49mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date



"ALPROSTADIL 10 MCG/mL " INDICATION : LIVER September-05

Dose rate in mcg/kg/hourSoft Min Soft Max

Weight 0.1 0.25 0.5 0.60.5 kg 0.01 0.01 0.03 0.031.5 kg 0.02 0.04 0.08 0.093 kg 0.03 0.08 0.15 0.186 kg 0.06 0.15 0.3 0.36

20 kg 0.2 0.50 1 1.240 kg 0.4 1 2 2.4


"ALPROSTADIL 20 MCG/mL " INDICATION : LIVER April-06


Weight 0.1 0.25 0.5 0.60.5 kg 0 0.01 0.01 0.021.5 kg 0.01 0.02 0.04 0.053 kg 0.02 0.04 0.08 0.096 kg 0.03 0.08 0.15 0.18

20 kg 0.1 0.25 0.5 0.640 kg 0.2 0.50 1 1.2


Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (risk fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range


NEONATAL / PEDIATRIC ALTEPLASE Neonatal/Pediatric Alteplase IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose DVT: 0.03mg/kg/hour PE: Please consult hematology/oncology attending for dosing

Usual/ Maximum Dose

1mg/mL in SWFI

Maximum: 0.06mg/kg/hour

ALTEPLASE – 1MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Alteplase 50mg/50mL * * Reconstitute with supplied

diluent (SWFI)

50mL

Please page the unit pharmacist for a 24-hour supply.

To make 50mL: 1. Reconstitute Alteplase 50mg vials with 50mL SWFI. 2. Using a 60mL syringe, draw up 50mL of Alteplase. 3. 24 hour expiration date



"ALTEPLASE 1 MG/mL" September-05

Dose rate in mg/kg/hourSoft Min Soft Max

Weight 0.03 0.1 0.3 0.5 0.60.5 kg 0.02 0.05 0.15 0.25 0.301.5 kg 0.05 0.15 0.45 0.75 0.90

3 kg 0.09 0.3 0.9 1.5 1.86 kg 0.18 0.6 1.8 3 4

20 kg 0.6 2 6 10 1240 kg 1.2 4 12 20 24


Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range


NEONATAL / PEDIATRIC AMIODARONE Neonatal/Pediatric Amiodarone IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Load: 5mg/kg (up to 150mg) over 15-30minutes Continuous Infusion: 5mcg/kg/minute

Usual/ Maximum Dose

1.8mg/mL in D5W (1800mcg/mL)

Usual: 5-15mcg/kg/minute Maximum: 15mcg/kg/minute

AMIODARONE 1.8MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Amiodarone 50mg/mL

1.8mL

D5W

48.2mL

Please page the unit pharmacist for a 24-hour supply in a glass bottle.

To make 50mL: 1. Using a 3 mL syringe with filter needle, draw up 1.8mL

from an Amiodarone 50mg/mL ampule. 2. Using a 60mL syringe, draw up 48.2mL measure 0.2 mL of

D5W. 3. Add the 1.8mL of Amiodarone to the 48.2mL of D5W. 4. Mix the syringe contents gently. 5. 2 hour expiration date



"AMIODARONE 1.8 MG/mL" September-05


Weight 4 5 10 12.5 150.5 kg 0.07 0.08 0.17 0.21 0.251.5 kg 0.2 0.25 0.5 0.63 0.75

3 kg 0.4 0.5 1 1.25 1.5

6 kg 0.8 1 2 2.5 320 kg 2.67 3.33 6.67 8.33 1040 kg 5.33 6.67 13.33 16.67 20




NEONATAL / PEDIATRIC Dexmedetomidine

Neonatal/Pediatric Dexmedetomidine IV Administration Guidelines Concentration Provided Starting Dose

Continuous Infusion: 0.2 mcg/kg/hour Usual/ Max Dose

4 mcg/ml in NS

Usual: 0.2-0.7 mcg/kg/hour Max: 0.7 mcg/kg/hour

DEXMEDETOMIDINE 4 MCG/mL (PRECEDEX)

INGREDIENTS QUANTITY

FOR 1 SYRINGE

Dexmedetomidine

To make 50 mL: Contact pharmacy for the syringe


Flow Rate as function of Drug Concentration, Dose Rate and Patient Weight

"Dexmedetomidine 4 mcg/mL" (Precedex) September-06


Weight 0.2 0.3 0.4 0.5 0.6 0.70.5 kg 0.03 0.04 0.05 0.06 0.08 0.091.5 kg 0.08 0.11 0.15 0.19 0.23 0.26

3 kg 0.15 0.23 0.3 0.38 0.45 0.53

6 kg 0.30 0.45 0.6 0.75 0.9 1.0520 kg 1 1.5 2 2.5 3 3.540 kg 2 3 4 5 6 7




NEONATAL / PEDIATRIC DOBUTAMINE Neonatal/Pediatric Dobutamine IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose 2-5mcg/kg/minute

Usual/ Maximum Dose 0-5kg - 1mg/mL 6-21kg - 2mg/mL

Over 21kg - 5mg/mL


DOBUTAMINE 1MG/mL (10mL) INGREDIENTS QUANTITY

FOR 1 SYRINGE

Dobutamine 12.5mg/mL

0.8mL

D5W 9.2mL

To make 10mL: 1. Using a 1mL syringe, draw up 0.8mL of Dobutamine

12.5mg/mL. 2. Using a 10mL syringe, draw up 9.2mL of D5W. 3. Add the 0.8mL of Dobutamine to the 9.2mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date

DOBUTAMINE 1MG/mL (50mL)


SYRINGE Dobutamine 12.5mg/mL

4mL

D5W 46mL

To make 50mL: 1. Using a 10mL syringe, draw up 4mL of Dobutamine

12.5mg/mL. 2. Using a 60mL syringe, draw up 46mL of D5W. 3. Add the 4mL of Dobutamine to the 46mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date

DOBUTAMINE 2MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Dobutamine 12.5mg/mL 8mL

D5W 42mL



DOBUTAMINE 5MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Dobutamine 12.5mg/mL

20mL

D5W 30mL





"DOBUTAMINE 1 MG/mL" September-05

Dose Rate in mcg/kg/minuteSoft Min Soft Max

Weight 2 5 15 20 400.5 kg 0.06 0.15 0.45 0.6 1.21.5 kg 0.18 0.45 1.35 1.8 3.6

3 kg 0.36 0.9 2.7 3.6 7.2

6 kg 0.72 1.8 5.4 7.2 14.420 kg 2.4 6 18 24 4840 kg 4.8 12 36 48 96


"DOBUTAMINE 2 MG/mL"Dose Rate in mcg/kg/minute

Soft Min Soft MaxWeight 2 5 15 20 40

0.5 kg 0 0.1 0.2 0.3 0.61.5 kg 0.1 0.2 0.7 0.9 1.8

3 kg 0.2 0.5 1.4 1.8 3.6

6 kg 0.4 0.9 2.7 3.6 7.220 kg 1.2 3 9 12 2440 kg 2.4 6 18 24 48


"DOBUTAMINE 5 MG/mL"Dose Rate in mcg/kg/minute

Soft Min Soft Max Weight 2 5 15 20 40

0.5 kg 0.01 0.03 0.09 0.12 0.241.5 kg 0.04 0.09 0.27 0.36 0.723 kg 0.07 0.18 0.54 0.72 1.446 kg 0.14 0.36 1.08 1.44 2.88

20 kg 0.48 1.2 3.6 4.8 9.640 kg 0.96 2.4 7.2 9.6 19.2




NEONATAL / PEDIATRIC DOPAMINE

Neonatal/Pediatric Dopamine IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose

Continuous Infusion:

Low dose: 1–5mcg/kg/minute

Moderate dose: 5-15mcg/kg/minute

High dose: > 15mcg/kg/minute

Usual/ Maximum Dose

0-1kg – 0.8mg/mL = 800mcg/mL

1-5kg - 1.6mg/mL = 1600mcg/mL

6-21kg – 3.2mg/mL =3200mcg/mL

Over 21kg- 8mg/mL = 8000mcg/mL

Usual: 1-20mcg/kg/minute

Maximum: 50mcg/kg/minute

DOPAMINE 0.8MG/ML (10mL)


FOR 1

SYRINGE

Dopamine 40mg/mL 0.2mL

D5W 9.8mL

To make 10mL:

1. Using a 1mL syringe, draw up 0.2mL of Dopamine

40mg/mL.

