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Intravenous Administration of Formulary Medications – Pediatric/Neonatal – Inpatient/Ambulatory

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2


Intravenous Administration of Formulary Medications
– Pediatric/Neonatal – Inpatient/Ambulatory
Clinical Practice Guideline
Table of Contents
Executive Summary ............................................................................................................................................... 3
Scope ...................................................................................................................................................................... 4
Methodology........................................................................................................................................................... 4
Definitions .............................................................................................................................................................. 5
Introduction ............................................................................................................................................................ 5
Recommendations ................................................................................................................................................. 6
UW Health Implementation ................................................................................................................................. 72
References............................................................................................................................................................ 72
Appendix A. Evidence Grading Scheme ........................................................................................................... 74
Appendix B. Medications Requiring Central Lines ......................................................................................... 75

Contact for Content and Changes:
Philip Trapskin, Manager, Patient Care Services and Drug Policy Program
Phone Number: (608) 263-1328
Email: PTrapskin@uwhealth.org

Guideline Authors:
Joshua Vanderloo, PharmD
Emily Zimmerman, PharmD

Coordinating Team Members:
Joshua Vanderloo, PharmD; Philip Trapskin, PharmD, BCPS

Review Individuals/Bodies:
AFCH Nursing Leadership:
Barbara Byrne, VP AFCH Clinical Operations; Laura Ahola, Nurse Manager PUCU; Angela Baker, Nurse
Manager NICU; Devon Christenson, Nurse Manager Diagnostic/Therapy Center; Carrie Cronk, Nurse
Manager P4; Kirsten Koffarnus, CNS P5; Laura Konkol, CNS NICU; Kitty Montgomery, CNS P4; Anne
Moseley, Director Pediatric Nursing; Sue Quamme, Nurse Manager PI44; Windy Smith, Nurse Manager P5
Deborah Soetenga, CNS PI44; Lori Williams, CNS PUCU

Pharmacists; Brian LaRowe, PharmD; Nicole Lubcke, PharmD; Mary Mably, Pharmacy Coordinator
Oncology, PharmD, BCOP; Aaron Steffenhagen, Pharmacy Manager Critical Care, PharmD, BCPS;
Meghann Voegeli, Pharmacy Manager Pediatrics, PharmD

Dan O’Connell, MD, Pediatric Gastroenterology
Daniel Sklansky, MD, Hospitalist
Benjamin Walker, MD, Pediatric Anesthesiology

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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3

Committee Approvals/Dates:
Pharmacy and Therapeutics Committee (Last Periodic Review: September 2014)
• Interim Revisions: November 2014, January 2015, September 2015, Novemeber 2015, November
2017, December 2017, January 2018

Release Date: October 2016 Next Review Date: October 2018

Executive Summary
Guideline Overview
This guideline directs the appropriate administration of intravenous medications to pediatric patients across UWHealth
throughout inpatient, procedural, and ambulatory settings. Necessary elements include appropriate level of care,
monitoring, and physicochemical considerations.

There are many medications given intravenously both in inpatient settings, procedural areas, or ambulatory care
settings. The purpose of this guideline is to provide guidance for the administration of intravenous medications to
pediatric patients across these care settings. The medications in this guideline were chosen based on their inclusion
in the UWHC medication formulary and the units were administration is appropriate. These administration guidelines
are not absolute; administration of intravenous medications should be tailored to fit the therapeutic needs of a
pediatric patient as appropriate.

Key Revisions
January 2018 Minor Revision
• Addition of siltuximab

December 2017 Minor Revision
• Midazolam use in general care areas for prolonged epilepsy monitoring

November 2017 Minor Revision
• Addition of guidance for rapid infusion of infliximab

2016 Periodic Review
• Addition of new intravenous medications since previous September 2014 revision: ethacrynic acid,
tocilizumab, isavuconazole, eculizumab, C1 esterase inhibitor (CINRYZE
®
), peramivir, levofloxacin,
dinutuximab, doripenem, laronidase, granisetron, sugammadex, vedolizumab, lacosamide, defibrotide,
daratumumab, vincristine
• Clarification of magnesium administration rates for repletion, torsades de pointes, and bronchospasm
• Addition of appendix detailing medications requiring central line

Key Practice Recommendations
The guideline includes recommendations for UWHealth formulary intravenous medications with respect to
recommended infusion rates, considereations for administration, and monitoring of medications with administration.
See table in Recommendations section for information on specific medications.

Companion Documents
• Guideline for the Management of Extravasation of Chemotherapeutic Agents – Adult/Pediatric –
Inpatient/Ambulatory Clinical Practice Guideline
• Guideline for Non-chemotherapeutic Agents: Prevention and Treatment of Chemical Phlebitis and
Extravasation of Peripherally Administered Non-chemotherapeutic Agents – Adult and Pediatric – Inpatient
Clinical Practice Guideline
• Acetylcysteine (N-Acetylcysteine) – Pediatric/Adult – Inpatient Clinical Practice Guideline
• Procoagulant Therapy for Treatment of Non-Hemophiliac Bleeding – Adult Clinical Practice Guideline
• Granulocyte Colony Stimulating Factor – Adult/Pediatric – Inpatient Clinical Practice Guideline
• Fosphenytoin and Phenytoin – Adult and Pediatric – Inpatient Clinical Practice Guideline
• Therapeutic Dosing of Unfractionated Heparin – Pediatric/Neonatal – Inpatient Clinical Practice Guideline
• Intravenous Immunoglobulin (IVIG) – Adult/Pediatric – Inpatient /Ambulatory Clinical Practice Guideline
• High-dose Methotrexate, Leucovorin, and Glucarpidase Dosing, Administration, and Monitoring –
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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4

Adult/Pediatric Intpatient Clinical Practice Guideline
• Use of Rasburicase – Adult and Pediatric – Inpatient Clinical Practice Guideline
• Intravenous Hypertonic Sodium Chloride – Adult and Pediatric – Inpatient Clinical Practice Guideline

Pertinent UWHC Policies and Procedures
• Policy 8.31 Guidelines for Hospital Location Specific Administration of IV Medications
• Policy 8.33 High Alert Medication Administration
• Policy 8.56 Pediatric Sedation
• Policy 6.1.11 Preventing Non-therapeutic Exposure to Hazardous Drugs
• Factor 7a Recombinant Operating Procedure
• Factor 9 Complex Concentrate (PCC) Operating Procedure
• Policy 10.18 Parenteral Lidocaine for Neuropathic Pain

Scope
Disease/Condition:
Intravenous medication administration

Extravasation of medications is not addressed in this guideline. For this information, refer to:
• UWHC Guidelines for the Management of Extravasation of Chemotherapeutic Agents – Adult/Pediatric –
Inpatient/Ambulatory Clinical Practice Guideline
• Guideline for Non-chemotherapeutic Agents: Prevention and Treatment of Chemical Phlebitis and
Extravasation of Peripherally Administered Non-chemotherapeutic Agents – Adult and Pediatric – Inpatient
Clinical Practice Guideline

Clinical Specialty:
This guideline is intended for all personnel authorized to prescribe, to monitor, or to administer intravenous
medications in all clinical specialties of pediatric practice.

Intended Users:
Physicians, advanced practice providers, pharmacists, and nurses

Objective:
To provide guidelines and monitoring parameters for the intravenous administration of UWHC formulary medications
to pediatric patient.

Target Population:
Pediatric patients requiring intravenous medications.

Interventions and Practices Considered:
• Physiochemical properties of intravenous medications
• Appropriate administration technique
• Safe and effective dosing and administration rates
• Key monitoring parameters for intravenous medications

Major Outcomes Considered:
• Safe and standardized administration of intravenous medications to prevent patient harm.

Methodology
Methods Used to Collect/Select the Evidence
Electronic database searches, literature review,manufacturer labeling and tertiary care references were used to collect
evidence for review.

Methods Used to Formulate the Recommendations
Available evidence from the literature, manufacturer labeling and tertiary references was combined to formulate
recommendations. Clinical expert consensus was utilized to formulate specific recommendations and levels of care for
administration.

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5

Methods Used to Assess the Quality and Strength of the Evidence
Internally developed recommendations, or those adopted from external sources without an assigned evidence grade,
were evaluated by the guideline workgroup using and algorithm adapted from the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) methodology (see Figure 1 in Appendix A).
1


Cost Analysis:
No formal cost analysis was performed.

Recognition of Potential Health Care Disparities:
No health care disparities were identified.

Definitions
1.0 IV administration routes and lines
1.1 Central: intravenous medication to be administered through a central IV line
1.1.1 A central line placed
1.1.2 Some medications cannot be administered through a peripheral IV line due to osmolarity of
the drug or risk of vein irritation. A patient must have a central line available to receive these
medications.
1.2 Peripheral: intravenous medication to be administered through a peripheral IV line
1.2.1 Mildline catheters should not be used in pediatric patients based on Policy 1.55A Midline
Intravenous Midline Catheters
1.3 Vesicant: An agent that can produce local irritation, necrosis, and sloughing of tissues when
inadvertently injected into subcutaneous or muscle tissue during intravenous administration
1.3.1 Guideline for the Management of Extravasation of Chemotherapeutic Agents – Adult/Pediatric
– Inpatient/Ambulatory Clinical Practice Guideline
1.3.2 Guideline for Non-chemotherapeutic Agents: Prevention and Treatment of Chemical Phlebitis
and Extravasation of Peripherally Administered Non-chemotherapeutic Agents – Adult and
Pediatric – Inpatient Clinical Practice Guideline

Introduction
The following table presents guidelines and monitoring parameters for the intravenous administration of UWHC
formulary drugs. Although some recommendations may exist to prevent serious toxicities, often the rates of
administration or amount of diluent can be different provided appropriate precautions are taken. When using this table,
tailor the guidelines to fit the patient’s total therapeutic needs. Use of this guideline is encouraged but is not a substitute
for researching drugs with which you are not familiar.

If a specific patient’s fluid or dosing requirements do not fit within the guidelines presented, the following questions
should be asked:
• What information exists regarding a faster rate (e.g., can cause hypotension, cardiac arrhythmias, etc.) or
more concentrated dilutions (e.g., may cause thrombophlebitis, toxic peak blood concentrations, etc.)?
• What is the incidence of this adverse reaction (i.e., is the reaction rarely induced versus always induced)?
• What is the benefit/ risk ratio in this particular patient?
• What parameters could be monitored to decrease the risk of serious adverse effects?
• What other special precautions could be taken?

In accordance with Administrative Policy 8.31, a level has been assigned to each medication to designate the nursing
units on which the drug may be administered. If a patient is in the process of being transferred to an Intermediate
Care Unit (IMC) or ICU and requires a level 3 or 4 medication, the medication can be ordered and initiated in the
transition process. The levels are defined as follows:

• Level 1 medications: May be administered on all General Care Nursing Units..
• Level 2 medications: May be administered on General Nursing Units with telemetry including the
Pediatric Universal Care Unit, Pediatric Sedation, Hybrid Catheterization Lab, Day Treatment, and
Campground.
• Level 3 medications: May be administered on Intermediate Care Units (IMC) and in Interventional
Radiology. Each IMC is qualified to administer different Level III drugs based on specialty populations
served.
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6

• Level 4 medications: May be administered on Intensive Care Units, the Emergency Department,
Operating Room, Recovery Room, Medflight, Children’s Hospital Emergency Transport Ambulance
(CHETA), the Diagnostic Pavilion (excluding Day Treatment). Interventional Radiology may monitor on-
going infusions of Level 4 drugs based on appropriate competency assessment.

Administration of medications outside of indicated level on this guideline may occur if the unit nurse manager and
pharmacist agree to deviate from this guideline in the interest of patient care.

Some medications (e.g. benzodiazepenes) may be used for more than one indication (e.g. benzodiazepenes for
anxiolysis or sedation). Areas of administration and monitoring requirements may differ based on what the medication
is being used for and the table contained within this guideline should be referenced to guide use.

Approved investigational protocols will detail specific administration guidelines and monitoring parameters.

Chemotherapeutic agents may only be administered by nurses certified in chemotherapy and only on P4 and Day
Treatment. Exceptions may be made where chemotherapy certified nurses go to another unit to administer
chemotherapy, but only by prior agreement and when appropriate monitoring can be accomplished following
chemotherapy.

High-alert medications pose a heightened risk of causing significant patient harm or injury when administered in error
and are noted in this guideline for convenience. Specific practices for high alert medications are included in
Administrative Policy 8.33 High Alert Medication Administration.

Recommendations
All recommendations within this guideline have been given a UWHealth Strong Recommendation, Moderat Quality of
Evidence recommendation based on information obtained from initial clinical trials of the medications, product
package inserts, and drug databases.
2
When available, specific recommendations for neonates is called out; this
information is derived from Neofax.
3


For adolescent patients weighing 40 kg or more, the Adult Intravenous Administration Guidelines may be reasonable
to use for guidance of the administration of medications. (UWHealth Weak/conditional Recommendation,Very Low
Quality of Evidence).
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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7

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Abatacept

Level 1
250 mg vial; 25
mg/mL after
reconstitution
Dilute in 100 mL NS; max
conc 10 mg/mL
Infuse over 30 min Central or peripheral

Use non-pyrogenic, low-
protein binding 0.2-1.2
micron filter

Must use silicone-free
syringe
Infusion-related reactions,
dizziness, headache,
abdominal pain, nausea

Worsening of respiratory
status in COPD patients
Acetaminophen

Level 1
1000 mg/100
mL single-use
vial
Not recommended Infuse over 15 min

Doses <1000 mg, withdraw
dose from vial and place
into separate container

Doses ≥1000 mg,
administer from vial

Neonates: withdraw dose
from vials and place into
separate container
Central or peripheral

Glass vials must be vented
with adapter vented spike
(CS#9997527)

Discard any remaining drug
Pain relief, body temperature,
allergic reaction
Acetazolamide

Level 1
500 mg/5 mL

Special
dilutions:
• 5 mg/mL
• 20 mg/mL
Dilute in D5W or NS
Max conc: 100 mg/mL
Max rate: 500 mg/min

IV push given 500mg over
3 min has been reported
Central or peripheral

IM route not recommended
Vein irritation,
thrombophlebitis

See Non-Chemotherapy
Extravasation Guideline
Acetylcysteine

Level 1

See Acetylcysteine
Guideline
20% Loading dose: 150 mg/kg
in 250 mL D5W;
2
nd
dose: 50 mg/kg in 500
mL D5W;
3
rd
dose: 100 mg/kg in
1000 mL D5W;
For children <40kg
reduce diluent so that
conc range is 5-37.5
mg/mL
Loading dose over 60 min
2
nd
dose: Over 4 hrs;
3
rd
dose: Over 16 hrs

IV Push not recommended
Should be administered
within 24 hours of
acetaminophen overdose.

