• Read the Preface and the Format and Content of Intravenous Medications sections at least once. They’ll answer many of your questions and save you time.

USUAL DOSE

• Doses calculated on body weight are usually based on pretreatment weight and not on edematous weight.
• Normal renal or hepatic function is usually required for drugs metabolized by these routes.
• Formula to calculate creatinine clearance (CrCl) from serum creatinine value (Cockcroft–Gault equation):
  • Males:
  • Females: 0.85 × Male CrCl value calculated from above formula.
• Children:
  • K for children >1 year of age = 0.55
  • K for infants = 0.45
• Lean body weight (LBW)
  • Males: 50 kg + 2.3 kg for each inch over 5 feet
  • Females: 45.5 kg + 2.3 kg for each inch over 5 feet
  • Children weighing 15 kg or less: Use actual body weight in kg
• Formula to calculate body surface area (BSA):
• To prevent unintentional overdose, a premixed solution such as DUPLEX or Galaxy containers available in a specific dose (e.g., 1 Gm, 2 Gm) should be used in pediatric patients only when the individual dose is the entire contents of the container and not any fraction thereof.

DILUTION

• Check all labels (drugs, diluents, and solutions) to confirm appropriateness for IV use.
• Sterile technique is imperative in all phases of preparation.
• Use a filter needle when withdrawing IV meds from ampules to eliminate possible pieces of glass.
• Pearls:
  • 1 Gm in 1 Liter yields 1 mg/mL.
  • 1 mg in 1 Liter yields 1 mcg/mL.
  • % of a solution equals the number of grams/100 mL (5% = 5 Gm/100 mL).
• Pediatric dilution:
  • If you dilute 6.0 mg/kg in 100 mL, 1 mL/hr equals 1.0 mcg/kg/min.
  • If you dilute 0.6 mg/kg in 100 mL, 1 mL/hr equals 0.1 mcg/kg/min.
• To prevent unintentional overdose, a premixed solution such as DUPLEX or Galaxy containers available in a specific dose (e.g., 1 Gm, 2 Gm) should be used in pediatric patients only when the individual dose is the entire contents of the container and not any fraction thereof.
• See charts on inside front cover.
• Do not use bacteriostatic diluents containing benzyl alcohol for neonates, as doing so may cause a fatal toxic syndrome. Signs and symptoms (S/S) include CNS depression, hypotension, intracranial hemorrhage, metabolic acidosis, renal failure, respiratory problems, and seizures.
• Ensure adequate mixing of all drugs added to a solution.
• When combining drugs in a solution (additives), always consider the required rate adjustment of each drug.
• Examine solutions for clarity and any possible leakage.
• Frozen infusion solutions should be thawed at room temperature (25°C; 77°F) or under refrigeration. Do not force by immersion in water baths or in the microwave. All ice crystals must be melted before administration. Do not refreeze.
• Syringe prepackaging for use in specific pumps is now available for many drugs. Concentrations are often the strongest permissible, but length of delivery is accurate.
• Controlled room temperature (CRT) is considered to be 25°C (77°F). Most medications tolerate variations in temperature from 15°C to 30°C (59°F to 86°F).

INCOMPATIBILITIES

• Some manufacturers routinely suggest discontinuing the primary IV for intermittent infusion, which is usually done to avoid any possibility of incompatibility. Flushing the line before and after administration may be indicated and/or appropriate for some drugs.
• The brand of intravenous fluids or additives, concentrations, containers, rate and order of mixing, pH, and temperature all affect solubility and compatibility. Consult your pharmacist with any questions, and document appropriate instructions on the care plan.

TECHNIQUES

• Do not hang IV infusions in flexible plastic containers in series connection, do not pressurize IV infusions in flexible plastic containers to increase flow rates without first fully evacuating residual air from the container, and do not use vented IV administration sets with IV infusions in flexible plastic containers. All may result in air embolism.
• Confirm the patency of peripheral and/or central sites. Avoid extravasation.
• Avoid accidental arterial injection, as it can cause gangrene.

RATE OF ADMINISTRATION

• Life-threatening reactions (time-related overdose or allergy) are frequently precipitated by a too-rapid rate of injection.
• If a common IV line is used to administer other drugs through the same IV line, flush the IV line before and after each infusion with a compatible solution (e.g., NS, D5W). When flushing before administration, be sure to flush with an amount adequate to clear the previous drug (e.g., mL of drug or mL of lumen of catheter). When flushing after administration, be sure to flush with an amount at least equal to that of the drug administered (e.g., mL of drug or mL of lumen of catheter).

PATIENT EDUCATION

• A well-informed patient is a great asset; review all appropriate drug information with every conscious patient.

SIDE EFFECTS

• Reactions may be caused by a side effect of the drug itself, allergic response, overdose, or the underlying disease process.