2. Using a 10mL syringe, draw up 9.8mL of D5W.

3. Add the 0.2mL of Dopamine to the 9.8mL of D5W.

4. Mix the syringe contents gently.

5. 24 hour expiration date

DOPAMINE 0.8MG/mL


FOR 1

SYRINGE

Dopamine 40mg/mL 1mL

D5W 49mL

To make 50mL:

1. Using a 1mL syringe, draw up 1mL of Dopamine

40mg/mL.

2. Using a 60mL syringe, draw up 49mL of D5W.

3. Add the 1mL of Dopamine to the 49mL of D5W.



DOPAMINE 1.6MG/mL


FOR 1

SYRINGE


D5W 48mL

To make 50mL:


40mg/mL.





DOPAMINE 3.2MG/mL


FOR 1

SYRINGE


D5W 46mL

To make 50mL:


40mg/mL





DOPAMINE 8MG/mL


FOR 1

SYRINGE


D5W 40mL

To make 50mL:


40mg/mL.



4. Mix syringe contents gently.




September-05

"DOPAMINE 0.8 MG/mL- PERIPHERAL OR CENTRAL LINE"Dose rate in mcg/kg/minute


0.5 kg 0.08 0.11 0.38 0.56 0.751.5 kg 0.23 0.34 1.13 1.69 2.25

3 kg 0.45 0.68 2.25 3.38 4.5

6 kg 0.9 1.35 4.5 6.75 920 kg 3 4.5 15 23 3040 kg 6 9 30 45 60


"DOPAMINE 1.6 MG/mL- CENTRAL LINE"Dose rate in mcg/kg/minute


0.5 kg 0.04 0.06 0.19 0.28 0.381.5 kg 0.11 0.17 0.56 0.84 1.13

3 kg 0.23 0.34 1.13 1.69 2.25

6 kg 0.45 0.68 2.25 3.38 4.520 kg 1.5 2.25 7.5 11.25 1540 kg 3 4.5 15 22.5 30


"DOPAMINE 3.2 MG/mL- CENTRAL LINE"Dose rate in mcg/kg/minute


0.5 kg 0.02 0.03 0.09 0.14 0.191.5 kg 0.06 0.08 0.28 0.42 0.563 kg 0.11 0.17 0.56 0.84 1.136 kg 0.23 0.34 1.13 1.69 2.25

20 kg 0.75 1.13 3.75 5.63 7.540 kg 1.5 2.25 7.5 11.25 15


"DOPAMINE 8 MG/mL- CENTRAL LINE"Dose rate in mcg/kg/minute


0.5 kg 0.01 0.01 0.04 0.06 0.081.5 kg 0.02 0.03 0.11 0.17 0.233 kg 0.05 0.07 0.23 0.34 0.456 kg 0.09 0.14 0.45 0.68 0.9

20 kg 0.3 0.45 1.5 2.25 340 kg 0.6 0.9 3 4.5 6

Pump flow rate (mL/hr) Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range


NEONATAL / PEDIATRIC EPINEPHRINE Neonatal/Pediatric Epinephrine IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Continuous Infusion: 0.1mcg/kg/minute

Usual/ Maximum Dose 20mcg/mL

Usual: 0.1-1mcg/kg/minute Maximum: 1mcg/kg/minute up to 20mcg/minute

EPINEPHRINE 0.02MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Epinephrine 1mg/mL

1mL

D5W

49mL

To make 50mL: 1. Using a 1mL syringe, draw up 1mL of Epinephrine 1mg/mL

(1:1000). 2. Using a 60mL syringe, draw up 49mL of D5W. 3. Add the 1mL of Epinephrine to the 49mL of D5W. 4. Mix syringe contents gently. 5. 24 hour expiration date



"EPINEPHRINE 0.02 MG/mL" September-05


Weight 0.01 0.02 0.05 0.1 0.5 10.5 kg 0.02 0.03 0.08 0.15 0.75 1.5

1.5 kg 0.05 0.09 0.23 0.45 2.25 4.5

3 kg 0.09 0.18 0.45 0.9 4.5 9

6 kg 0.18 0.36 0.9 1.8 9 18

20 kg 0.6 1.2 3 6 30 60

40 kg 1.2 2.4 6 12 60 120


= MAX OF 1MCG/KG/MIN OR 20MCG/MIN, WHICHEVER IS LESS



NEONATAL / PEDIATRIC ESMOLOL- Post-operative hypertension

Neonatal/Pediatric Esmolol IV Dosing and Preparation Guidelines Concentration Provided

Load: 500mcg/kg (over 1-2minutes) Continuous Infusion: 50mcg/kg/minute

Usual/ Maximum Dose

1-5kg – 10mg/mL in NS 6-21kg – 10mg/mL in NS

Over 21kg – 50mg/mL Usual: 50-250mcg/kg/minute Maximum: 1000mcg/kg/minute

ESMOLOL 10MG/mL (HYPERTENSION)


SYRINGE Esmolol 10mg/mL

10mL

To make 10mL: 1. Using a 10mL syringe, draw up 10mL of Esmolol

10mg/mL. 2. 24 hour expiration date

ESMOLOL 50MG/mL (HYPERTENSION)



10mL

0.9% Sodium Chloride 40mL


250mg/mL. 2. Using a 60mL syringe, draw up 40mL of 0.9% sodium

chloride. 3. Add the 10mL of Esmolol to the 40mL of 0.9% sodium

chloride. 4. Mix the syringe contents gently. 5. 24 hour expiration date



September-05

"ESMOLOL 10 MG/mL"INDICATION: HYPERTENSION


Weight 40 50 150 200 250 300 6000.5 kg 0.12 0.15 0.45 0.6 0.75 0.9 1.81.5 kg 0.36 0.45 1.35 1.8 2.25 2.7 5.4

3 kg 0.72 0.9 2.7 3.6 4.5 5.4 10.8

6 kg 1.44 1.8 5.4 7.2 9 10.8 21.620 kg 4.8 6 18 24 30 36 7240 kg 9.6 12 36 48 60 72 144


"ESMOLOL 50 MG/mL"INDICATION: HYPERTENSION


Weight 40 50 150 200 250 300 6000.5 kg 0.02 0.03 0.09 0.12 0.15 0.18 0.361.5 kg 0.07 0.09 0.27 0.36 0.45 0.54 1.08

3 kg 0.14 0.18 0.54 0.72 0.9 1.08 2.16

6 kg 0.29 0.36 1.08 1.44 1.8 2.16 4.3220 kg 0.96 1.2 3.6 4.8 6 7.2 14.440 kg 1.92 2.4 7.2 9.6 12 14.4 28.8



NEONATAL / PEDIATRIC ESMOLOL- Supraventricular tachycardia (SVT) Neonatal/Pediatric Esmolol IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Load: 100-500mcg/kg (over 1-2minutes) Continuous Infusion: 200mcg/kg/minute