Central or peripheral

Blood pressure,
bronchospasm, wheezing
Acyclovir

Level 1
50 mg/mL

Special
dilutions:
• 7 mg/mL
•10 mg/mL
Dilute in D5W or NS; max
conc:
7 mg/mL peripheral, 10
mg/mL central


Over at least 1 hr

IV Push not recommended
Central or peripheral

Concentrated solutions
(greater than 10 mg/mL or
greater) through central
line only

Irritant, avoid extravasation
Encephalopathic changes
(lethargy, tremors, confusion,
agitation, seizures), injection
site reactions, maintain
adequate fluid intake,
extravasation

See Non-Chemotherapy
Extravasation Guideline
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8

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Adenosine

Level 2
6 mg/2 mL Patient weight <50 kg:
0.05-0.1 mg/kg over 1-2
seconds, increase dose by
0.05-0.1mg/kg, max single
dose: 0.3 mg/kg;

≥50 kg: 6-12 mg over 1-2
seconds
Central line preferred (or site
as proximal to trunk as
possible) or peripheral

Infusion not appropriate
Continuous ECG to
document effects during
dosing, continuous blood
pressure and heart rate;
physician presence required
Albumin

Level 1


5% or 25% No further dilution
needed. May dilute in
NS or D5W

Central or peripheral
5%: max rate: 2-4 mL/min

25% max rate: 1 mL/min

IV Push not recommended
Vital signs, fluid balance
Aldesleukin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
18 million
international
units/mL
Dilute in 50 mL D5W;
conc: 30 -70 mcg/mL

Over 15 min;
or cont infusion for
AML: 1.6 or 9 million
units/m
2
/day daily

IV Push not recommended
Allow solution to reach room
temperature

Do NOT filter, flush with D5W
before and after infusion

Central or peripheral

Doses >12 to 15 million
units/m
2
are associated with
a moderate emetic potential;
antiemetics are
recommended to prevent
nausea and vomiting
Continuous ECG, vital signs,
respiratory status, pulse
oximetry

See Chemotherpeutic
Extravasation Guidelines
Alemtuzumab
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
30 mg/mL
single-use vial
Dilute in 100 mL NS or
D5W
Infuse over 2 hrs

IV Push not recommended
Central or peripheral

Consider premedication with
acetaminophen and
diphenhydramine
Vital signs, infusion
reactions, headache,
parasthesias, rash, pruritis

See Chemotherpeutic
Extravasation Guidelines
Alfentanil
HIGH ALERT
MEDICATION

Level 4
500 mcg/mL Dilute in D5W or NS,
Max conc 80 mcg/mL
Inject slowly over 3-5 min

Cont infusion 0.5-1.5
mcg/kg/min
Central or peripheral Respiratory status, vital
signs, cardiac status
Allopurinol

Level 1
20 mg/mL

Special dilution:
• 5 mg/mL
Dilute in D5W or NS; max
conc: 6 mg/mL
Over at least 30 min

IV Push not recommended
Central or peripheral Nausea, vomiting, rash
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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9

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Alpha1-Proteinase
Inhibitor

Level 1
25 mg/mL after
reconstitution
No further dilution Infuse at 0.08 mL/kg/min Central or peripheral Vital signs, infusion reactions
Alprostadil
HIGH ALERT
MEDICATION–
Continuous Infusion

Level 4


500 mcg/mL

Special dilution:
• 5 mcg/mL
• 10 mcg/mL
• 20 mcg/mL
Pediatric max conc: 20
mcg/mL, use large vein

Neonate max conc: 10
mcg/mL, use large vein
of umbilical artery
catheter placed at the
ductus arteriosus
Neonates and infants: 0.05
to 0.1 mcg/kg/min.

IV Push not recommended
After a therapeutic response
is achieved, the infusion rate
should be reduced to the
lowest possible dosage that
maintains the response;
range: 0.01-0.4 mcg/kg/min

Must change infusion
syringe every 24 hours
Continuous respiratory status
and cardiac status, vein
irritation/ thrombophlebitis.
Neonates: Apnea is seen
most often in neonates
weighing fewer than 2 kg at
birth, and usually appears
during the first hour of drug
infusion

Flushing of arm or face may
indicate misplacement of
catheter

See Non-Chemotherapy
Extravasation Guideline

Also used perioperatively for
liver transplant with different
dosing regimen
Alteplase
HIGH ALERT
MEDICATION
(excepting low-dose
injections for line
clearance)

Level 4

Alteplase Flushes—
Level 1
500 mcg/mL

Special dilution:
• 0.1 mg/mL
• 0.2 mg/mL
No further dilution; or
may dilute to 0.5 mg/mL
in NS or 12.5 mg/250 mL
for DVT pts with arterial
or venous clots

Loading dose over 1 min;
give remaining drug as
infusion.

Systemic thrombosis: 0.1-
0.6 mg/kg/hr; titrated to
effect, optimum dose
unknown
Central or peripheral

Catheter clearance – See
Central Venous Access
Device Occlusion Guideline
Signs/symptoms of bleeding,
blood pressure every 15
minutes for 2 hours
Amikacin Sulfate

Level 1
250 mg/mL

Special dilution:
• 5 mg/mL
Dilute in D5W or NS; max
conc: 10 mg/mL

Neonates
Dilute to a final
concentration of 2.5-5
mg/mL
Over 30 - 60 min

Neonates
Infuse over 60-120 min.


IV Push not recommended
Central or peripheral Respiratory status, vitals,
cardiac status

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10

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Aminocaproic Acid
HIGH ALERT
MEDICATION–
continuous infusion

Level 1
250 mg/mL

Special
Dilution:
• 20 mg/mL
Max conc: 20 mg/mL

Neonates
Conc: 16-20mg/mL
Single doses over at least 1
hour; cont infusion 33.3
mg/kg/hr or 1 g/m
2
/h, total
dose not to exceed 18
g/m
2
/day

IV Push not recommended
Central or peripheral Vital signs, neurologic
assessment based on patient
condition
Aminophylline

Level 1


25 mg/mL

Special
Dilution:
• 1 mg/mL
• 5 mg/mL
• 10 mg/mL
Intermittent:
Dilute in 50 mL D5W;
cont infusion conc: 1
mg/mL; max conc: 25
mg/mL


Intermittent: over 30 min;
cont infusion: 0.50- 1
mg/kg/hr

Max rate of infusion:
0.36mg/kg/min, not to
exceed 25mg/min
Infusion rate should not
exceed 21 mg/hour in
patients with cor pulmonale,
cardiac decompensation,
liver dysfunction, >60 years
of age, or taking
medications which reduce
clearance.

Neonates
IV bolus over 30-60 mins

IV Push not recommended
Central or peripheral Vital signs (including lung
sounds), cardiac status.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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11

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Amiodarone
HIGH ALERT
MEDICATION

Level 3

50 mg/mL

Special dilution:
• 1.2 mg/mL
• 2 mg/mL
• 6 mg/mL
Central
infusion conc: 2 mg/mL,
max: 6 mg/mL D5W;

Peripheral conc: ≤2
mg/mL
PALS dose for pulseless
VF/VT: 5 mg/kg rapid IV
bolus

PALS perfusing
tachycardia, load: 5 mg/kg
over 20-60 min may repeat
to max dose of 15
mg/kg/day
Central line preferred;
Central line required for 650
mg/250 mL or any infusion
concentration >2 mg/mL

Administer via 0.2 or 0.22
micron in-line filter

PVC tubing is recommended
for administration regardless
of infusion duration

Infusions lasting longer than
2 hours should be
administered in glass or
polyolefin bottles containing
D5W

Incompatible with heparin;
flush with saline prior to and
following infusion
Continuous ECG and HR,
blood pressure every 15 min,
extravasation

Incidence of phlebitis may
occur with peripheral
infusions >3mg/mL

See Non-Chemotherapy
Extravasation Guideline
Amobarbital

Level 4
100 mg/mL No information Max infusion rate 50
mg/min
Administer IV only when IM is
not feasible
Respiratory rate and depth,
blood pressure, CNS
changes, extravasation
Amphotericin B
Conventional –
Fungizone
®


Level 1
50 mg/10 mL

Special dilution:
• 0.1 mg/mL
• 0.5 mg/mL
IV infusion conc not to
exceed 0.1 mg/mL via
peripheral line; 0.5
mg/mL for central venous
catheter


Neonates
Max conc 0.1 mg/mL
Infuse over 2-6 hrs,
increase rate as patient
tolerates

Neonates
Infuse over 2 to 6 hrs

IV Push not recommended
Central line only

Initiate therapy with slow
infusion and increase rate as
tolerated.

Consider premedication

Bolus infusion of normal
saline immediately
preceding and following
infusion may reduce drug-
induced nephrotoxicity.
Incompatible with NS; must
flush line with D5W before
and after boluses

May use an in-line filter to
administer
Vein irritation/
thrombophlebitis, heart rate,
blood pressure, fever, chills,
rigors.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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12

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Amphotericin B Lipid
Complex – Abelcet
®


Level 1

100 mg/20 mL

Special dilution:
• 2 mg/mL
Dilute in D5W, conc: 1
mg/mL; max conc: 2
mg/mL

Neonates
Max conc 1-2 mg/mL
Infuse at 2.5 mg/kg/hr


Neonates
Infuse over 2 hours (2.5
mg/kg/hr)

IV Push not recommended
Central or peripheral

Shake bag every 2 hrs

Consider premedication

Flush existing IV line with
D5W prior to infusion or
administer in a separate IV
line.

Incompatible with NS

Do not use an in-line filter to
administer
Vein irritation/
thrombophlebitis, heart rate,
blood pressure, fever, chills,
rigors
Amphotericin B
Liposomal –
AmBisome
®

Level 1
4 mg/mL

Special dilution:
• 2 mg/mL
Dilute in D5W, conc 1-2
mg/mL

Infants and small
children: dilute to 0.2-0.5
mg/mL
Infuse over 2 hr. May
reduce to 1 hr in patient
who tolerate treatment

Neonates
Infuse over 2 hours
Central or peripheral

Do not use and in-line filter
less than 1 micron to
administer

Flush line with D5W prior to
administration
Incompatible with NS

Ampicillin Sodium

Level 1
1 g/10mL

Special dilution:
• 30 mg/mL
max conc is 30 mg/mL
(intermittent infusion) or
100 mg/mL (piggy back)

IV Push not recommended

Rate not to exceed 100
mg/min

Infuse over 30 min
Central or peripheral Anaphylaxis, rash, vein
irritation, thrombophlebitis.

See Non-Chemotherapy
Extravasation Guideline
Ampicillin/sulbactam
(Unasyn
®
)

Level 1
375 mg/mL

Special dilution:
• 30 mg/mL
Dilute to max of 45
mg/mL Unasyn (30mg
ampicillin, 15 mg
sulbactam) in D5W or NS
IV Push not recommended

Infuse over 30 min
Central or peripheral Anaphylaxis, venous
irritation, phlebitis, seizure

See Non-Chemotherapy
Extravasation Guideline
Antihemophilic
Factor, VII

Level 1

See Procoagulant
Guideline
1.2, 2.4 or 4.8
mg vials
Bolus over 2-5 min

No information on infusion
rate
Central or peripheral Hypersensitivity, signs and
symptoms of bleeding.
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

13

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Antihemophilic Factor
IX, Recombinant

Level 1

See Procoagulant
Guideline
Begin at 2 mL/min and
gradually increase to 10
mL/min
No information on IV push
rate
Central or peripheral Anaphylaxis, chest tightness
Antihemophilic Factor
VIII, Monoclonal

Level 1

See Procoagulant
Guideline
Begin at 2 mL/min and
gradually increase to 10
mL/min

No information on IV push
rate
Central or peripheral Anaphylaxis, chest tightness
Antihemophilic Factor
VIII, Recombinant

Level 1

See Procoagulant
Guideline
Over 5-10 min, max rate:
10 mL/min

No information on IV push
rate
Central or peripheral Anaphylaxis, chest tightness
Antithrombin III,
Human

Level 1
100 units/mL
solution
100 units/mL solution Infuse loading dose over
10-20 min

No information on IV push
rate
Prior to administration, allow
reconstituted solution to
warm to room temperature

Central or peripheral
Vital signs, cardiac status,
CNS changes, anaphylaxis
Antithymocyte
Globulin (ATG) –
Equine
HIGH ALERT
MEDICATION

Level 1
50 mg/mL Dilute to a minimum
concentration of 4 mg/mL
in NS, D51/4NS, or
D51/2NS
Infuse over at least 4 hrs

IV Push not recommended
Central or peripheral

Administer via 0.2 or 0.22
mircon in-line filter

Incompatible with D5W

Pretreat with antipyretic,
antihistamine, corticosteroid
Infusion reactions, cardiac
status, respiratory status
Antithymocyte
Globulin (ATG) –
Rabbit
HIGH ALERT
MEDICATION

Level 1
5 mg/mL
(25 mg/mL)
Dilute each dose in 250
mL NS

Children: over 6-12 hrs

Subsequent doses over at
least 4 hrs

IV Push not recommended
Central line only

Administer via 0.2 or 0.22
mircon in-line filter


Consider premedication with
acetaminophen,
corticosteroids or
antihistamine
Anaphylaxis, abdominal pain,
fever, headache, dyspnea,
dizziness, vital signs
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

14

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Antivenin,
Lactrodectus mactans

Level 2
6000 units/2.5
mL
Dilute in 10-50 mL NS Over at least 15-30 min

IV Push not recommended
Central or peripheral Anaphylaxis, angioedema,
cardiac status, frequent vital
signs, signs and symptoms of
shock
Aprotinin
HIGH ALERT
MEDICATION–
continuous infusion

Level 2


2 million units No further dilution (conc:
1.4 mg/mL)


Test dose over 10 min
and at least 10 min prior
to load

Loading Dose: over 20-30
min,

Limited data: BSA ≤1.16m
2
,
then 56 mg/m
2
/hr
continuous;
BSA >1.16 m
2
, cont
infusion: 70 mg/m
2
/hr;
Alternative cont infusion:
30,000 units/kg/hr

IV Push not recommended
Central line only

Do not administer other
medications in the same line

Patient supine for load
Anaphylaxis
Arginine

Level 2
100 mg/mL Dilute in D5W; conc: 100
mg/mL

May be infused without
dilution, however dilution
recommended due to
vein irritation
Over 30 min;
Loading dose for urea cycle
disorders: over 90 min; max
infusion rate: 1g/kg/hr, (max
dose: 60 g/hr)

IV Push not recommended
Central (recommended) or
peripheral

Administer via 0.2 or 0.22
mircon in-line filter

Change bottle and tubing
every 24 hr
Vein irritation, flushing,
nausea/ vomiting,
anaphylaxis.