Usual/ Maximum Dose

1-21kg - 10mg/mL = 10,000mcg/mL in NS Over 21kg - 50mg/mL = 50,000mcg/mL in NS


ESMOLOL 10MG/ML (10mL) (SVT)



10mL



ESMOLOL 50MG/mL (SVT)



10mL

0.9% Sodium Chloride 40mL


250mg/mL. 2. Using a 60mL syringe, draw up 40mL of 0.9% sodium

chloride. 3. Add the 10mL of Esmolol to the 40mL of 0.9% sodium

chloride. 4. Mix the syringe contents gently. 5. 24 hour expiration date



"ESMOLOL 10 MG/mL" September-05

INDICATION: SVTDose rate in mcg/kg/minute

Soft Min Soft Max Weight 100 200 400 600 800 1000

0.5 kg 0.3 0.6 1.2 1.8 2.4 31.5 kg 0.9 1.8 3.6 5.4 7.2 9

3 kg 1.8 3.6 7.2 10.8 14.4 18

6 kg 3.6 7.2 14.4 21.6 29 3620 kg 12 24 48 72 96 12040 kg 24 48 96 144 192 240


"ESMOLOL 50 MG/mL"INDICATION: SVT


Weight 100 200 400 600 800 10000.5 kg 0.06 0.12 0.24 0.36 0.48 0.61.5 kg 0.18 0.36 0.72 1.08 1.44 1.8

3 kg 0.36 0.72 1.44 2.16 2.9 3.6

6 kg 0.72 1.44 2.88 4.32 5.8 7.220 kg 2.4 4.8 9.6 14.4 19 24.040 kg 4.8 9.6 19.2 28.8 38 48.0



NEONATAL / PEDIATRIC FENTANYL Neonatal/Pediatric Fentanyl IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Load: 1-2mcg/kg (over 5-10minutes) Continuous Infusion: 0.5-1mcg/kg/hour Bolus: 0.5 – 4 mcg/kg (over 5 minutes)

Usual/ Maximum Dose

0kg-1kg - 0.005mg/mL = 5mcg/mL in D5W 1kg-5kg - 0.01mg/mL = 10mcg/mL in D5W

6kg to over 21kg – 0.05mg/mL = 50mcg/mL in D5W

Usual: 0.5-4mcg/kg/hour Maximum: Titrate to effect

FENTANYL 5MCG/mL/ML INGREDIENTS QUANTITY

FOR 1 SYRINGE

Fentanyl 5mcg/mL

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Fentanyl 5mcg/mL. 2. 24 hour expiration date

FENTANYL 10MCG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Fentanyl 10mcg/mL 50mL


FENTANYL 50MCG/mL


SYRINGE Fentanyl 50mcg/mL

20mL



Flow Rate as function of Drug Concentration, Dose and Patient Weight

"FENTANYL 5 MCG/mL" September-05


Weight 0.5 1 2 4 100.5 kg 0.05 0.1 0.2 0.4 11.5 kg 0.15 0.3 0.6 1.2 3

3 kg 0.3 0.6 1.2 2.4 6

6 kg 0.6 1.2 2.4 4.8 1220 kg 2 4 8 16 4040 kg 4 8 16 32 80


"FENTANYL 10 MCG/mL"Dose rate in mcg/kg/hour

Soft Min Soft Max Weight 0.5 1 2 4 10

0.5 kg 0.03 0.05 0.1 0.2 0.51.5 kg 0.08 0.15 0.3 0.6 1.5

3 kg 0.15 0.3 0.6 1.2 3

6 kg 0.3 0.6 1.2 2.4 620 kg 1 2 4 8 2040 kg 2 4 8 16 40


"FENTANYL 50 MCG/mL" August-05


Weight 0.5 1 2 4 100.5 kg 0.005 0.01 0.02 0.04 0.11.5 kg 0.015 0.03 0.06 0.12 0.3

3 kg 0.03 0.06 0.12 0.24 0.6

6 kg 0.06 0.12 0.24 0.48 1.220 kg 0.2 0.4 0.8 1.6 440 kg 0.4 0.8 1.6 3.2 8




NEONATAL / PEDIATRIC FUROSEMIDE Neonatal/Pediatric Furosemide IV Dosing and Preparation Guidelines

Concentration Provided - Starting Dose Continuous Infusion: 0.05mg/kg/hour

Usual/ Maximum Dose 1-21kg - 0.5mg/mL in D5W

Over 21kg - 10mg/mL in D5W Usual: 0.05-0.15mg/kg/hour Maximum: Titrate to effect

FUROSEMIDE 0.5MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Furosemide 10mg/mL

2.5mL

D5W

47.5mL

To make 50mL: 1. Using a 3mL syringe, draw up 2.5mL of Furosemide

10mg/mL. 2. Using a 60 mL syringe, draw up 47.5mL of D5W. 3. Add the 2.5mL of Furosemide to 47.5mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date

FUROSEMIDE 10MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Furosemide 10mg/mL

10mL

To make 10mL: 1. Using a 10mL syringe, draw up 10mL of Furosemide




"FUROSEMIDE 0.5 MG/mL" September-05


Weight 0.05 0.15 0.2 0.30.5 kg 0.05 0.15 0.2 0.31.5 kg 0.15 0.45 0.6 0.9

3 kg 0.3 0.9 1.2 1.8

6 kg 0.6 1.8 2.4 3.620 kg 2 6 8 1240 kg 4 12 16 24

"FUROSEMIDE 10 MG/mL"Dose rate in mg/kg/hour

Soft Min Soft Max Weight 0.05 0.15 0.2 0.3

0.5 kg 0 0.01 0.01 01.5 kg 0.01 0.02 0.03 0

3 kg 0.02 0.05 0.06 0.1

6 kg 0.03 0.09 0.12 0.220 kg 0.1 0.3 0.4 0.640 kg 0.2 0.6 0.8 1.2



NEONATAL / PEDIATRIC HEPARIN

Neonatal/Pediatric Heparin IV Dosing and Preparation Guidelines Concentration Provided Starting Dose

Load: 50-75units/kg (slowly over 10minutes)

Note: do not load if Alteplase (TPA) infusion is being used

Continuous Infusion: Children under 1 year: 28units/kg/hour Children 1 year & older: 20units/kg/hour

Starting Dose- Low Dose

Continuous infusion: 5-10 units/kg/hour

Usual/ Maximum Dose

1-21kg - 100UNITS/ML Over 21kg - 500UNITS/ML

Usual: Titrate to desired PTT ratio

HEPARIN REQUIRES A SECOND SIGNATURE BY AN ATTENDING OR FELLOW PRIOR TO ADMINISTRATION IN THE NEONATAL INTENSIVE CARE UNIT

HEPARIN 100UNITS/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Heparin Premixed Bag 100U/ML

(25,000 units/250 mL 0.45% Sodium chloride)

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Heparin

100Units/mL. 2. 24 hour expiration date

HEPARIN 500UNITS/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Heparin Premixed Syringe 500U/ML

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Heparin 500

Units/mL. 2. 24 hour expiration date



"HEPARIN 100 UNIT/mL - LOW DOSE" September-05

Dose rate in units/kg/hourSoft Min Soft Max

Weight 5 8 100.5 kg 0.03 0.04 0.051.5 kg 0.08 0.11 0.15

3 kg 0.15 0.23 0.3

6 kg 0.3 0.45 0.620 kg 1 1.5 240 kg 2 3 4


"HEPARIN 100 UNIT/mL"Dose rate in units/kg/hour

Soft Min Soft Max Weight 20 28 30 32 34 36 38

0.5 kg 0.1 0.14 0.15 0.16 0.17 0.18 0.191.5 kg 0.3 0.42 0.45 0.48 0.51 0.54 0.57

3 kg 0.6 0.84 0.9 0.96 1.02 1.08 1.14

6 kg 1.2 1.68 1.8 1.92 2.04 2.16 2.2820 kg 4 5.6 6 6.4 6.8 7.2 7.640 kg 8 11.2 12 12.8 13.6 14.4 15.2


"HEPARIN 500 UNIT/mL"Dose rate in units/kg/hour

Soft Min Soft Max Weight 20 28 30 32 34 36 38

0.5 kg 0.02 0.03 0.03 0.03 0.03 0.04 0.041.5 kg 0.06 0.08 0.09 0.1 0.1 0.11 0.11

3 kg 0.12 0.17 0.18 0.19 0.2 0.22 0.23

6 kg 0.24 0.34 0.36 0.38 0.41 0.43 0.4620 kg 0.8 1.12 1.2 1.28 1.36 1.44 1.5240 kg 1.6 2.24 2.4 2.56 2.72 2.88 3.04




NEONATAL / PEDIATRIC INSULIN Neonatal/Pediatric Insulin Regular IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Load:

Neonates: No load Infants and Children: 0.1units/kg over 2-3minutes

Continuous Infusion: Neonates: 0.01units/kg/hour Infants and Children: 0.05-0.1units/kg/hour

Usual/ Maximum Dose

0-1kg - 0.06units/mL in SWFI or NS 1-Over 21kg - 1unit/mL in SWFI or NS

Usual: 0.01-0.1units/kg/hour Maximum: Neonates: 0.1units/kg/hour Infants and Children: 0.2units/kg/hour

INSULIN REQUIRES A SECOND SIGNATURE BY AN ATTENDING OR FELLOW PRIOR TO ADMINISTRATION IN THE NEONATAL INTENSIVE CARE UNIT

INSULIN 0.06UNIT/ML (10mL) INGREDIENTS QUANTITY

FOR 1 SYRINGE

Regular Human Insulin 100u/mL (CZI)

0.1mL

SWFI or NS

20mL

(for Step 1 & 2)

To make a final volume of 10mL: Step One (1unit/mL): 1. Using a 1mL syringe, draw up 0.1 mL of regular Insulin

100units/mL. 2. Using a 10mL syringe, draw up 9.9 mL of SWFI or NS. 3. Add 0.1mL of regular insulin to 9.9 of SWFI or NS to yield

a concentration of 1unit/mL. 4. Mix the syringe contents gently. Step Two (0.06unit/mL): 1. Using a 1mL syringe, draw up 0.6mL of the regular insulin

1unit/mL. 2. Using a 10mL syringe, draw up 9.4mL of SWFI or NS. 3. Add the 0.6mL of regular insulin 1unit/mL to the 9.4mL of

SWFI or NS to yield a concentration of 0.06unit/mL 4. Mix the syringe contents gently. 5. 24 hour expiration date

INSULIN 1UNIT/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Regular Insulin Human 100u/mL (CZI)

0.5mL

SWFI or NS

49.5mL

To make 50mL: 1. Using a 1mL syringe, draw up 0.5mL of regular

insulin 100units/mL. 2. Using a 60mL syringe, draw up 49.5mL of SWFI or

NS. 3. Add the 0.5mL of regular insulin to 49.5mL of SWFI

or NS to yield a concentration of 1unit/mL 4. Mix the syringe contents gently. 5. 24 hour expiration date.



September-05

"INSULIN 0.06 UNIT/mL"- AVAILABLE IN THE NEONATAL INTENSIVE CARE UNIT ONLY Dose rate in units/kg/hour

Soft Min Soft Max Weight 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.1 0.2 0.4

0.5 kg 0.08 0.17 0.25 0.33 0.42 0.5 0.58 0.83 1.67 3.33

1.5 kg 0.25 0.5 0.75 1 1.25 1.5 1.75 2.5 5 10

3 kg 0.5 1 1.5 2 2.5 3 3.5 5 10 20

6 kg 1 2 3 4 5 6 7 10 20 40

20 kg 3.33 6.67 10.00 13.33 16.67 20 23.33 33.33 66.67 133.33


"INSULIN 1 UNIT/mL" September-05

Dose rate in units/kg/hourSoft Min Soft Max

Weight 0.05 0.1 0.15 0.20.5 kg 0.03 0.05 0.08 0.1

1.5 kg 0.08 0.15 0.23 0.3

3 kg 0.15 0.3 0.45 0.6

6 kg 0.3 0.6 0.9 1.2

20 kg 1 2 3 4

40 kg 2 4 6 8




NEONATAL / PEDIATRIC ISOPROTERENOL

Neonatal/Pediatric Isoproterenol IV Dosing and Preparation Guidelines Concentration Provided Starting Dose

Continuous Infusion: 0.05mcg/kg/minute Usual/ Max Dose

20mcg/mL

Usual: 0.05-2mcg/kg/minute Maximum: 2mcg/kg/minute

ISOPROTERENOL 0.02MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Isoproterenol 0.2mg/mL

5mL

D5W

45mL

To make 50mL: 1. Using a 10mL syringe, draw up 5mL of Isoproterenol

0.2mg/mL. 2. Using a 60mL syringe, draw up 45mL of D5W. 3. Add the 5mL of Isoproterenol to the 45mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date



"ISOPROTERENOL 0.02 MG/mL" September-05


Weight 0.05 0.1 0.2 0.4 0.8 1.6 20.5 kg 0.08 0.15 0.3 0.6 1.2 2.4 31.5 kg 0.23 0.45 0.9 1.8 3.6 7.2 9

3 kg 0.45 0.9 1.8 3.6 7.2 14.4 18

6 kg 0.9 1.8 3.6 7.2 14.4 28.8 3620 kg 3 6 12 24 48 96 12040 kg 6 12 24 48 96 192 240




NEONATAL / PEDIATRIC KETAMINE

Neonatal/Pediatric Ketamine IV Dosing and Preparation Guidelines Concentration Provided Starting Dose

Load: 1-2mg/kg over 3-5 minutes Continuous Infusion: 5mcg/kg/minute

Usual/ Maximum Dose

10mg/mL


KETAMINE 10MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Ketamine 10mg/mL

20mL

To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Ketamine 10mg/mL 2. 24 hour expiration date



"KETAMINE 10 MG/mL" September-05


Weight 5 10 15 200.5 kg 0.02 0.03 0.05 0.061.5 kg 0.05 0.09 0.14 0.18

3 kg 0.09 0.18 0.27 0.36

6 kg 0.18 0.36 0.54 0.7220 kg 0.6 1.2 1.8 2.440 kg 1.2 2.4 3.6 4.8



NEONATAL / PEDIATRIC LABETALOL Neonatal/Pediatric Labetalol IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Continuous Infusion: 0.4mg/kg/hour

Usual/ Maximum Dose 1-21kg- 1mg/mL in D5W

Over 21kg - 5mg/mL in D5W Usual: 0.4-1mg/kg/hour Maximum: 3mg/kg/hour

LABETALOL 1MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Labetalol 5mg/mL

10mL

D5W

40mL

To make 50mL: 1. Using a 10mL syringe, draw up 10mL of Labetalol 5mg/mL2. Using a 60mL syringe, draw up 40mL of D5W. 3. Add the 10mL of Labetalol to the 40mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date

LABETALOL 5MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Labetalol 5mg/mL

20mL

To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Labetalol 5mg/mL2. 24 hour expiration date



"LABETALOL 1 MG/mL" September-05

Dose rate in mg/kg/houSoft Min Soft Max

Weight 0.4 0.75 1 1.25 1.5 2 30.5 kg 0.2 0.38 0.5 0.63 0.75 1 1.51.5 kg 0.6 1.13 1.5 1.88 2.25 3 4.5