See Non-Chemotherapy
Extravasation Guideline
Arsenic Trioxide
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL
single-use
ampules
Dilute in 100-250 mL of
NS or D5W
Infuse over 1-2 hours, may
extend to up to 4 hours for
acute vasomotor reaction
Central or peripheral Acute tachycardia, chest
pain, hypotension, fever,
ECG, serum electrolytes

See Chemotherpeutic
Extravasation Guidelines
Ascorbic Acid

Level 1
500 mg/mL Dilute in D5W or NS
should be diluted in at
least an equal volume of
fluid
Give slowly over a
minimum of 10 min

IV Push not recommended
IM utilization better

Central or peripheral

Dizziness, faintness with
rapid injection
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

15

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Atracurium Besylate
HIGH ALERT
MEDICATION

Level 4

10 mg/mL Dilute in D5W or NS; max
conc: 0.5 mg/mL


IV Push: Over 2-3 min

0.4-1.2 mg/kg/hr cont
infusion (6.7-20
mcg/kg/min)
Patient must be intubated.
Ensure patient is adequately
sedated prior to
administration of
neuromuscular blockade

Central or peripheral
Cardiovascular effects,
erythema, neuromuscular
blockade monitor
Atropine Sulfate

Level 1 (as preop)
Level 2 (other
indications)
400 mcg/mL,
100 mcg/mL
IV Push: Over 1 min

IV infusion not
recommended
Central or peripheral Vital signs, ECG based on
specific situation
Azathioprine

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
100 mg/10 mL Max conc 10 mg/mL
D5W or NS


IV Push: Over 5 min, conc
not to exceed 10 mg/mL

Infusion over 15-60 min
Central or peripheral Blood pressure, GI
hypersensitivity reaction
(severe nausea and
vomiting), WBC, CBC
Azacitidine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL Dilute in 50-100 mL of
NS or LR
Infuse over 10 to 40 min;
must complete infusion with
60 min of reconstitution
Central or peripheral

Incompatible with D5W
Rigors, blood pressure, chest
pain, injection site reactions

See Chemotherpeutic
Extravasation Guidelines
Azithromycin

Level 1
100 mg/mL

Special dilution:
• 2 mg/mL
Dilute in D5W or NS; max
conc: 2 mg/mL


Over 1 hr (2 mg/mL)-3 hrs
(1 mg/mL)

Pediatrics/Neonates
Infuse over 60 min

IV Push not recommended
Central or peripheral Vital signs, hypersensitivity,
avoid extravasation.

See Non-Chemotherapy
Extravasation Guideline
Aztreonam

Level 1
1 g/3 mL

Special dilution:
• 20 mg/mL
Max conc: 20 mg/mL
D5W or NS


IV Push: over 3-5 min, conc
not to exceed 66 mg/mL

Infuse over 20-60 min, conc
not to exceed 20 mg/mL
Central or peripheral Anaphylaxis,
thrombophlebitis.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

16

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Basiliximab
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
20 mg/5 mL Dilute in 50 mL NS


Infuse over 20-30 min

Pediatrics/neonates
IV bolus of 4 mg/ml over 10
mins.
Infusion of 0.4 mg/ml over
20-30 mins

IV Push not recommended
Do not add other agents to
the bag.

Central or peripheral
Vital signs, nausea, vomiting,
local injection site reaction

See Chemotherpeutic
Extravasation Guidelines

Belimumab
HIGH ALERT
MEDICATION

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
120 mg, 400
mg powder
vials for
reconstitution
Dilute reconstituted
solution in 250 mL NS
only
Over 1 hour Central or peripheral

Dedicated IV line required

Consider premedication with
antihistamine and antipyretic
Infusion and hypersensitivity
reactions including
anaphylaxis
Bendamustine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
5 mg/mL Dilute in 500 mL NS to
conc of 0.2-0.6 mg/mL
Infuse over 30 -60 mins Central or peripheral Infusion reactions
(anaphylaxis, tumor lysis
syndrome), skin reactions

See Chemotherpeutic
Extravasation Guidelines
Benztropine

Level 1
1 mg/mL No information No information IM or PO route preferred Heart rate and blood
pressure
Bevacizumab
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
25 mg/mL Dilute in 100 mL NS Infuse first dose over 90
min; if tolerated may infuse
second dose over 60 min; if
tolerated, may infuse third
dose (and subsequent
doses) over 30 min

IV push not recommended
Central or peripheral Infusion reactions
(bronchospasm, chills,
dyspnea, fever, hypotension,
itching, rash)

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

17

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Bivalirudin
HIGH ALERT
MEDICATION

Level 1
50 mg/mL Dilute in 50 mL NS or
D5W to conc 5 mg/mL

For low-rate infusion,
may dilute 5 mg/mL with
500 mL NS or D5W to
0.5 mg/mL
IV bolus and infusion Central or peripheral aPTT, blood pressure,
bleeding
Bleomycin Sulfate
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
15 units Dilute in 50 mL NS Over 10-15 min, no greater
than 1 unit/min, or 15-20
units/m
2
/day cont infusion
for 3-5 days

IV Push Rate: Over 10 min,
no greater than 1 unit/min;
max conc: 3 units/mL
Central or peripheral

Premedicate with
acetaminophen and
diphenhydramine.
respiratory rate/ depth,
anaphylaxis, fever, chills,
injection site reactions, ,
vitals, avoid extravasation

See Chemotherpeutic
Extravasation Guidelines
Bortezomib
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Not recommended 3-5 second bolus Central or peripheral

Premedicate with
acetaminophen,
diphenhydramine, and
ondansetron
Peripheral neuropathy, rash,
dyspnea, nausea/vomiting

See Chemotherpeutic
Extravasation Guidelines
Bumetanide
HIGH ALERT
MEDICATION–
continuous infusion

Level 1
0.25 mg/mL

Special dilution:
• 0.05 mg/mL
• 0.1 mg/mL
Dilute in NS or D5W


Over 5 min;
For continuous infusion
dilute to 0.024 mg/mL

IV Push Rate: Over 5 min
undiluted
Central or peripheral Blood pressure, anaphylaxis
Busulfan
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
6 mg/mL Dilute in NS (preferred)
or D5W; conc: 0.5 mg/mL
Over 2 hrs

IV Push not recommended
Central line only

Flush with 5 mL NS or D5W
before and after infusion

Antiemetics may be
recommended to prevent
nausea and vomiting
Nausea/vomiting

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

18

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
C1 esterase inhibitor:
(CINRYZE)

Level 1
100 units/mL No further dilution 1 mL/minute (over 10
minutes; 100 units/minute)
Central or peripheral

Use silicone-free syringe
Hypersensitivity reaction and
thrombotic events.
Epinephrine should be
available during
administration

Solution will be colorless or
slightly blue.
Caffeine Citrate

Level 2
20 mg/mL

Special dilution:
• 5 mg/mL
May administer undiluted
or dilute with D5W to 10
mg/mL
Infuse loading dose over at
least 30 min

Infuse maintenance dose
over at least 10 min

Neonates
Infuse loading dose over
30 min; maintenance dose
as slow IV push
Central or peripheral\ Respiratory rate, heart rate,
blood pressure

Neonates
Heart rate, number of apnea
spells, agitation
Caffeine Sodium (not
Citrate) Benzoate

Level 2
250 mg/mL Dilute in 1000 mL D5W
or NS

Not for use in neonates
Over 60-90 min; follow with
1000 mL NS infused over 1
hour

IV Push not recommended
Central or peripheral

Not for use in neonates
Respiratory rate, heart rate,
blood pressure
Calcitriol

Level 1

1 mcg/mL No information


IV Push rate: 2-3 mL/min
Undiluted

No information on infusion
rate
Hemodialysis catheter Signs and symptoms of
vitamin D intoxication (bone
pain, dry mouth, headache,
metallic taste, muscle pain)
Calcium Chloride

Level 2


100 mg/mL
(1.36mEq)

Special dilution:
• 0.02 g/mL (20
mg/mL)
• 0.05 g/mL (50
mg/mL)
Max conc: 20 mg/mL
D5W or NS


Infuse 45-90 mg/kg over 1
hr ( 0.6-1.2 mEq/kg over 1
hr); max rate: 50-100
mg/min

Pediatrics/Neonates
Slow IV push over 3-5
mins, max rate of 50-100
mg/min

IV Push not recommended
Central line preferred or
deep vein (do not use scalp,
small hand or foot veins)
Cardiac status, extreme
irritant, avoid extravasation.

Monitor ECG if infused at >
2.5mEq/min, stop infusion if
complaints of pain/discomfort

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

19

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Calcium Gluconate

Level 1


100 mg/mL
(0.46mEq)

Special dilution:
• 0.05 g/mL (50
mg/mL)
max conc: 50 mg/mL
D5W or NS


IV Push: infuse slowly over
3-5 mins or at a max rate of
50-100 mg/min (cardiac
arrest may be administered
over 10-20 seconds)


Infuse over 120-240 mg/kg
over 1 hr (0.6- 1.2 mEq/kg
over 1 hr).; max rate: 50-
100 mg/min

IV Push not recommended
Central or peripheral Cardiac status, vital signs,
vein irritation, avoid
extravasation.

See Non-Chemotherapy
Extravasation Guideline
Carboplatin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL Max conc 2 mg/mL NS or
D5W


give over 15 min to 1 hr or
cont infusion

IV Push not recommended
Central or peripheral

Antiemetics are
recommended to prevent
nausea and vomiting
Anaphylaxis

See Chemotherpeutic
Extravasation Guidelines
Carfilzomib
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug
60 mg vial,
reconstituted to
2 mg/mL
Dilute in 50 mL D5W Infuse over 2-10 min

IV push not recommended
Recommend prehydration
with 250-500 mL NS or other
IV fluid prior to dose

Recommend premedication
with dexamethasone
Infusion reactions, dyspnea,
hypotension, fever, tumor
lysis syndrome, fluid
overload, worsening of CHF

See Chemotherpeutic
Extravasation Guidelines
Carmustine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg/3 mL Dilute in D5W (0.2 - 1
mg/mL)


Over at least120 min

IV Push not recommended
Central or peripheral;
central line if undiluted or
doses ≥300 mg/m
2


Antiemetics are
recommended to prevent
nausea and vomiting
Vein irritation, flushing , vital
signs

Patients should be supine
during infusion and may
require the Trendelenburg
position, fluid support, and
vasopressor support

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

20

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Cefazolin Sodium

Level 1
1 g/3 mL

Special dilution:
• 20 mg/mL
Dilute in NS or D5W IV Push: over 3-5 min, max
conc: 100 mg/mL

Infusion Rate: Over 30-60
min at conc of 20 mg/mL

Pediatrics/Neonates
Infuse over 10-60 min at
conc of 20 mg/mL min
Central or peripheral Vein irritation,
thrombophlebitis
Cefepime

Level 1
1 g/50 mL

Special dilution:
• 40 mg/mL
Dilute in NS or D5W

IV Push: over 3-5 min, max
conc: 100 mg/mL

Infusion Rate: Over 30 min;
max conc: 40 mg/mL

Pediatrics/neonates
IV Push: over 3-5 min, max
conc: 40 mg/mL
Central or peripheral Hypersensitivity
(anaphylaxis, rash), phlebitis
Cefotaxime

Level 1
500 mg, 1 g, 2
g vials

Special dilution:
• 50 mg/mL
Dilute to conc 20-60
mg/mL with NS or D5W,
max conc 200 mg/mL

Neonates
IV push conc 50-100
mg/mL
Infusion conc 10-40
mg/mL
At 20-60 mg/Ml infuse over
15-30 min

At 200 mg/mL may infuse
over 3-5 min

Neonates
At 50-100 mg/mL IV push
At 10-40 mg/mL infuse over
10-30 min
Central or peripheral Itching, injection site irritation,
hypersensitivity (anaphylaxis,
rash), extravasation
Cefoxitin

Level 1
1 g, 2 g powder

Special dilution:
• 40 mg/mL
Dilute in NS or D5W


IV Push: over 3-5 min, max
conc: 100 mg/mL

Infuse over 10-60 min, max
conc: 40 mg/mL

Pediatrics/neonates
IV Push: over 3-5 min, max
conc: 200 mg/mL
Central or peripheral Hypersensitivity
(anaphylaxis, rash), phlebitis
Ceftaroline Fosamil

Level 1
Reconstituted
with 20 mL
sterile water to
20 or 30 mg/mL
Dilute in 50-250 mL
D5W, NS, or LRS
Infuse over 60 min Central or peripheral Hypersensitivity
(anaphylaxis, rash)
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

21

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Ceftazidime

Level 1
500 mg, 1 g, 2
g vials; 50
mg/mL

Special dilution:
• 40 mg/mL
Dilute to conc ≤40 mg/mL
with NS or D5W, max
conc 180 mg/mL

Neonates
Conc 1-40 mg/mL, max
conc 200 mg/mL
At ≤40 mg/mL infuse over
15-30 min

At 180 mg/mL may infuse
over 3-5 min

Neonates
At 200 mg/mL infuse over
3-5 min
At 1-40 mg/mL infuse over
30 min
Central or peripheral Hypersensitivity
(anaphylaxis, rash), phlebitis
Ceftriaxone

Level 1
1 g/10 mL

Special dilution:
• 40 mg/mL
Dilute in NS or D5W Infuse over 30 min, max
conc: 40 mg/mL

IV Push not recommended

Pediatrics/Neonates
IVP over 5 min, max conc:
40-100 mg/mL
Central or peripheral Hypersensitivity
(anaphylaxis, rash)
Cefuroxime

Level 1
90 mg/mL

Special dilution:
• 30 mg/mL
Dilute in NS or D5W

IV Push: over 3-5 min, max
conc: 100 mg/mL

Infusion Rate: Over 15-30
min, max conc: ≤ 30 mg/mL
Central or peripheral Hypersensitivity
(anaphylaxis, rash), phlebitis
Cetuximab
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
2 mg/mL No further dilution Infuse first dose over 2 hrs
and subsequent doses over
1 hr.

Max rate 10 mg/min
Central or peripheral

Administer via 0.2 or 0.22
mircon in-line filter
Vital signs, infusion reaction
(chills, fever, dyspnea,
hypotension, bronchospasm)

See Chemotherpeutic
Extravasation Guidelines
Chloramphenicol

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
1 g powder Dilute in D5W


IV Push: over 5 min, max
conc: 100 mg/mL

Infusion Rate: Over 15-30
min, max conc: ≤ 20 mg/mL

Pediatrics/Neonates:
Infusion Rate: Over 15-60
min, max conc: ≤25 mg/mL
Not recommended for IM
use.

Central or peripheral
Serum levels,
hypersensitivity (anaphylaxis,
rash), Gray Syndrome (circ.
collapse, acidosis,
myocardial depression and
abdominal distension), blood
counts.
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

22

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Chlorothiazide

Level 1

500 mg vial

Special dilution:
• 5 mg/mL
NS, D5W


IV Push: 500 mg vial in 18
mL sterile water (27.8
mg/mL) over 3-5 min

Infusion Rate: Over 30 min
Central or peripheral Avoid extravasation, blood
pressure.

See Non-Chemotherapy
Extravasation Guideline
Chlorpromazine

Level 1
25 mg/mL Max conc 1 mg/mL Max infusion rate 0.5
mg/min
Central or peripheral

Patient must remain lying
down during and for 30 min
after injection due to
hypotension
Hypotension, vital signs
Cidofovir

Level 1

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
75 mg/mL vial

Dilute in NS or D5W, max
conc: 8 mg/mL

Over 60 min

IV Push not recommended
Central or peripheral

Hydration with NS pre and
post dose also probenecid
pre and post dose to avoid
nephrotoxicity
Flushing, rash,
signs/symptoms of
uvetitis/iritis
Ciprofloxacin

Level 1
10 mg/mL vial

Special dilution:
• 2 mg/mL
Dilute in D5W or NS to
final conc: 1-2 mg/mL


Over 60 min into a large
vein

IV Push not recommended
Central or peripheral Skin reaction at infusion site,
phlebitis.

See Non-Chemotherapy
Extravasation Guideline
Cisatracurium
HIGH ALERT
MEDICATION

Level 4

1 mg/mL, 2
mg/mL,
or 10 mg/mL
Dilute in D5W or NS;
conc: 0.1-0.4 mg/mL


IV Push: over 5-15 seconds

Infusion Rate: Children ≥
2yrs: 1-4 mcg/kg/min
Patient must be intubated.
Ensure patient is adequately
sedated prior to
administration of
neuromuscular blockade

Central or peripheral
Blood pressure, cardiac
status, respiratory rate/depth,
use neuromuscular blockade
monitor
Cisplatin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Dilute in NS; max conc: 1
mg/mL
Over 2-24 hrs; max rate: 1
mg/min

Also see chemo protocol

IV Push not recommended
Central or peripheral

Ensure proper needle or
catheter placement prior to
and during infusion

Antiemetics are
recommended to prevent
nausea and vomiting

Pre/post-treatment hydration
with 1 to 2 L of fluid
Nausea/ vomiting, renal
function, infusion reactions
(facial edema, hypotension,
tachycardia, wheezing)

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

23

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Cladribine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Dilute in 500 mL NS for
each daily dose


Children: hairy cell
leukemia: 0.09 mg/kg/day
cont infusion;
AML: < 3yrs: 0.3 mg/kg/day
over 2 hours; ≥ 3 yrs 9
mg/m
2
/day over 2 hrs

IV Push not recommended
Central or peripheral Fever, injection site reactions

See Chemotherpeutic
Extravasation Guidelines
Clindamycin

Level 1
150 mg/mL,
600 mg, 900
mg PB

Special dilution:
• 4 mg/mL
Dilute in NS or D5W, max
conc: 18 mg/mL


Over 30-60 min,
max rate: 30 mg/min

IV Push not recommended
Central or peripheral

IM route not recommended
for doses > 600 mg
Phlebitis, diarrhea
Clofarabine

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Dilute with D5W or NS to
a final concentration of
0.15-0.4 mg/mL
Over 2 hours Central, midline, or peripheral

Continuous IV fluids are
encouraged to decrease
adverse events and tumor
lysis effects

Consider steroids and
antihyperuricemic therapy

Dedicated IV line required
Blood pressure, cardiac
function, and respiratory
status during infusion

Signs and symptoms of
tumor lysis syndrome,
hepatic sinusoidal obstruction
syndrome, and cytokine
release syndrome

Hydration status
Colistimethate

Level 1
75 mg/mL

Special dilution:
• 10 mg/mL
Dilute in NS or D5W

2.5 to 5 mg/kg/day; 50% of
daily dose over 3-10 min.
Then infuse remaining 50%
over 22-23 hrs

Or

2.5 to 5 mg/kg/day in 2 to 4
divided doses over 30 min
each
Central or peripheral Tingling of extremities
Cosyntropin

Level 1
250 mcg/mL Dilute in D5W or NS


IV Push: over 2 min

Infusion Rate: Children >2
yrs: over 4-8 hrs
Central or peripheral Continuous observation for at
least first 30 minutes, blood
pressure, hypersensitivity
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

24

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Cyclophosphamide
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
20 mg/mL Dilute in D5W or NS ;
max conc: 20 mg/mL

Over 30-60 min or per
protocol

IV Push not recommended
Central or peripheral

Prehydration recommended
Antiemetics are
recommended to prevent
nausea and vomiting

Lightheadedness,
anaphylaxis, extravasation

See Chemotherpeutic
Extravasation Guidelines
Cyclosporine
HIGH ALERT
MEDICATION–
continuous infusion

Level 4

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
50 mg/mL Dilute each 50 mg in 20-
100 mL D5W or NS; max
conc: 2.5 mg/mL
Over 2-6 hrs or cont
infusion

IV Push not recommended
Central or peripheral

Use non-PVC sets for
administration
Blood pressure, anaphylaxis
Cytarabine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
100 mg/mL Dilute in D5W or NS, max
conc: 100 mg/mL


High dose (> 1g/m
2
) infuse
over 1-3 hrs or longer or
cont infusion

IV Push Rate: Over 15 min
Central or peripheral

Avoid extravasation

Antiemetics are
recommended to prevent
nausea and vomiting
Hypersensitivity, signs and
symptoms of bleeding

See Chemotherpeutic
Extravasation Guidelines
Cytomegalovirus
immune globulin

Level 1
50 mg/mL No further dilution (50
mg/mL)

Central or peripheral
15 mg/kg/hr for 15 min,
then 30 mg/kg/hr for 15
minutes, then 60 mg/kg/hr;
max rate: 75 mL/hr

IV Push not recommended
Central or peripheral

Administer via 15 mircon
filter; a 0.2 micron filter may
be used
Flushing, fever, chills,
nausea, vomiting, shortness
of breath,

Vital signs prior to infusion
and at each rate change
Dacarbazine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL Dilute in D5W or NS; max
conc: 10 mg/mL
IV push: Dilute vial with 2
mL D5W or NS, then further
with 5-10 mL, give over 2-3
min

Infusion Rate: Over 15-120
min
Central or peripheral

Avoid extravasation

Antiemetics are
recommended to prevent
nausea and vomiting
Vein irritation,
thrombophlebitis,
anaphylaxis

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

25

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Daclizumab
HIGH ALERT
MEDICATION

Level 1
5 mg/mL Dilute in 50 mL of NS Infuse over 15 min Central or peripheral Vital signs, chills, fever,
dyspnea, hypersensitivity
Dactinomycin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
500 mcg/mL Dilute in D5W or NS; max
conc: 500 mcg/mL

IV push: into running IV
over 1-5 min
IV Infusion Rate:
Over 15 min
Central or peripheral

Avoid extravasation
Vesicant, avoid extravasation

See Chemotherpeutic
Extravasation Guidelines
Dantrolene

Level 2
1 mg/3 mL No further dilution IV push: rapid

Prevention and treatment of
malignant hyperthermia:
over 60 min
Central or peripheral Respiratory rate, ECG, vital
signs, and urine output
continuously
Daptomycin

Level 1
Reconstitute in
10 mL NS to 50
mg/mL

Special dilution:
• 10 mg/mL
Ages 2-6 years dilute in
25 mL NS

Ages 7-17 years dilute in
50 mL NS

Neonates no dilution
information
Ages 2-6 years infuse over
60 min

Ages 7-17 years infuse
over 30 min

Neonates
Infuse over 60 min
Central or peripheral Muscle pain or weakness
Daratumumab

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
100 mg/5 mL
vial

400 mg/20 mL
vial
Dilute in 1000 mL NS for
first infusion

Dilute in 500 mL NS for
subsequent infusions



First and second infusion:
50 mL/hour for first hour,
then increase by 50
mL/hour every hour to a
maximum rate of 200
mL/hour

Subsequent infusions: 100
mL hour for first hour, then
increase by 50 mL/hour
every hour to a maximum
rate of 200 mL/hour only if
no grade 1 infusion
reactions noted in the first 2
infusions
Central or peripheral

Premedicate with an IV
corticosteroid,
acetaminophen, and an IV or
oral antihistamine
approximately 60 minutes
prior to administration

Administer with an infusion
set fitted with a flow regulator
and with an inline, sterile,
non-pyrogenic, low protein-
binding polyethersulfone filter
(0.22 or 0.2 micrometer)
Complete blood counts as
clinically necessary; type and
screen (blood type) prior to
initiating therapy;
signs/symptoms of infusion
reactions
Darbepoetin

Level 1
25, 40, 60, 100,
150, 200, 300,
or 500 mcg
No additional dilution

IV push: over at least 1 min

Infusion Rate: Over 1-3
min
Central or peripheral Blood pressure, line clotting
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

26

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Daunorubicin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
5 mg/mL Dilute in 10-15 mL NS for
IV push

IV push: into rapid running
IV over 1-5 min

Infusion per protocol (30-45
min)
Central or peripheral ECG, signs and symptoms of
hemorrhage, vesicant, avoid
extravasation

See Chemotherpeutic
Extravasation Guidelines
Deferoxamine

Level 2

500 mg/2 mL Dilute in D5W, NS, or LR


First dose max rate: 15
mg/kg/hr

Acute iron toxicity:
subsequent doses may be
given over 4-12 hours at a
rate not to exceed 125
mg/hour

Chronic: 15mg/kg/hr over 8-
12 hours, 5-7 days/week
IM route preferred.

Central or peripheral
Blood gases, central venous
pressure, cardiac output,
urticaria, hypotension, and
shock
Defibrotide

Level 1
200 mg/2.5 mL Dilute in NS or D5W to a
final concentration of 4-
20 mg/mL
Infuse over 2 hours Central or peripheral

Flush IV line with NS or D5W
before and after
administration

0.2 micron in-line filter
required
Hypersensitivity, bleeding
Desmopressin

Level 1
4 mcg/mL

Special dilution:
• 0.5 mcg/mL
Dilute in NS; max conc:
0.5 mcg/mL

Over 15-30 min

IV Push not recommended
Central or peripheral Blood pressure and pulse
during infusion
Dexamethasone


Level 1
4 mg/mL or
10 mg/mL

Special dilution:
• 0.02 mg/mL
• 0.075 mg/mL
• 0.5 mg/mL
• 1 mg/mL
Dilute in D5W or NS


IV Push: 4 mg/mL solution
over 1 to 4 min if dose is
fewer than 10 mg

Infusion preferred to avoid
perineal clawing

Infusion Rate: Over 15-60
min, or cont infusion
Central or peripheral Burning sensation,
hypersensitivity (anaphylaxis)
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

27

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Dexmedetomidine
HIGH ALERT
MEDICATION

Level 4
4 mcg/mL 4 mcg/mL Infuse loading dose over 10
min

Maintenance infusion usual
0.2-0.7 mcg/kg/hr
Central or peripheral Vital signs, oxygenation, fluid
status

Rapid infusions associated
with severe side effects
bradycardia and sinus arrest
Dexrazoxane

Level 1

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL after
reconstitution
Dilute with LR to 1.3-3
mg/mL
Infuse over 15-30 min

IV Push not recommended
Central or peripheral large
vein


Extravasation
Diazepam

IV Push – Level 1
Infusion – Level 3
5 mg/mL Dilute in D5W


Max rate for infants &
children: 1-2 mg/min

Continuous infusion not
recommended
Central or peripheral Blood pressure, respiratory
rate/ depth, avoid
extravasation.