3 kg 1.2 2.25 3 3.75 4.5 6 9

6 kg 2.4 4.5 6 7.5 9 12 1820 kg 8 15 20 25 30 40 6040 kg 16 30 40 50 60 80 120


"LABETALOL 5 MG/mL" September-05


Weight 0.4 0.75 1 1.25 1.5 2 30.5 kg 0.04 0.08 0.1 0.13 0.15 0.2 0.31.5 kg 0.12 0.23 0.3 0.38 0.45 0.6 0.9

3 kg 0.24 0.45 0.6 0.75 0.9 1.2 1.8

6 kg 0.48 0.9 1.2 1.5 1.8 2.4 3.620 kg 1.6 3 4 5 6 8 1240 kg 3.2 6 8 10 12 16 24




NEONATAL / PEDIATRIC LIDOCAINE Neonatal/Pediatric Lidocaine IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Load: 1mg/kg (over 2-3min) q10minutes Continuous Infusion: 20mcg/kg/minute

Usual/ Maximum Dose

1-21kg - 8mg/mL Over 21kg - 40mg/mL


LIDOCAINE 8MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Lidocaine 1% (10mg/mL)

40mL

D5W 10mL

To make 50mL: 1. Using a 60mL syringe, draw up 40mL of Lidocaine

10mg/mL. 2. Using a 10mL syringe, draw up 10mL of D5W. 3. Add the 10mL of D5W to the 40mL of Lidocaine. 4. Mix the syringe contents gently. 5. 24 hour expiration date

LIDOCAINE 40MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Lidocaine 4% (40mg/mL)

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Lidocaine

40mg/mL 2. 24 hour expiration date



"LIDOCAINE 8 MG/mL" September-05


Weight 20 30 40 500.5 kg 0.08 0.11 0.15 0.191.5 kg 0.23 0.34 0.45 0.56

3 kg 0.45 0.68 0.9 1.13

6 kg 0.9 1.35 1.8 2.2520 kg 3 4.5 6 7.540 kg 6 9 12 15


"LIDOCAINE 40 MG/mL" September-05


Weight 20 30 40 500.5 kg 0.02 0.02 0.03 0.041.5 kg 0.05 0.07 0.09 0.11

3 kg 0.09 0.14 0.18 0.23

6 kg 0.18 0.27 0.36 0.4520 kg 0.6 0.9 1.2 1.540 kg 1.2 1.8 2.4 3




NEONATAL / PEDIATRIC MIDAZOLAM Neonatal/Pediatric Midazolam IV Dosing and Preparation Guidelines


Usual/ Maximum Dose 1mg/mL

Usual: 0.05-0.1mg/kg/hour Maximum: Titrate to effect

MIDAZOLAM 1MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Midazolam 5mg/mL

10mL

D5W 40mL

To make 50mL: 1. Using a 10mL syringe, draw up 10mL of Midazolam 5mg/mL 2. Using a 60mL syringe, draw up 40mL of D5W. 3. Add the 10mL of Midazolam to the 40mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date

MIDAZOLAM 5MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Midazolam 5mg/mL

50mL

To make 50mL: Using a 60mL syringe, draw up 50mL of Midazolam 5mg/mL 24 hour expiration date



"MIDAZOLAM 1 MG/mL" September-05


Weight 0.05 0.1 0.2 0.3 0.4 0.50.5 kg 0.03 0.05 0.1 0.15 0.2 0.31.5 kg 0.08 0.15 0.3 0.45 0.6 0.8

3 kg 0.15 0.3 0.6 0.9 1.2 1.5

6 kg 0.3 0.6 1.2 1.8 2.4 320 kg 1 2 4 6 8 1040 kg 2 4 8 12 16 20


"MIDAZOLAM 5 MG/mL"Dose rate in mg/kg/hour

Soft Min Soft Max Weight 0.05 0.10 0.20 0.30 0.40 0.50

0.5 kg 0.01 0.01 0.02 0.03 0.04 0.051.5 kg 0.02 0.03 0.06 0.09 0.12 0.15

3 kg 0.03 0.06 0.12 0.18 0.24 0.3

6 kg 0.06 0.12 0.24 0.36 0.48 0.620 kg 0.2 0.4 0.8 1.2 1.6 240 kg 0.4 0.8 1.6 2.4 3.2 4



NEONATAL / PEDIATRIC MILRINONE Neonatal/Pediatric Milrinone IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Load: 50-75mcg/kg over 15minutes Continuous Infusion: 0.25mcg/kg/minute

Usual/ Maximum Dose

1-21kg- 0.2mg/mL = 200mcg/mL in D5W Over 21kg- 0.4mg/mL = 400mcg/mL in D5W

Usual: 0.25-0.75mcg/kg/minute Maximum: 1mcg/kg/minute

MILRINONE 0.2MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Milrinone 0.2mg/mL (40mg/200mL premixed

bag)

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Milrinone

0.2mg/mL. 2. 24 hour expiration date

MILRINONE 0.4MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Milrinone 1mg/mL

20mL

D5W 30mL

To make 50mL: 1. Using a 60mL syringe, draw up 20mL of Milrinone

1mg/mL 2. Using a 60mL syringe, draw up 30mL of NS. 3. Add the 20mL of Milrinone to the 30mL of NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date


Flow Rate as a function of Drug Concentration, Dose Rate, Patient Weight

"MILRINONE 0.2 MG/mL" September-05


Weight 0.25 0.4 0.5 0.6 0.7 0.75 10.5 kg 0.04 0.06 0.08 0.09 0.11 0.11 0.151.5 kg 0.11 0.18 0.23 0.27 0.32 0.34 0.45

3 kg 0.23 0.36 0.45 0.54 0.63 0.68 0.9

6 kg 0.45 0.72 0.9 1.08 1.26 1.35 1.820 kg 1.5 2.4 3 3.6 4.2 4.5 640 kg 3 4.8 6 7.2 8.4 9 12


"MILRINONE 0.4 MG/mL"Dose rate in mcg/kg/minute

Soft Min Soft Max Weight 0.25 0.4 0.5 0.6 0.7 0.75 1

0.5 kg 0.02 0.03 0.04 0.05 0.05 0.06 0.081.5 kg 0.06 0.09 0.11 0.14 0.16 0.17 0.23

3 kg 0.11 0.18 0.23 0.27 0.32 0.34 0.45

6 kg 0.23 0.36 0.45 0.54 0.63 0.68 0.920 kg 0.75 1.2 1.5 1.8 2.1 2.25 340 kg 1.5 2.4 3 3.6 4.2 4.5 6




NEONATAL / PEDIATRIC MORPHINE Neonatal/Pediatric Morphine IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Continuous Infusion:

Neonates: 0.01-0.05mg/kg/hour Infants & children: 0.05-0.1mg/kg/hour

Usual/ Maximum Dose

0-1kg - 0.2mg/mL 1-over 21kg- 1mg/mL

Usual: 0.01-0.1mg/kg/hour Maximum: Titrate to effect

MORPHINE 0.2MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Morphine Sulfate 0.2mg/mL

50mL

To make 10mL: 1. Using a 60mL syringe, draw up 10mL of Morphine 0.2mg/mL. 2. 24 hour expiration date.

.