If used for conscious
sedation: see Policy 8.56:
Pediatric Sedation Policy
for monitoring requirements.

See Non-Chemotherapy
Extravasation Guideline
Digoxin

Level 1
250 mcg/mL,
100 mcg/mL

Special dilution:
• 25 mcg/mL
Dilute in D5W or NS,
minimum 4-fold dilution


IV push: over 5-10 min

Infusion Rate: Over 5-15
min
IM erratic absorption

Central or peripheral

Vesicant
Heart rate, blood pressure,
baseline ECG, avoid
extravasation

See Non-Chemotherapy
Extravasation Guideline
Digoxin Immune FAB

Level 4

38 mg/4 mL vial No further dilution
necessary, conc: 9.5
mg/mL. Can be further
diluted using NS


Over at least30 min

IV Push Rate: If clinical
condition warrants, bolus
over 2-3 min (caution –
infusion related reaction
may occur)
Administer via 0.2 or 0.22
mircon in-line filter
Central or peripheral
Vital signs, ECG, signs and
symptoms of acute allergic
reaction (angioedema,
bronchospasm, tachycardia)
Dihydroergotamine
Mesylate

Level 2
1 mg/mL Not recommended Infuse over 2-3 min Central or peripheral

Antiemetic administration
prior to dihydroergotamine
administration is
recommended
Vital signs, localized edema,
dizziness, somnolence
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

28

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Diltiazem
HIGH ALERT
MEDICATION–
continuous infusion

Push Level 2
Infusion Level 3

5 mg/mL Usual conc: 1 mg/mL,
max conc 1 mg/mL




IV push adolescents: over 2
min

IV Infusion: Adolescents
and adults cont infusion: 5-
15 mg/hr for up to 24 hrs
Central or peripheral Blood pressure, heart rate,
ECG, respiratory rate/ depth
Dinutuximab
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
17.5 mg/5 mL Dilute in 100 mL NS Do not administer as IV
push or bolus

Administer as IV infusion
only

Administer NS 10 mL/kg IV
over 1 hour just prior to
each dinutuximab infusion

Initiate infusion at a rate of
0.875 mg/m
2
/hour for 30
minutes. Increase infusion
rate gradually as tolerated
to a maximum rate of 1.75
mg/m
2
/hour to infuse over
10 to 20 hours each day
Central or peripheral

Do not shake

Premedicate with antiemetic,
analgesic, antihistamine,
antipyretic
Infusion reaction during and
at least four hours following
completion of infusion

Blood pressure, pain,
peripheral neuropathy,
capillary leak syndrome,
hemolytic uremic syndrome,
and ocular toxicity

Diphenhydramine

Level 1
50 mg/mL

Special dilution:
• 5 mg/mL
Dilute in D5W or NS; max
conc: 25 mg/mL
IV Push Rate and Infusion
Rate: Over 15 min
Central or peripheral Vital signs
Dobutamine
HIGH ALERT
MEDICATION–
continuous infusion

Level 3


12.5 mg/mL Dilute in D5W or NS;
max conc: 5 mg/mL

Initial:
Neonates: 2-15
mcg/kg/min, titrate to
desired response

Children and adults: 2.5-15
mcg/kg/min titrate to
response, max rate: 40
mcg/kg/min

IV Push not recommended
Central line preferred,
however,
peripheral/intraosseous
access may be used when
benefit outweighs risks
Continuous blood pressure,
heart rate, ECG, and urine
flow.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

29

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Docetaxel
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
Dose 30 - 75
mg: 100 mL
D5W
Dose 75 - 200
mg: 250 mL
D5W
Dose > 200 mg:
500 mL D5W
non-PVC bag
Infuse over 1 hour

Infusion should be
completed within 4 hours of
final preparation due to its
stability
Central or peripheral

Use nonsorbing (non-DEHP)
tubing; do not use in-line filter

Irritant, avoid extravasation

Dexamethasone
premedication required
Extravasation, fluid status,
edema, hypersensitivity,
neurosensory symptoms,
gastrointestinal toxicity,
cutaneous reactions,
epiphora

See Chemotherpeutic
Extravasation Guidelines
Dopamine
HIGH ALERT
MEDICATION–
continuous infusion

Level 4
80 mg/mL Usual conc: 800 mg/250
mL; max conc: 3.2
mg/mL
Neonates: 1-20 mcg/kg/min
titrate to response.

Infants and children: 1-20
mcg/kg/min, max rate: 50
mcg/kg/min cont infusion

IV Push not recommended
Central line only

Do not administer through
Umbilical Artery Catheter
(UAC)
Vesicant, avoid
extravasation, continuous
blood pressure, heart rate,
ECG, and urine flow.

See Non-Chemotherapy
Extravasation Guideline
Doripenem

Level 1
250 mg/10 mL
500 mg/10 mL
Dilute with NS or D5W
• 250 mg: further dilute
with 50 or 100 mL
• 500 mg: further dilute
with 100 mL
Infuse over 1 hour Central or peripheral Anaphylaxis
Doxacurium

Level 4
1 mg/mL D5W or NS IV push: 5-10 seconds

Infusion Rate: Children 2 -
12yrs: 0.1-0.2 mcg/kg/min
or 6-12 mcg/kg/hr; Children
>12yrs: same
Blood pressure, cardiac
status, respiratory rate/ depth
Doxorubicin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
2 mg/mL Dilute in D5W or NS


IV push: over 3-10 min into
running IV

Infusion Rate: Over 1-4 hrs
at a conc not to exceed 2
mg/mL, or by cont infusion
Central or peripheral;
Central line required for
continuous infusion

Antiemetics are
recommended to prevent
nausea and vomiting
Cardiac status, vesicant,
avoid extravasation

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

30

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Doxycycline

Level 1
100 mg/10 mL

Special dilution:
• 1 mg/mL
Dilute in mL D5W or NS

Over 1hours ; conc not to
exceed 1 mg/mL (conc <0.1
mg/mL not recommended)

IV Push not recommended
Central or peripheral Vein irritation,
thrombophlebitis, avoid
extravasation

See Non-Chemotherapy
Extravasation Guideline
Droperidol

Level 1
2.5 mg/mL

Special dilution:
• 0.25 mg/mL
Dilute in D5W or LR; max
conc: 2.5 mg/mL
IV push: over 2-5 min

Infusion: No information
Central or peripheral Vital signs, respiratory rate/
depth, palpitations, syncope,
ECG prior to use and
continued through first 2-3
hrs following administration
Eculizumab

Level 1
10 mg/mL Dilute to concentration of
5 mg/mL in D5W, NS,
1/2NS, or LR
Do not administer as IV
push or bolus

Infuse over 1-4 hours
Decrease rate or
discontinue for infusion
reactions
Central or peripheral

Do not shake
Infusion reaction

Monitor for infusion reaction
for 1 hour after infusion
Edetate calcium
disodium

Level 2
200 mg/mL Dilute in 250-500 mL
D5W or NS


IV infusion: Asymptomatic
patients over at least 1
hour, symptomatic patients
over at least 2 hours

IV Push not recommended
Central or peripheral ECG and vital signs
Edrophonium
Chloride

Level 2
10 mg/mL Dilute in D5W or NS


IV Push Rate: Children:
0.04 mg/kg over 1 min
followed by 0.16mg/kg
given within 45 seconds (if
no response, max total
dose 10 mg)

Infusion: No information

Infants
Initial: 0.1 mg, followed by
0.4 mg (if no response, total
dose 0.5mg)
Central or peripheral Blood pressure, cardiac
status
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

31

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Elotuzumab

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
300 mg, 400
mg vial
reconstituted to
25 mg/mL
Dilute with 230 mL of
0.9% Sodium Chloride or
D
5
W in a polyvinyl
chloride or polyolefin
infusion bag

The volume of the diluent
may be adjusted in order
to not exceed 5 mL/kg of
body weight
Cycle 1, Dose 1: Initiate
infusion at 30 mL/hr for 30
minutes, if no reaction then
increase to 60 mL/hr for 30
minutes and then to 120
mL/hr thereafter based on
tolerability

Cycle 1, Dose 2: If no
infusion reaction occurred
during prior infusion, initiate
at 60 mL/hr for 30 minutes,
then increase to 120 mL/hr
based on tolerability

Cycle 1, Dose 3, 4 and all
subsequent doses: If no
infusion reaction occurred
during prior infusion, initiate
at 120 mL/hr based on
tolerability

After 4 cycles may increase
to a maximum rate of 300
mL/hr

Do not administer as IV
push or IV bolus
Central or pPeripheral

Low protein-binding filter (0.2
to 1.2 micrometer) required

Premedication with
dexamethasone,
acetaminophen, and an H
1
-
and H
2
- blocker
approximately 45 to 90
minutes prior to infusion

Infusion reactions

Vital signs during infusion
(every 30 minutes during
infusion and for 2 hours after
the end of infusion)
Enalaprilat

Level 1
1.25 mg/mL

Special dilution:
• 0.025 mg/mL
• 0.1 mg/mL
Dilute in D5W or NS; can
give undiluted
IV push: Over 5 min

Infusion: Over 15-30 min
Central or peripheral

Consider test dose
Vital signs frequently, allergic
reaction
Ephedrine

Level 4
50 mg/mL No information Slow IV push

Infusion: No information
Blood pressure and heart
rate every 5 minutes, ECG
Epinephrine
HIGH ALERT
MEDICATION

Level 4


1 mg/mL

Special dilution:
• 0.1 mg/mL
Dilute in D5W or NS;
conc: 4 mcg/mL; max
cont infusion conc: 64
mcg/mL


IV push: Over 15-30
seconds

Infusion: Infants and
children: 0.05-1 mcg/kg/min
cont infusion titrate to
response
Central line only Continuous blood pressure
(invasive arterial line), heart
rate, ECG, and urine flow.
Vasoconstrictor, avoid
extravasation

See Non-Chemotherapy
Extravasation Guideline
Epoetin Alfa

Level 1
2000, 10,000 or
40,000 units/mL
Dilute 1:1 in NS IV Push Rate: Over 1-3min

Infusion: No information
Venous line at end of
dialysis procedure
Blood pressure, monitor line
for clotting
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

32

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Epoprostenol
HIGH ALERT
MEDICATION

Level 4
500, 1000,
3000, or 5000
ng/mL

Only use manufacturer
diluent
Continuous IV infusion:
initial 1-2 ng/kg/min titrate
every ~15 to response
Central line preferred, may
use peripheral as central is
established
Hemodynamics
Ertapenem

Level 1
1g

Special dilution:
• 20 mg/mL
20mg/mL in NS Intermittent Infusion:
20mg/mL may be
administered over 30
minutes
Central or peripheral

Do not co-infuse with other
medications
Neurologic assessment
Erythromycin
lactobionate

Level 1
50 mg/mL

Special dilution:
• 5 mg/mL
Dilute in NS or D5W;
conc 1-5 mg/mL


Intermittent infusion: Over
20-60 min.

Neonate and pediatrics
Infuse over at least 60 min;
to decrease vein irritation
dilute to ≤ 1 mg/mL
Central or peripheral Vital signs, if vein irritation/
thrombophlebitis, decrease
rate of infusion or increase
volume of dilution or add
lidocaine 10 mg.

See Non-Chemotherapy
Extravasation Guideline
Esmolol
HIGH ALERT
MEDICATION–
continuous infusion

Level 4
10 mg/mL, 250
mg/mL or 2.5
g/250 mL
Dilute to final conc: 10
mg/mL max


IV push: Over 1 minute

Infusion50-1000
mcg/kg/min
Central line preferred; use
large peripheral vein
Continuous blood pressure
(invasive arterial line),
respiratory rate, heart rate
and ECG.

See Non-Chemotherapy
Extravasation Guideline
Ethacrynic acid

Level 1
1 mg/mL Max conc: 2 mg/mL Infuse over a period of
several minutes or infuse
slowly through the tubing of
a running infusion
Central or peripheral Blood pressure
Etomidate
HIGH ALERT
MEDICATION

Level 4
2 mg/mL No further dilution IV push: Over 30-60
seconds

Infusion: 10-20 mcg/kg/min
Patient should be intubated.
Avoid small vessels of the
head or hand.
Airway, blood pressure, heart
rate
Etoposide
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
20 mg/mL Dilute in NS or D5W (for
stability), conc: 0.2-0.4
mg/mL in peripheral line


Over at least 60 min; do not
exceed 100 mg/m
2
/hr (or
3.3 mg/kg/hr)

IV Push: Not recommended
Central line required if
undiluted

Use with in-line 0.2 or 0.22
micron filter
Blood pressure, avoid
extravasation

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

33

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Fat Emulsion 20%
HIGH ALERT
MEDICATION

Level 1
For local anesthetic toxicity:
IV push over 1 minute

Infusion: Initial 0.25
mL/kg/min, max total dose
of 8mL/kg

TPN:
Infusion: max of 1g/kg in 4
hours
Peripheral or central

Use a 1.2 micron filter for any
infusion containing IV fat
emulsion

If used as infusion (not part
of TPN), discard after 12
hours fo use

Fenoldopam
HIGH ALERT
MEDICATION–
continuous infusion

Level 4
0.06 mg/mL In NS or D5W IV push: Not
recommended

Infusion: 0.2 – 0.8
mcg/kg/min for up to 4
hours of use
Higher doses have been
shown to worsen tachycardia
without any additional BP
benefits

Central or peripheral
Heart rate and blood
pressure


Fentanyl Citrate
HIGH ALERT
MEDICATION –
PCA, infusion,
epidural

Level 1


50 mcg/mL

Special dilution:
• 5 mcg/mL
Dilute to any convenient
volume
Opioid-naïve IV push: Over
3-5 min; doses > 5 mcg/kg
give over 5-10 min

Infusion:
Neonates: Dilute to a
concentration of 10mcg/mL;
administer over 15-30 min

Neonates and younger
infants: 0.5-1 mcg/kg/hr
titrated up;

Older infants and children
1-12 yrs: 1-3 mcg/kg/hr
titrate up
Central or peripheral Respiratory rate/ depth, vital
signs.