MORPHINE 1MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Morphine Sulfate 1mg/mL

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Morphine 1mg/mL. 2. 24 hour expiration date



"MORPHINE 0.2 MG/mL" April-05


Weight 0.05 0.1 0.5 10.5 kg 0.13 0.25 1.25 2.5

0.75 kg 0.19 0.38 1.88 3.751 kg 0.25 0.5 2.5 5

1.5 kg 0.38 0.75 3.75 7.5

3 kg 0.75 1.5 7.5 15

6 kg 1.5 3 15 3020 kg 5 10 50 100


"MORPHINE 1 MG/mL"Dose rate in mg/kg/hour

Soft Min Soft Max Weight 0.05 0.1 0.5 1

0.5 kg 0 0.05 0.25 0.51.5 kg 0.08 0.15 0.75 1.5

3 kg 0.15 0.3 1.5 3

6 kg 0.3 0.6 3 620 kg 1 2 10 2040 kg 2 4 20 40


"MORPHINE 10MG/mL"Dose rate in mg/kg/hour


0.5 kg 0 0.01 0.03 0.051.5 kg 0.01 0.02 0.08 0.153 kg 0.02 0.03 0.15 0.3

6 kg 0.03 0.06 0.3 0.620 kg 0.1 0.2 1 240 kg 0.2 0.4 2 4




0.5 kg 0 0 0.02 0.031.5 kg 0.01 0.01 0.05 0.13 kg 0.01 0.02 0.1 0.2

6 kg 0.02 0.04 0.20 0.420 kg 0.07 0.13 0.67 1.3340 kg 0.13 0.27 1.33 2.67




0.5 kg 0 0 0 01.5 kg 0 0 0 03 kg 0 0 0 0

6 kg 0 0 0 020 kg 0 0 0 140 kg 0 0 1 2


Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1- 0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range


NEONATAL / PEDIATRIC NITROGLYCERIN Neonatal/Pediatric Nitroglycerin IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Continuous Infusion: 1mcg/kg/minute

Usual/ Maximum Dose 1-21kg - 0.2mg/mL = 200mcg/mL in D5W

Over 21kg – 1mg/mL = 1000mcg/mL in D5W Usual: 1-5mcg/kg/minute Maximum: 5mcg/kg/minute

NITROGLYCERIN 0.2MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Nitroglycerin 0.2mg/mL (10mg/50mL vial)

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Nitroglycerin

0.2mg/mL. 2. 24 hour expiration date

NITROGLYCERIN 1MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Nitroglycerin 1mg/mL (50mg/50mL vial)

50mL

To make 50mL: 1. Using a 60mL syringe, draw up 50mL of Nitroglycerin




"NITROGLYCERIN 0.2 MG/mL" September-05


Weight 1 2 3 4 50.5 kg 0.15 0.3 0.45 0.6 0.751.5 kg 0.45 0.9 1.35 1.8 2.25

3 kg 0.9 1.8 2.7 3.6 4.5

6 kg 1.8 3.6 5.4 7.2 920 kg 6 12 18 24 3040 kg 12 24 36 48 60


"NITROGLYCERIN 1 MG/mL"Dose rate in mcg/kg/minute


0.5 kg 0.03 0.06 0.09 0.12 0.151.5 kg 0.09 0.18 0.27 0.36 0.45

3 kg 0.18 0.36 0.54 0.72 0.9

6 kg 0.36 0.72 1.08 1.44 1.820 kg 1.2 2.4 3.6 4.8 640 kg 2.4 4.8 7.2 9.6 12



NEONATAL / PEDIATRIC NITROPRUSSIDE Neonatal/Pediatric Nitroprusside IV Dosing and Preparation Guidelines


Usual/ Maximum Dose 200mcg/mL

Usual: 1-5mcg/kg/minute Maximum: 5mcg/kg/minute * Doses greater than 4mcg/kg/minute, and/or prolonged infusions may cause cyanide toxicity

NITROPRUSSIDE 0.2MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Sodium Nitroprusside 25mg/mL

0.4mL

D5W

49.6mL

To make 50mL: 1. Using a 1mL syringe, draw up 0.4mL of Nitroprusside

25mg/mL. 2. Using a 60mL syringe, draw up 49.6mL of D5W. 3. Add the 0.4mL of Nitroprusside to the 49.6mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date 6. Protect from light (wrap dose in foil or place in a dark

colored bag).



"NITROPRUSSIDE 0.2 MG/mL" September-05


Weight 0.5 1 1.5 2 2.5 3 3.5 4 50.5 kg 0.08 0.15 0.23 0.3 0.38 0.45 0.53 0.6 0.751.5 kg 0.23 0.45 0.68 0.9 1.13 1.35 1.58 1.8 2.25

3 kg 0.45 0.9 1.35 1.8 2.25 2.7 3.15 3.6 4.5

6 kg 0.9 1.8 2.7 3.6 4.5 5.4 6.3 7.2 920 kg 3 6 9 12 15 18 21 24 3040 kg 6 12 18 24 30 36 42 48 60


Doses greater than 3 mcg/kg/min may lead to cyanide toxicity Flow rate <0.3 mL (at or near pump minumum) or >20 mL/hr (assess for fluid overload) Flow rates 0.1-0.3mL may be initiated in an emergency, please page the pharmacist Flow rate within recommended range


NEONATAL / PEDIATRIC NOREPINEPHRINE Neonatal/Pediatric Norepinephrine IV Dosing and Preparation Guidelines


Usual/ Maximum Dose 0.08mg/mL

Usual: 0.05-2mcg/kg/minute


NOREPINEPHRINE 0.08MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Norepinephrine 1mg/mL

4mL

D5W

46mL

To make 50mL: 1. Using a 10mL syringe, draw up 4mL of Norepinephrine

1mg/mL. 2. Using a 60mL syringe, draw up 46mL of D5W. 3. Add the 4mL of Norepinephrine to the 46mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date



"NOREPINEPHRINE 0.04 MG/mL" April-06


Weight 0.04 0.05 0.2 0.75 1 1.5 20.5 kg 0.03 0.04 0.15 0.56 0.75 1.13 1.51.5 kg 0.09 0.11 0.45 1.69 2.25 3.38 4.5

3 kg 0.18 0.23 0.9 3.38 4.50 6.75 9

6 kg 0.36 0.45 1.8 6.75 9 13.5 1820 kg 1.2 1.5 6 23 30 45 6040 kg 2.4 3 12 45 60 90 120


"NOREPINEPHRINE 0.08 MG/mL" September-05


Weight 0.04 0.05 0.2 0.75 1 1.5 20.5 kg 0.02 0.02 0.08 0.28 0.38 0.56 0.751.5 kg 0.05 0.06 0.23 0.84 1.13 1.69 2.25

3 kg 0.09 0.11 0.45 1.69 2.25 3.38 4.5

6 kg 0.18 0.23 0.9 3.38 4.5 6.75 920 kg 0.6 0.75 3 11.25 15 22.5 3040 kg 1.2 1.5 6 22.5 30 45 60


= MAX OF 2MCG/KG/MIN OR 20MCG/MIN, WHICHEVER IS LESS



NEONATAL / PEDIATRIC PANCURONIUM Neonatal/Pediatric Pancuronium IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Continuous Infusion: 0.05-0.1mg/kg/hour

Usual/ Maximum Dose 1mg/mL

Maximum: 0.2mg/kg/hour

PANCURONIUM 1MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Pancuronium 2mg/mL

5mL

D5W 5mL

To make 10mL: 1. Using a 10mL syringe, draw up 5mL of Pancuronium

2mg/mL. 2. Using a 10mL syringe, draw up 5mL of D5W. 3. Add the 5mL of Pancuronium to the 5mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date