If used for conscious
sedation see Policy 8.56,
Pediatric Sedation Policy for
monitoring requirements.

Ferric Sodium
Gluconate

Level 1
Avoid dilution in D5W

For test dose: In 50mL
NS
Infusion: Over at least 1
hour. Do not exceed
12.5mg/min

IV push: 12.5mg iron per
minute
Central or peripheral Vital signs, signs of
anaphylactic reaction
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

34

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Filgrastim

Level 1

See GCSF Guideline
300 mcg/mL Dilute in D5W, conc: 5-15
mcg/mL


Infusion: Over 15- 30 min

IV Push: No information

Continuous infusion: Over
4-24 hours in BMT pts at
final conc of at least 15
mcg/mL
Central or peripheral

Do not administer in the 24
hours prior to or earlier than
24 hours after cytotoxic
chemotherapy

Filgrastim concentration:
>15mcg/ mL - no albumin
needed
2mcg-15mcg/ mL add 2mg/
mL albumin to stabilize
<2mcg/ mL – albumin not
recommended.
Temperature, bone pain
Fluconazole

Level 1
400 mg/200 mL
or 200 mg/100
mL bag
No further dilution


200 mg/hr max rate; Doses
≥ 6 mg/kg/day, infuse over
2 hrs

IV Push not recommended
Central or peripheral
Fludarabine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
25 mg/mL Dilute in D5W or NS
Max conc 1 mg/mL


Intermittent infusion: 0.25-
1mg/mL over 15-30 min; or
cont infusion over 24 hrs or
per protocol

IV Push not recommended
Central or peripheral Infusion reactions

See Chemotherpeutic
Extravasation Guidelines
Flumazenil
Level 1
100 mcg/mL No information IV push: Over 15-30
seconds into free running
IV infusion

Infusion: do not exceed 0.2
mg/min
Blood pressure, heart rate,
respiratory status.
Fluorouracil
HIGH ALERT
MEDICATION –
continuous infusion

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
50 mg/mL Dilute in D5W or NS to
any convenient volume
for infusion
IV push: over 5-15 min

Infusion: over 22-24 hrs
Central or peripheral

Avoid extravasation
Dose limiting factor for
infusion is mucous
membrane toxicity
(stomatitis, diarrhea)

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

35

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Folic Acid

Level 1
5 mg/mL Dilute in D5W or NS to
0.1 mg/mL

IV push: Doses ≤5mg over
≥1 min
Infusion: Doses ≤5mg dilute
in 50mL NS or D5W and
infuse over 30 min. May be
added to IV maintenance
fluid and infused.
Central or peripheral Slight flushing possible
Fomepizole

Level 2
Dilute in at least 100mL
NS of D5W to conc of
<25mg/mL
Infusion: Over 30 minutes Concentrations ≥25mg/mL
have been associated with
vein irritation and
phlebosclerosis
Vital signs, acid base status,
signs and symptoms of
toxicity from ingested agent
Fosaprepitant

Level 1
Dilute in 250 mL NS Infusion:
150mg over 20-30 min
115mg over 15 min
Central or peripheral Immediate hypersensitivity
reactions
Foscarnet

Level 1
24 mg/mL

Special dilution:
• 12 mg/mL
Central line: no further
dilution

Peripheral line: dilute in
D5W or NS, max conc:
12 mg/mL
40 mg/kg: over 60 min; 90
mg/kg: over 90-120 min
Infusion rate not to exceed
60 mg/kg/dose over 1 hr or
120 mg/kg/dose over 2 hrs

IV Push not recommended
Central or peripheral line
administration dependent
on dilution;
Central line required if
undiluted
Phlebitis.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

36

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Fosphenytoin

Level 4 for Load

Level 1 for
Maintenance

See Fosphenytoin and
Phenytoin Guideline
50 mg
phenytoin
equivalents
(PE)/ 1 mL

Special dilution:
• 5 mg PE/mL
• 20 mg PE/mL
Dilute in D5W or NS,
conc: 1.5-25 mg PE/mL


Children
IV push: Not recommended

Neonates
IV push: maintenance
doses may be administered
slow IV push at rate of 1-
3mg PE/kg/min; max
150mg PE/min


Intermittent IV infusion:
Children 5-18 years: 1-3mg
PE/kg/min; max 150mg
PE/min
Central or peripheral Continuous HR, ECG and BP
monitoring. BP and pulse
every 15 min for 1 hour after
administration or more
frequent with emergent use,
infusion site reactions.

Peak serum concentrations
should be drawn 1 hour after
end of IV infusion


See Non-Chemotherapy
Extravasation Guideline
Furosemide
HIGH ALERT
MEDICATION –
continuous infusion

Level 1


10 mg/mL

Special dilution:
• 1 mg/mL
Dilute in D5W or NS

IV push: max of
0.5mg/kg/min or 4mg/min

Pediatric:
Intermittent infusion:
Max of 10mg/mL over 10-
15 min

Neonates
Intermittent infusion:
2-10mg/mL over 15 to 30
minutes
Central or peripheral Blood pressure, hearing
Ganciclovir

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
50 mg/mL

Special dilution:
•5 mg/mL
Dilute in D5W or NS, max
conc: 10 mg/mL

Over 60 min

IV Push not recommended
Central or peripheral

Larger veins with higher
blood flow preferred due to
high pH of drug (pH=11)
Pain at site of infusion,
phlebitis.

See Non-Chemotherapy
Extravasation Guideline
Gemcitabine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
38mg/mL Dilute with NS to final
concentration as low as
0.1mg/mL
Infusion: Over 30-90
minutes. Infusion time > 60
minutes has been shown to
prolong gemcitabine’s half-
life and increase toxicity in
adults.
Central or peripheral Vascular irritant, avoid
extravasation

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

37

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Gentamicin

Level 1
40 mg/mL, 10
mg/mL

Special dilution:
• 4 mg/mL
• 10 mg/mL
Dilute in D5W or NS; max
conc: 10 mg/mL


Infuse over 30-60 min
IV Push not recommended

Neonates
Infuse over 30-60 min
Central or peripheral

Administer beta-lactams at
least 1 hour before or after
gentamicin.
Respiratory rate/ depth
Glucagon

Level 1
1 mg/vial Dilute with solution
provided, max conc: 1
mg/mL
1-5 mg/hr

IV Push: no information
Easily absorbed IM or
subcutaneously.

Central or peripheral

Glucarpidase

Level 1

1000 unit vial
reconstituted
with 1 mL
Infuse over 5 minutes Flush IV line before and after
administration

Ensure adequate hydration
Hypersensitivity,
hypotension, flushing,
parasthesias
Glycopyrrolate

Level 1
200 mcg/mL Dilute in D5W or NS

Max conc: 200 mcg/mL
Over 15-20 min; max rate:
20 mcg/min

IV Push: no information
Central or peripheral Apical pulse, HR
Granisetron

Level 1
1 mg/mL May be diluted with 2-20
mL of D5W or NS for
infusion
Undiluted: infuse over 30
secs

Diluted: infuse over 5 mins
Central or peripheral EKG changes including QT
prolongation
Haloperidol Lactate

Level 1
5 mg/mL

Special dilution:
• 0.5 mg/mL
Dilute in D5W, usual
conc: 1 mg/mL, max
conc: 5 mg/mL
No information for infusion
or IV Push rate
Haloperidol decanoate not
for IV use

Central or peripheral
Blood pressure, cardiac
conduction (QTc),
extrapyramidal symptoms
Heparin
HIGH ALERT
MEDICATION
(excepting <500 unit
flushes)
Level 1

See Heparin Infusion
Guideline
See Heparin Use in
ECMO Guideline
50 units/mL Dilute in D5W or NS



IV Push Rate: over 10 min

Infusion: titrate to aPPT or
anti-Xa goal
Central or peripheral

Do NOT administer IM
Allergic reactions, signs and
symptoms of bleeding
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

38

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Hetastarch
HIGH ALERT
MEDICATION –
continuous infusion

Level 1
6% No further dilution


Max infusion rate (shock):
1.2 g/kg/hr (20 mL/kg/hr)

IV Push: no information
Central or peripheral

If administered by pressure
infusion, air should be
withdrawn or expelled from
bag prior to infusion to
prevent air embolus.

Do not administer blood and
hetastarch through same
administration set. Flush line
between hetastarch and
blood.
Hypersensitivity reactions
(including anaphylaxis),
vomiting, chills
Hydralazine

Level 1
20 mg/mL

Special dilution:
• 0.5 mg/mL
• 10 mg/mL
Max conc: 20 mg/ mL


IV Push max rate: 0.2
mg/kg/min

Infusion not recommended
Central or peripheral Heart rate, blood pressure
Hydrocortisone
Sodium Succinate

Level 1
50 mg/mL

Special dilution:
• 0.25 mg/mL
• 1 mg/mL
• 5 mg/mL
• 10 mg/mL
Dilute in D5W or NS, max
conc: 1 mg/mL


Pediatrics and neonates
IV push: Dilute to 50mg/mL
and give over at least 30
sec. Doses ≥500 mg give
over 10 minutes.

Intermittent infusion: over
20-30 min, max conc 5
mg/mL
Central or peripheral Blood pressure, blood
glucose
Hydromorphone
HIGH ALERT
MEDICATION –
PCA, infusion

Level 1
1-2 mg/mL

Special dilution:
• 0.1 mg/mL
Dilute in D5W or NS,
usual conc: 1 mg/mL


IV push: Over at least 3-5
min

Infusion: no information
Central or peripheral Vital signs, respiratory
rate/depth, pain relief
Hydroxocobalamin

Level 4
Infusion: First dose over 15
minutes, second dose over
15 min to 2 hours
Solution should be dark red

Chemically incompatible with
sodium thiosulfate and
sodium nitrite and separate
IV lines must be used if
concomitant administration is
desired.
Blood pressure, heart rate
Hydroxyzine

Level 1
50 mg/mL

Special dilution:
• 5 mg/mL
DO NOT ADMINISTER AS
IV - Vesicant
Give as an IM injection Blood pressure
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

39

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Ibutilide

Level 3
0.1 mg/mL Dilute in 50 mL D5W or
NS

IV Push Rate and infusion
rate: Over 10 min
Central or peripheral Blood pressure, heart rate,
continuous ECG
Idarubicin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Dilute in D5W or NS Infusion: Final conc of
1mg/mL over 10-30 min in
free flowing IV solution of
NS of D5W
Central or peripheral

Vesicant, avoid extravasation
ECG, extravasation

See Chemotherpeutic
Extravasation Guidelines
Ifosfamide
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
50 mg/mL Dilute in D5W or NS,
conc: 0.6-20 mg/mL; max
conc: 40 mg/mL
Infusion Rate: Over at least
30 min, usual infusion time
2 hours, or as 24 hour
infusion

IV Push not recommended
Central or peripheral

Administer with mesna
Urinalysis for blood in urine,
neurologic symptoms

See Chemotherpeutic
Extravasation Guidelines
Imipenem/ cilastatin
Level 1

500 mg/100 mL
or 1 g/250 mL

Special dilution:
• 5 mg/mL
Max conc: 5 mg/mL

Doses ≤ 500 mg over 15-30
min, >500 mg over 40-60
min

IV Push not recommended

Neonates
Infuse over 15-30 min
Central or peripheral Seizures, hypersensitivity
(including anaphylaxis),
phlebitis, slow infusion if
nausea develops.

See Non-Chemotherapy
Extravasation Guideline
Immune Globulin
(IVIG)

Level 1

See IVIG Guideline

See IVIG Rate
Calculator (follow link
and choose to
“download”)
Gammagard
Liquid 20 g/200
mL

Gammagard
S/D 50-100
mg/mL
No further dilution See IVIG Guideline for
infusion rate instructions

IV Push not recommended
Central or peripheral

Gammagard Liquid requires
no filter

Gammagard S/D requires 15
micron filter

Flebogamma filter is
recommended
Anaphylaxis, blood pressure,
temperature, fever, chills,
infusion site discomfort, vital
signs, observe continuously.

See Non-Chemotherapy
Extravasation Guideline
Indigotindisulfonate
Sodium

Level 1
8 mg/mL No information IV Push Rate: Rapid
injection

Infusion rate: no information

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

40

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Indomethacin

Level 2
Dilute in preservative free
SWI or preservative free
NS
Pediatrics:
Infusion: Over 20-30
minutes at concentration of
0.5-1mg/mL

Neonatal:
Infusion: Over at least 30
minutes.

IV Push: No
recommendation
Central or peripheral If treating PDA: HR, murmur,
ECG
Infliximab
HIGH ALERT
MEDICATION

Level 1
10 mg/mL Dilute to final volume of
250 mL NS, conc: 0.4-4
mg/ mL
Standard Infusion Rate
(over at least 2 hours):
Administer at 10 mL/hr for
15 minutes, then 20 mL/hr
for 15 minutes, then 40
mL/hr for 15 minutes, then
80 mL/hr for 15 minutes,
then 150 mL/hr for 30
minutes, then 250 mL/hr
until completed.

Rapid Infusion Rate for
use in Day Treatment or
Campground for IBD
patients who have
tolerated at least three
previous doses of
infliximab with Standard
Infusion Rate:
Administer at 100 mL/hr for
15 min, then 300 mL/hr until
completed

IV Push Rate: No
information
Do not infuse with other
drugs. Administer with 0.2 or
0.22 mircon in-line filter

Standard Infusion Rate
Adverse Reactions:
For adverse reactions, stop
infusion. When symptoms
resolve, resume infusion at
10 mL/hr and follow same
titration schedule

Rapid Infusion Rate
Adverse Reactions:
For adverse reactions, stop
infusion. When symptoms
resolve, resume infusion at
10 mL/hr and follow the
standard titration schedule

Central or peripheral
Vitals prior to infusion and
every 15-30 minutes during
infusion including blood
pressure, pulse, and
respiratory
Insulin, Regular
HIGH ALERT
MEDICATION –
continuous infusion

Level 4
100 units/mL Dilute in NS or D5W;
usual conc: 0.5-1 unit/mL
IV push: Over 10-15
seconds

Infusion: Give at desired
rate
Central or peripheral Frequent blood glucose
levels
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

41

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Interferon Alfa – 2B,
Recombinant
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
10, 25, or 50
million units
No information No information on infusion
rate

IV Push not recommended
Subcutaneous only for
children
Frequent blood pressure

See Chemotherpeutic
Extravasation Guidelines
Ipilimumab

Level 1

Hazardous Drug –
MODERATE RISK

See UW Health Clinical
Policy 6.1.11
50 mg/10 mL;
200 mg/40 mL
Dilute with NS or D5W to
a final concentration of 1-
2 mg/mL
Over 90 minutes Central or peripheral

Administer with 0.22 micron
filter
Electrolytes, LFTs, TSH prior
to each dose
Irinotecan
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
20 mg/mL Dilute in D5W (preferred)
or NS, conc: 0.12-2.8
mg/mL
Infusion: Over 90 min

IV Push not recommended
Central or peripheral

Avoid extravasation
Vital signs, diarrhea

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

42

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Iron Dextran

Level 1
50 mg/mL Dilute in NS

Max conc: 50 mg/mL

Central or peripheral
IV Push rate: Test dose for
infants: 12.5 mg; for
children, adolescents: 25
mg; test dose over at least
5 min

Infusion Rate: Over 2-6 hrs
as tolerated; max rate: 50
mg/min

Neonates
Infusion Rate:0.4 to 1
mg/kg (400 to 1000
mcg/kg) per day IV
continuous infusion in
Dex/AA solutions
containing at least 2%
amino acids.
Central or peripheral Vital signs, anaphylaxis,
phlebitis.

See Non-Chemotherapy
Extravasation Guideline
Iron Sucrose

Level 1
20 mg/mL

Special dilution:
• 2 mg/mL
Dilute in NS

Central or peripheral
IV push rate: 20 mg/min
(usually in dialysis)

Infusion Rate: Over 15-30
min
Central or peripheral Vital signs during and
immediately after
administration,
hypersensitivity reaction
Isavuconazonium
sulfate
(isavuconazole)

Level 1
372 mg as
lyophilized
powder in
single use vial
Dilute to 1.5 mg/mL or
250 mL
Infuse over at least 1 hour.
Complete infusion within 6
hours

Do not administer as a
bolus
Infuse through a dedicated
line with a 0.2-1.2 micron
inline filter

Central or peripheral

Do not shake
Hypersensitivity reactions
with initial doses

Infusion-related reactions
(hypotension, dyspnea,
dizziness, paresthesias,
hypoesthesia)
Isoproterenol
HIGH ALERT
MEDICATION

Level 4
200 mcg/mL Dilute D5W or NS, conc:
4 mcg/mL; max conc: 20
mcg/mL
Infusion rate: 0.05-2
mcg/kg/min

IV Push rate: no information
Central or peripheral Continuous blood pressure
(invasive arterial line), heart
rate, ECG
Ketamine
HIGH ALERT
MEDICATION

Level 1 for continuous
infusion analgesia

Level 4 for continuous
infusion sedation
50 mg/mL or
100 mg/mL

Special dilution:
• 10 mg/mL
Dilute in D5W or NS to
conc: 1-2 mg/mL
IV push: Over 2-3 min

Infusion: Sedation, children:
5-20 mcg/kg/min; max rate:
0.5 mg/kg/min
Central or peripheral Pain rating, sedation level,
respiratory rate

Continuous ECG (if used
Level 4), vital signs, sedation
level
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

43

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Ketorolac

Level 1
30 mg/mL

Special dilution:
• 2 mg/mL
No information


IV Push rate: Children:
dose over 5 min

Infusion rate: No
information
Central or peripheral Vital signs
Labetalol
HIGH ALERT
MEDICATION –
continuous infusion

Level 3 - IV push
Level 4 - infusion
5 mg/mL

Special dilution:
• 1 mg/mL
Dilute in D5W or NS,
usual conc: 1 mg/mL
IV push: Over 2-3 min, no
faster than 2 mg/min

Infusion Rate: Limited
information: 0.25-1.5
mg/kg/hr
Central or peripheral Blood pressure before and 5
and 10 minutes after each
injection, or every 5 minutes
during infusion, respiratory
rate/depth
Lacosamide

Level 1
20 mg/mL NS, LR, D5W Infusion: Over 30-60
minutes with or w/o further
dilution
Central or peripheral ECG prior to initiating therapy
and at steady state
maintenance dose:
bradycardia, AV block
Laronidase

Level 2
2.9 mg/5 mL Dilute in 100 – 250 mL
NS
• ≤ 20 kg: 100 mL
• > 20 kg: 250 mL
Over 3 -4 hours depending
on weight
≤ 20 kg: 2 mL/hour and
double rate every 15
minutes not exceed 32
mL/hour;
> 20 kg: 5 mL/hour and
double rate every 15
minutes not to exceed 80
mL/hour

A total infusion volume of
100 mL NS and slower
infusion rate may be
considered for patients with
cardiac or respiratory
compromise who weigh up
to 30 kg
Central or peripheral

Requires dedicated line and
0.2 micron filter

Hypersensitivity: monitor vital
signs every 15 minutes
Leucovorin Calcium
finflix
Level 1
10 mg/mL or 20
mg/mL
Dilute in 100-500 mL
D5W or NS
IV push: Over 3 min, max
rate: 160 mg/min

Infusion Rate: Over 1- 6 hrs
Central or peripheral
Levetiracetam

Level 1
100 mg/mL

Special dilution:
• 15 mg/mL
Infusion: Pediatrics <16
years: Dilute in NS to conc
of 15mg/mL, infuse over 15
min

Neonates: Dilute to conc 5-
15mg/mL and infuse over
15 min
Central or peripheral Dizziness, somnolence, vital
signs
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

44

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Levocarnitine

Level 1
1 g/5 mL

Special dilution:
• 15 mg/mL
Dilute in NS or LR


Over 2-3 min
Convenient rate
Central or peripheral
Levofloxacin

Level 1
250 mg/50 mL,
500 mg/100
mL, 750 mg/
150 mL
No further dilution Infusion: 250-500mg over
60 minutes, 750 mg over 90
minutes.

IV Push not recommended
Central or peripheral

Maintain adequate hydration
to prevent crystalluria or
cylinduria
Blood pressure (rapid
administration can cause
hypotension)
Levothyroxine

Level 1
100 mcg/mL Not recommended

IV Push: Over 2-3 min

Infusion: Not recommended
Central or peripheral Observe patient
continuously, vital signs
Lidocaine
HIGH ALERT
MEDICATION when
administered as
epinephrine w/
lidocaine or infusion

Level 1 for continuous
infusion for pain
See Policy 10.18
Lidocaine for
Neuropathic Pain

Level 4 for arrhythmia
20 mg/mL or
2 g/500 mL
Dilute in D5W, max conc:
8 mg/mL

Dilute in ___. Final conc
no more than 20mg/mL
for IV push; no more than
8mg/mL for IV infusion.
IV push: Do not exceed 0.7
mg/kg/min or 50 mg/min
whichever is less

Infusion rate: 20 - 50
mcg/kg/min
Central or peripheral



Continuous ECG when used
for arrhythmias; neurologic
status (dizziness, blurred
vision, confusion, anxiety,
seizures, etc); convuslsions,
thrombophlebitis, perioral
numbness, serum lidocaine
concentrations
Linezolid

Level 1
600 mg/300
mL, 400
mg/200 mL,
200 mg/100 mL
No further dilution


Infusion rate: Over 30-120
min

IV Push not recommended
Central or peripheral
Liothyronine

Level 1
Do not admix with other
solutions
IV push: Min rate:
10mcg/min
Administer doses at least 4
hours and no more than 12
hours apart.

Lorazepam
HIGH ALERT
MEDICATION –
continuous infusion

Level 1 - push
Level 4 - infusion


2 mg/mL or 4
mg/mL

Special dilution:
• 0.2 mg/mL
Dilute in D5W, conc: 0.1-
0.2 mg/mL




IV push: Dilute with equal
volume D5W, SW or NS;
max rate: 2 mg/min or 0.05
mg/kg over 2-5 min

Infusion Rate: 0.02-0.19
mg/kg/hr
Central or peripheral

Avoid extravasation
Respiratory rate/depth, blood
pressure

If used for conscious
sedation see Hospital
Administration Policy 8.56:
Pediatric Sedation Policy for
monitoring requirements.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

45

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Magnesium Sulfate

Level 2
8 mEq/1 g/2
mL, 16 mEq/2
g/4 mL

Special dilution:
• 0.02 g/mL
• 0.06 g/mL
Dilute in D5W or NS, max
conc: 200 mg/mL
Usual dose: 50 mg/kg (to a
maximum of 2 g)

For replacement, infuse
over a minimum of 3 hours;
preferable to infuse over 4-
6 hours to increase
retention
Max rate: 125 mg/kg/hr

For bronchospasm or
Torsades de Pointes, infuse
over 20 min
Central or peripheral Blood pressure, cardiac
status
Mannitol

Level 1
250 mg/mL
(25%), 200 mg/
mL (20%)
No further dilution


IV push: 0.2 g/kg (max 12.5
g) over 3-5 min

Infusion: Over 30-90 min
Central line only

Administer via 0.2 or 0.22
mircon in-line filter; observe
solution for crystals
Cardiac status, fluid status,
avoid extravasation.

See Non-Chemotherapy
Extravasation Guideline
Mechlorethamine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL IV Push Rate: Over 3-5 min
into running IV line; max
conc: 1 mg/mL

Infusion: Not recommended
Central line only

Vesicant, avoid extravasation
Hypersensitivity,
extravasation

See Chemotherpeutic
Extravasation Guidelines
Melphalan
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
5 mg/mL Dilute in NS; usual conc:
0.1-0.45 mg/ mL

Central or peripheral
Doses ≤ 0.45 mg/mL use
peripheral line, doses ≤
2 mg/ mL use central
Infusion: Over 15 -30 min,
max rate: 10 mg/min but
total infusion should be
administered within 1 hr

IV push: no information
Administration through
central or peripheral lines
depends on concentration;
Central line required if
undiluted; central line
preferred when diluted


Avoid extravasation
Infusion site reaction,
extravasation

See Non-Chemotherapy
Extravasation Guideline
Meperidine
HIGH ALERT
MEDICATION

Level 1
25 - 100 mg/mL Dilute in D5W or NS,
conc: 1 mg/mL


IV Push rate: Over 4-5 min,
dilute to fewer than 10
mg/mL

Infusion not recommended
Infusion: Dilute to 1mg/mL
and give over 15-30 min
Central or peripheral Blood pressure, vital signs,
respiratory rate/ depth.
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

46

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Meropenem

Level 1
50 mg/mL

Special dilution:
• 10 mg/mL
IV push: 50mg/mL over 3 to
5 min

Pediatrics
Infusion: 1-50 g/mL in D5W
or NS over 15 to 30 min, or
extended interval infusion
over 4 hours.

Neonates
Infuse over 30 min conc of
1 to 20 mg/mL
Central or peripheral Signs/Symptoms of CNS
reactions, infusion site for
inflammation,
thrombophlebitis
Mesna

Level 1
100 mg/mL Dilute in D5W or NS,
conc: 1-20 mg/mL

Infusion: Over 15-30 min or
1000 mL over 24 hrs

IV Push: No information
Given as adjuvant to
chemotherapy.

Central or peripheral

May be added to solutions
containing ifosfamide or
cyclophsphamide

Methadone

Level 1
10 mg/mL

Special dilution:
• 0.2 mg/mL
• 1 mg/mL
May dilute each mL (10
mg) in 1-5 mL NS


IV Push: Over at least 5
min

Infusion: Not recommended
Central or peripheral Vital signs, respiratory status
Methotrexate
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11

See Methotrexate
Guideline
25 mg/mL Doses >100 mg: dilute in
D5W or NS


Infusion: Rate determined
by protocol (over 30 min- 4
hr) or cont infusion over 24
hrs. Concentration not to
exceed 25mg/mL

IV push: no information
May be given at a
concentration no more than
25mg/mL

IV push rate: no information
Central or peripheral Close patient observation for
toxicity – CBC, platelets, skin
reactions

See Chemotherpeutic
Extravasation Guidelines
Methylene Blue

Level 1
10 mg/mL Dilute in NS


IV Push: 1 mL/1-2 min

Infusion: Dilute in 50mL NS
and infused over at least 5
minutes
Central or peripheral
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

47

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Methylprednisolone

Level 1


62.5 mg/mL

Special dilution:
• 10 mg/mL
Dilute in D5W



Infusion rate:
Over 30-60 min

Spinal cord injury: 5.4
mcg/kg/hr x 23hr

IV Push: LOW DOSE
ONLY- ≤1.8 mg/kg or ≤125
mg/dose): I.V. push over 3-
15 minutes; maximum
concentration: 125 mg/mL

Infusion: Moderate dose
(eg, ≥2 mg/kg or 250
mg/dose): Administer over
15-30 minutes

High dose (eg, ≥15 mg/kg
or ≥500 mg/dose):
Administer over 30-60
minutes; doses ≥1000 mg:
Administer over 60 minutes.
Central or peripheral Blood pressure, blood
glucose
Metoclopramide

Level 1
5 mg/mL

Special dilution:
• 0.2 mg/mL
Dilute in 50 mL to 0.2 mg/
mL, max conc: 5 mg mL
in D5W or NS
Infusion: Doses >10 mg
should be diluted in 50mL
of NS or D5W and
administered over 15 -30
min

IV Push: Max rate: 10 mg
over 2 min
Central or peripheral Vital signs, dystonic
reactions, agitation,
confusion
Metronidazole

Level 1
500 mg/100 mL No further dilution


Infusion: Conc of 5-8mg/mL
over 30-60 min

IV Push: Not recommended
Central or peripheral

Avoid extravasation
Thrombophlebitis, neurologic
symptoms

See Non-Chemotherapy
Extravasation Guideline
Micafungin

Level 1

Special dilution:
• 1 mg/mL
Dilute in NS or D5W to
final conc of 0.5-4mg/mL
Pediatrics and neonates
Infusion: Conc of 0.5-
4mg/mL over 1 hour. Conc
0.5-1.5mg/mL preferred in
pediatrics

Pediatrics and neonates:
IV push: Not recommended
Prior to administration, flush
line with NS.