"PANCURONIUM 1 MG/mL" September-05

Dose rate in mg/kg/hour Soft Min Soft Max

Weight 0.05 0.1 0.15 0.20.5 kg 0.03 0.05 0.08 0.1

0.75 kg 0.04 0.08 0.11 0.151.0 kg 0.05 0.1 0.15 0.21.5 kg 0.08 0.15 0.23 0.3

3 kg 0.15 0.3 0.45 0.6

6 kg 0.3 0.6 0.9 1.220 kg 1 2 3 440 kg 2 4 6 8




NEONATAL / PEDIATRIC PENTOBARBITAL Neonatal/Pediatric Pentobarbital IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Pentobarbital coma: Load: 5-10mg/kg over 1-2 hours Continuous Infusion: 1mg/kg/hour

Usual/ Maximum Dose

50mg/mL

Usual: 1-5mg/kg/hour Maximum: 5mg/kg/hour

PENTOBARBITAL 50MG/mL INGREDIENTS

QUANTITY

FOR 1 SYRINGE

Pentobarbital 50mg/mL

20mL

To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Pentobarbital




"PENTOBARBITAL 50 MG/mL" September-05


Weight 0.5 1 3 50.5 kg 0.01 0.01 0.03 0.051.5 kg 0.02 0.03 0.09 0.15

3 kg 0.03 0.06 0.18 0.3

6 kg 0.06 0.12 0.36 0.620 kg 0.2 0.4 1.2 240 kg 0.4 0.8 2.4 4




NEONATAL / PEDIATRIC PHENYLEPHRINE Neonatal/Pediatric Phenylephrine IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Continuous Infusion: 0.1-0.5mcg/kg/minute

Usual/ Maximum Dose 1-21kg – 0.08mg/mL = 80mcg/mL

Over 21kg – 1.2mg/mL = 1200mcg/mL Usual: 0.1-1mcg/kg/minute


PHENYLEPHRINE 0.08MG/mL INGREDIENTS

QUANTITY

FOR 1 SYRINGE

Phenylephrine 10mg/mL

0.4mL

D5W

49.6mL

To make 50mL: 1. Using a 1mL syringe, draw up 0.4mL of Phenylephrine

10mg/mL. 2. Using a 60mL syringe, draw up 49.6mL of D5W. 3. Add the 0.4mL of Phenylephrine to the 49.6mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date

PHENYLEPHRINE 1.2MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Phenylephrine 10mg/mL 6mL

D5W 44mL

To make 50mL: 1. Using a 10mL syringe, draw up 6mL of Phenylephrine

10mg/mL. 2. Using a 60mL syringe, draw up 44mL of D5W. 3. Add the 6mL of Phenylephrine to the 44mL of D5W. 4. Mix the syringe contents gently. 5. 24 hour expiration date



"PHENYLEPHRINE 0.08 MG/ML" September-05


Weight 0.1 0.25 0.5 0.75 10.5 kg 0.04 0.09 0.19 0.28 0.381.5 kg 0.11 0.28 0.56 0.84 1.13

3 kg 0.23 0.56 1.13 1.69 2.25

6 kg 0.45 1.13 2.25 3.38 4.520 kg 1.5 3.75 7.5 11.25 1540 kg 3 7.5 15 22.5 30

Pump flow rate (ml/hr)

"PHENYLEPHRINE 1.2 MG/ML"Dose rate in mcg/kg/minute

Soft Min Soft Max Weight 0.1 0.25 0.5 0.75 1

0.5 kg 0.00 0.01 0.01 0.02 0.031.5 kg 0.01 0.02 0.04 0.06 0.08

3 kg 0.02 0.04 0.08 0.11 0.15

6 kg 0.03 0.08 0.15 0.23 0.320 kg 0.1 0.25 0.5 0.75 140 kg 0.2 0.5 1 1.5 2

Pump flow rate (ml/hr)

Flow rate <0.3 ml (at or near pump minumum) or >20 ml/hr (assess for fluid overload) Flow rates 0.1-0.3ml may be initiated in an emergency, please page the pharmacist Flow rate within recommended range


NEONATAL / PEDIATRIC Dexmedetomidine Neonatal/Pediatric Dexmedetomidine IV Administration Guidelines

Concentration Provided Starting Dose Continuous Infusion: 0.2 mcg/kg/hour

Usual/ Max Dose 4 mcg/ml in NS

Usual: 0.2-0.7 mcg/kg/hour Max: 0.7 mcg/kg/hour

PRECEDEX 4 MCG/mL (DEXMEDETOMIDINE)


FOR 1 SYRINGE

Dexmedetomidine

To make 50 mL: Contact pharmacy for the syringe



"PRECEDEX 4 MCG/mL" (Dexmedetomidine) September-06


Weight 0.2 0.3 0.4 0.5 0.6 0.70.5 kg 0.03 0.04 0.05 0.06 0.08 0.091.5 kg 0.08 0.11 0.15 0.19 0.23 0.26

3 kg 0.15 0.23 0.3 0.38 0.45 0.53

6 kg 0.30 0.45 0.6 0.75 0.9 1.0520 kg 1 1.5 2 2.5 3 3.540 kg 2 3 4 5 6 7




NEONATAL / PEDIATRIC PROPOFOL Neonatal/Pediatric Propofol IV Dosing and Preparation Guidelines


Usual/ Maximum Dose 10mg /mL

Usual: 0.5-5mg/kg/hour Maximum: 5mg/kg/hour

PROPOFOL 10MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Propofol 10mg/mL (20mL vial)

20mL

To make 20mL: 1. Draw the 20 mL of Propofol directly from vial into 20mL syringe


PROPOFOL 10MG/mL INGREDIENTS Not for

Syringe Propofol 10mg/mL

(100mL bottle)*

* Restricted to infusion rates greater than 100mg/hr

Infusion bottles and tubing must be changed every 12 hours and unused drug discarded



"PROPOFOL 10 MG/mL" September-05


Weight 0.5 1 2 3 4 50.5 kg 0.25 0.5 1 1.5 2 2.51.5 kg 0.75 1.5 3 4.5 6 7.5

3 kg 1.5 3 6 9 12 15

6 kg 3 6 12 18 24 3020 kg 10 20 40 60 80 10040 kg 20 40 80 120 160 200




NEONATAL / PEDIATRIC TERBUTALINE Neonatal/Pediatric Terbutaline IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Load: 10mcg/kg over 3-5minutes Continuous Infusion: 0.4mcg/kg/minute

Usual/ Maximum Dose

1000mcg/mL

Usual: 0.4-6mcg/kg/minute Maximum: 6mcg/kg/minute

TERBUTALINE 1000MCG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Terbutaline 1mg/mL (20mg/20mL vial)

20mL

To make 20mL: 1. Using a 30mL syringe, draw up 20mL of Terbutaline




"TERBUTALINE 1000 MCG/mL" September-05


Weight 0.4 0.8 1 2 3 4 5 60.5 kg 0.01 0.02 0.03 0.06 0.09 0.12 0.15 0.181.5 kg 0.04 0.07 0.09 0.18 0.27 0.36 0.45 0.54

3 kg 0.07 0.14 0.18 0.36 0.54 0.72 0.9 1.08

6 kg 0.14 0.29 0.36 0.72 1.08 1.44 1.8 2.1620 kg 0.48 0.96 1.2 2.4 3.6 4.8 6 7.240 kg 0.96 1.92 2.4 4.8 7.2 9.6 12 14.4




NEONATAL / PEDIATRIC VASOPRESSIN Neonatal/Pediatric Vasopressin

DIABETES INSIPIDUS IV Dosing and Preparation Guidelines Concentration Provided Starting Dose

Continuous Infusion: 0.5milliunits/kg/hour Usual/ Maximum Dose

6-21kg – 0.02unit/mL = 20milliunits/mL in NS Over 21kg – 1unit/mL = 1000milliunits/mL in NS

Usual: 0.5-1milliunit/kg/hour

Maximum: 10 milliunits/kg/hour

VASOPRESSIN 0.02UNIT/mL (DIABETES INSIPIDUS)


SYRINGE Vasopressin 20unit/mL

0.05mL

NS 49.95mL

To make 50mL: 1. Using a 1mL syringe, draw up 0.05mL of Vasopressin

20u/mL. 2. Using a 60mL syringe, draw up 49.95mL of NS. 3. Add the 0.05mL of Vasopressin 20U/mL to the 49.95mL

of NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date

VASOPRESSIN 1UNIT/mL (DIABETES INSIPIDUS)


SYRINGE Vasopressin 20unit/mL

2.5mL

NS 47.5mL

To make 50mL: 1. Using a 3mL syringe, draw up 2.5mL of Vasopressin

20u/mL. 2. Using a 60mL syringe, draw up 47.5mL of 0.9%. 3. Add the 2.5mL of Vasopressin 20U/mL to the 47.5mL of

NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date



"VASOPRESSIN 0.02 UNITS/mL" September-05

INDICATION: DIABETES INSIPIDUSDose rate in milliunit/kg/hour

Soft Min Soft Max Weight 0.5 1 2.5 5 7.5 10

0.5 kg 0.01 0.03 0.06 0.13 0.19 0.251.5 kg 0.04 0.08 0.19 0.38 0.56 0.75

3 kg 0.08 0.15 0.38 0.75 1.13 1.5

6 kg 0.15 0.3 0.75 1.5 2.25 320 kg 0.5 1 2.5 5 7.5 1040 kg 1 2 5 10 15 20


Note: for Pediatric Patients >40KG use Adult ICU Protocol (below)

"VASOPRESSIN >40KG 1 UNIT/mL"INDICATION: DIABETES INSIPIDUS

Dose rate in units/hourSoft Min Soft Max

Weight 2.4 4 5 6 7 101.0 kg 2.4 4 5 6 7 10




NEONATAL / PEDIATRIC VASOPRESSIN Neonatal/Pediatric Vasopressin

GASTROINTESTINAL BLEED IV Dosing and Preparation Guidelines Concentration Provided Starting Dose

Continuous Infusion: 0.002units/kg/minute Usual/ Maximum Dose

0.02unit/mL = 20milliunits/mL in NS Over 21kg – 1unit/mL = 1000milliunits/mL in NS

Usual: 0.002-0.005 units/kg/minute Maximum: 0.01 units/kg/minute

VASOPRESSIN 1UNIT/mL (GI BLEED) GI


SYRINGE Vasopressin 20u/mL

2.5mL

NS 47.5mL

To make 50mL: 1. Using a 3mL syringe, draw up 2.5mLof Vasopressin

20u/mL. 2. Using a 60mL syringe, draw up 47.5mL of NS. 3. Add the 2.5mL of Vasopressin 20U/mL to the 47.5mL of




"VASOPRESSIN 1 UNIT/mL" September-05

INDICATION: GI BLEED

Dose rate in units/kg/minuteSoft Min Soft Max

Weight 0.002 0.005 0.01 0.030.5 kg 0.06 0.15 0.3 0.91.5 kg 0.18 0.45 0.9 2.73 kg 0.36 0.9 1.8 5.4

6 kg 0.72 1.8 3.6 10.820 kg 2.4 6 12 3640 kg 4.8 12 24 72



"VASOPRESSIN >40KG 1 UNIT/mL"INDICATION: GI BLEED

Dose rate in units/minuteSoft Min Soft Max

Weight 0.1 0.2 0.4 0.81.0 kg 6 12 24 48




Neonatal/Pediatric Vasopressin VASODILATORY SHOCK IV Dosing and Preparation Guidelines

Concentration Provided Starting Dose Continuous Infusion: 0.3milliunits/kg/minute

Usual/ Maximum Dose 6-21kg - 0.4units/mL = 400milliunits/mL in NS

Over 21kg - 1unit/mL = 1000milliunits/mL in NS Usual: 0.3-2milliunits/kg/minute Maximum: 2milliunits/kg/minute

VASOPRESSIN 0.4 UNIT/mL (VASODILATORY SHOCK)



1 mL

NS 50mL

To make 50mL: 1. Using a 1mL syringe, draw up 1 mL of Vasopressin

20u/mL. 2. Using a 60mL syringe, draw up 49mL of NS. 3. Add the 1mL of Vasopressin to the 49mL of NS. 4. Mix the syringe contents gently. 5. 24 hour expiration date

VASOPRESSIN 1UNIT/mL (VASODILATORY SHOCK)



2.5mL

NS 47.5mL

To make 50mL: 1. Using a 3mL syringe, draw up 2.5mLof Vasopressin

20u/mL. 2. Using a 60mL syringe, draw up 47.5mL of NS. 3. Add the 2.5mL of vasopressin 20U/mL to the 47.5mL of




"VASOPRESSIN O.4 UNITS/mL" September-05

INDICATION: VASODILATORY SHOCKDose rate in milliunit/kg/minute

Soft Min Soft Max Weight 0.3 0.5 1 2 5 7.5 10

0.5 kg 0.02 0.04 0.08 0.15 0.38 0.56 0.751.5 kg 0.07 0.11 0.23 0.45 1.13 1.69 2.25

3 kg 0.14 0.23 0.45 0.9 2.25 3.38 4.5

6 kg 0.27 0.45 0.9 1.8 4.5 6.75 920 kg 0.9 1.5 3 6 15 22.5 30


"VASOPRESSIN 1 UNIT/mL"INDICATION: VASODILATORY SHOCK

Dose rate in milliunit/kg/minuteSoft Min Soft Max

Weight 0.3 0.5 1 2 5 7.5 100.5 kg 0.01 0.02 0.03 0.06 0.15 0.23 0.31.5 kg 0.03 0.05 0.09 0.18 0.45 0.68 0.9

3 kg 0.05 0.09 0.18 0.36 0.9 1.35 1.8

6 kg 0.11 0.18 0.36 0.72 1.8 2.7 3.620 kg 0.36 0.6 1.2 2.4 6 9 1240 kg 0.72 1.2 2.4 4.8 12 18 24



"VASOPRESSIN >40KG 1 UNIT/mL"INDICATION: VASODILATORY SHOCK

Dose rate in units/minuteSoft Min Soft Max

Weight 0.01 0.02 0.03 0.040.5 kg 0.6 1.2 1.8 2.4




NEONATAL / PEDIATRIC VECURONIUM Neonatal/Pediatric Vecuronium IV Dosing and Preparation Guidelines


Usual/ Maximum Dose

1mg/mL

Usual: 0.1-0.15mg/kg/hour Maximum: 0.2mg/kg/hour

. VECURONIUM 1MG/mL INGREDIENTS QUANTITY

FOR 1 SYRINGE

Vecuronium 10mg/mL* 10mL

* Reconstitute Vecuronium 10 mg vial with 10mL SWFI

To make 10mL: 1. Reconstitute Vecuronium 10mg vial with 10mL SWFI. 2. Using a 10mL syringe, draw up 10mL of Vecuronium. 3. 24 hour expiration date



"VECURONIUM 1 MG/mL" September-05


Weight 0.04 0.05 0.1 0.20.5 kg 0.02 0.03 0.05 0.1

0.75 kg 0.03 0.04 0.08 0.151.00 kg 0.04 0.05 0.1 0.21.5 kg 0.06 0.08 0.15 0.33 kg 0.12 0.15 0.3 0.66 kg 0.24 0.3 0.6 1.2

20 kg 0.8 1 2 440 kg 1.6 2 4 8





MassGeneral Hospital for Children NICU/PICU Pediatric ...

Documents

Transcript of MassGeneral Hospital for Children NICU/PICU Pediatric ...