Concentrations >1.5mg/mL
should be administered via
central line
Histamine-mediated infusion
reactions, IV site irritation

Reduce rate of infusion with
histamine-mediated reactions
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

48

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Midazolam
HIGH ALERT
MEDICATION –
continuous infusion


Level 3, Pediatric
Sedation, Pediatric
Campground, and
general care for
prolonged epilepsy
monitoring



See Hospital
Administration Policy
8.56: Pediatric
Sedation Policy
1 mg/mL or 5
mg/mL

Special dilution:
• 0.05 mg/mL
Dilute in D5W or NS,
usual conc:
1 mg/mL; max conc: 5
mg/mL


IV push: Over 2-5 min at
concentration of 1-5 mg/mL

Infusion: 0.05-0.3 mg/kg/hr

Neonates
IV push: 0.05mg/kg over at
least 5 minutes;
Continuous infusion 0.01 to
0.06 mg/kg/hr
Central or peripheral Blood pressure, respiratory
rate/ depth, oxygen
saturation

If used for conscious
sedation see Hospital
Administration Policy 8.56:
Pediatric Sedation Policy for
monitoring requirements.

See Non-Chemotherapy
Extravasation Guideline
Milrinone
HIGH ALERT
MEDICATION –
continuous infusion

Level 4


1 mg/mL Dilute in D5W; usual
conc: ≤200 mcg/mL


IV Push Rate: Loading
dose of 50 -75 mcg/kg over
15 min

Infusion Rate:
0.25 - 0.75 mcg/kg/min

Premature infants fewer
than 30 weeks GA:
Loading dose 135mcg/kg IV
infused over 3 hours,
immediately followed by
maintenance infusion of
0.2mcg/kg/min
Central or peripheral Continuous blood pressure
(invasive arterial line), heart
rate, ECG, and urine flow,
extravasation

See Non-Chemotherapy
Extravasation Guideline
Mitomycin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
500 mcg/mL Final conc: 20-40
mcg/mL; 50-250 mL of
D5W or NS


IV Push Rate: Dose over 5-
10 min through Y site of
running IV, conc not to
exceed 0.5 mg/mL

Infusion Rate: Over 30-60
min
Central line only

Vesicant, avoid extravasation
See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

49

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Mitoxantrone
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
2 mg/mL Dilute in D5W or NS


Infuse over 15-30 min into
running IV

IV Push: may bolus over 5-
15 min
Central or peripheral

Avoid extravasation
ECG, extravasation

See Chemotherpeutic
Extravasation Guidelines
Morphine
HIGH ALERT
MEDICATION –
PCA, infusion,
epidural

Level 1


2-10 mg/mL

Special dilution:
• 0.05 mg/mL
• 0.1 mg/mL
Dilute in D5W or NS,
usual conc: 1mg/mL


Infuse 0.5-5mg/mL over 15-
30 min

IV Push: 0.5-5 mg/mL over
at least 5 minutes

Neonates
Initial rate 0.01 mg/kg/hr, do
not exceed infusion rates of
up to 0.02 mg/kg/hr;
max dose 0.2 mg/kg/dose
over at least 5 minutes
Central or peripheral Respiratory rate and depth,
oxygen saturation, mental
status, blood pressure, heart
rate, pain relief, level of
sedation

If used for conscious
sedation see Hospital
Administration Policy 8.56:
Pediatric Sedation Policy for
monitoring requirements.

See Non-Chemotherapy
Extravasation Guideline
Moxifloxacin

Level 1
400 mg/250 mL No further dilution


Infusion: Over 60 min

IV Push: not recommended
Central or peripheral Allergic reaction (including
anaphylaxis, rash, and
hypotension).

See Non-Chemotherapy
Extravasation Guideline
Multivitamins

Level 1
10 mL Dilute in D5W or NS

Over 30 min

IV Push: not recommended
Central or peripheral Vital signs, anaphylaxis
Mycophenolate

Level 1

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
500 mg vial

Special dilution:
• 5 mg/mL
Dilute in D5W to 6 mg/mL


Infuse over minimum of 2
hrs

IV Push rate: not
recommended
Do not administer as bolus
or rapid infusion.

Central or peripheral

Blood pressure

See Non-Chemotherapy
Extravasation Guideline
Nalbuphine

Level 1
10 mg/mL or 20
mg/mL
IV Push Rate: Over 5-10
min, larger dose over 10-15
min

Infusion: No information
Central or peripheral Vital signs, respiratory rate
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

50

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Naloxone
HIGH ALERT
MEDICATION –
continuous infusion

Level 1


20 mcg, 400
mcg, or 1
mg/mL

Special dilution:
• 0.04 mg/mL
Dilute 2.5 mg in 250 mL
D5W or NS, conc: 4
mcg/mL
IV push dose over 30 secs

Infusion: Titrate rate to
patient response; conc of 4
mcg/mL

Neonate
IV push recommended
Central or peripheral Respiratory rate/ depth,
blood pressure, level of
consciousness, oxygen
saturation
Nelarabine
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
5mg/mL Infusion: Undiluted over 1
hour
Central or peripheral Neurological toxicity
(somnolence, seizure,
peripheral neuropathy,
confusion, ataxia,
paresthesia, hypoesthesia)

See Chemotherpeutic
Extravasation Guidelines
Neostigmine

Level 2
1 mg/mL No information Pediatrics and neonates
IV push: undiluted by slow
IV injection over several
minutes

Infusion: No information
Central or peripheral

MD presence required at
bedside at least 30 minutes
after administration

Recommend administration
with atropine or
glycopyrrolate to prevent
possible bradycardia,
increased salivation and
hyperperisalsis.
Respiratory rate/ depth,
blood pressure, telemetry
required

Telemetry required to monitor
for bradycardia or asystole

MD presence required
Nicardipine
HIGH ALERT
MEDICATION –
continuous infusion

Level 4
2.5 mg/mL Dilute in D5W or NS to
conc: 0.1 to 0.5 mg/mL
Neonates: Dilute to
concentration of 0.1
mg/mL or use premixed
Infusion Rate: 0.5 to 5
mcg/kg/min

IV Push: Not recommended
Central or peripheral:
Central line preferred; use
large peripheral vein

Change infusion site every
12 hours if administered
peripherally.
Blood pressure, heart rate
extravasation


See Non-Chemotherapy
Extravasation Guideline
Nitroglycerin
HIGH ALERT
MEDICATION –
continuous infusion

Level 3

5 mg/mL Dilute in D5W or NS,
conc: 25 mcg/mL

Do not exceed 400
mcg/mL.

Initial: 0.25-0.5 mcg/kg/min
is usual; max rate: 5
mcg/kg/min; doses up to 20
mcg/kg/min have been
used

IV Push: Not recommended
Central or peripheral Continuous blood pressure
(invasive arterial line), heart
rate, ECG
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

51

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Nitroprusside
HIGH ALERT
MEDICATION –
continuous infusion

Level 4


50 mg/250 mL Dilute in D5W


Initial 0.3-0.5 mcg/kg/min
titrate to patient response
(usual range: 0.3-10
mcg/kg/min)

IV Push not recommended
Protect from light.

Central or peripheral
Continuous blood pressure
(invasive arterial line), heart
rate, ECG, avoid
extravasation, cyanide levels
(for long-term therapy).

See Non-Chemotherapy
Extravasation Guideline
Norepinephrine
HIGH ALERT
MEDICATION

Level 4

1 mg/mL Dilute in D5W; max conc:
4-16 mcg/mL

Neonates: dilute to conc
16-100 mcg/mL


Initial: 0.05-0.1 mcg/kg/min
Max rate: 1-2 mcg/kg/min.

IV Push not recommended

Neonates
Initial 0.2-0.5 mcg/kg/min
Central line only

Avoid extravasation
Blood pressure every 2
minutes until stabilized, then
every 5 minutes; heart rate;
ECG; extravasation

See Non-Chemotherapy
Extravasation Guideline
Obinutuzumab

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11

1000 mg/40 mL Dilute in 250 mL NS only
to a final concentration of
0.4-4 mg/mL
Initial: 25-50 mg/hr
(disease state dependent)

Subsequent: may increase
to 400 mg/hr if no infusion
reactions noted
Central, midline, or peripheral

Dedicated IV line required

Premedicate with
acetaminophen,
antihistamine and steroids;
antihyperuricemics if needed
for tumor lysis syndrome
CBC, LFTs
Infusion reactions, tumor
lysis syndrome

Octreotide
HIGH ALERT
MEDICATION –
continuous infusion

Level 1


100 or 500
mcg/mL

Special dilution:
• 10 mcg/mL
Dilute in 50-250 mL D5W
or NS

Neonates
Consider dilution of 10-25
mg/mL
IV push: Over 3 min in
emergent situations, may
be undiluted

Infuse over 15-30 min or
cont infusion over 24 hours

Neonates
Infuse at 1 mcg/kg/hr, max
rate 10 mcg/kg/hr
Central or peripheral


Hypotension, cardiac status

Neonates
Blood glucose,
signs/symptoms of
necrotizing enterocolitis
Ondansetron

Level 1
2 mg/mL

Special dilution:
• 1 mg/mL
For infusion, dilute with
NS or D5W to max conc
1 mg/mL
Infuse over 15 min

IV push over 2-5 minutes
undiluted
Central or peripheral


Hypotension, transient ECG
changes, CNS changes,
pruritus, injection site
reactions
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

52

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Oxacillin

Level 1
1 g, 2 g, 10 g
vials
Dilute to 100 mg/mL Infuse over 15-30 min at a
final conc ≤40 mg/mL

IV push over 10 min at max
conc of 100 mg/mL

Neonates
IV push over 10 min at max
conc 100 mg/mL
IV infusion over 15-60 min
at conc 10-40 mg/mL
Central or peripheral Anaphylaxis, rapid infusion
may result in seizure,
extravasation
Oxaliplatin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
5 mg/mL Dilute in D5W

DO NOT DILUTE WITH
NS or any chloride-
containing diluent


Over 120 min; extend
infusion to 6 hours for acute
toxicities

IV Push not recommended
DO NOT DILUTE WITH NS
Flush line with D5W prior to
administration of any
concomitant mediation

Avoid mucositis prophylaxis
with ice chips – may
exacerbate acute
neurological symptoms

Avoid extravasation

Central or peripheral
Hypersensitivity reactions
(including anaphylaxis, rash,
bronchospasm), hypotension

See Chemotherpeutic
Extravasation Guidelines

Avoid cold compress if
extravasation occurs – may
cause peripheral neuropathy
Oxytocin

Level 4
10 units/mL Dilute in D5W, NS or LR


Adjust as necessary; usual
0.001-0.002 units/min

IV Push not recommended
Central or peripheral

Blood pressure at least every
15 minutes, continuous
observation of patient
Paclitaxel
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
6 mg/mL Dilute in D5W or NS, final
conc: 0.3-1.2 mg/mL


Over 3-24 hrs

IV Push not recommended
Administer via non-PVC
tubing and 0.2 or 0.22 mircon
non-PVC in-line filter

Central or peripheral

Extreme irritant, avoid
extravasation

Dexamethasone
premedication required
Cardiac status, EKG,
anaphylaxis, extreme irritant.

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

53

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Paclitaxel Protein-
Bound
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
100 mg vial; 5
mg/mL after
reconstitution
Not recommended after
reconstitution
Over 30 minutes Do not use an in-line filter

Central or peripheral

Dexamethasone
premedication required
Infusion reactions, vein
irritation, cardiac status,
EKG, anaphylaxis

See Chemotherpeutic
Extravasation Guidelines
Palonosetron

Level 1
Infants, children, and
adolescents: May
administer undiluted or
further dilute in NS or
D5W

Adolescents ≥17 years:
Administer undiluted
Infants, children, and
adolescents: Infuse over
15 minutes

Adolescents ≥17 years:
Infuse over 30 seconds
Flush IV line with NS prior to
and following administration
Hypersensitivity reactions,
cardiac status
Pamidronate

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
3 mg/mL

Special dilution:
• 0.1 mg/mL
Dilute in D5W or NS to a
final concentration of
0.06-0.36 mg/mL

Over 2- 24 hrs

IV Push not recommended
Central or peripheral Vein irritation,
thrombophlebitis, cardiac
status
Pancuronium
HIGH ALERT
MEDICATION

Level 4
1 mg/mL For cont infusion dilute to
0.01-0.8 mg/mL in D5NS,
D5W, LR, NS


IV push: Over 60-90
seconds

Neonates and infants: 0.02-
0.04 mg/kg/hr; Children:
0.03-0.1 mg/kg/hr
Patient must be intubated.
Ensure patient is adequately
sedated prior to
administration of
neuromuscular blockade

Central or peripheral
Blood pressure, cardiac
status, respiratory rate/
depth, use neuromuscular
blockade monitor
Pantoprazole Sodium

Level 1
4 mg/mL Dilute doses of ≤ 40 mg
in 50 mL NS; dilute doses
of >40 mg in 100 mL NS;
conc: 0.4-0.8 mg/mL
IV push over 2 min, conc: 4
mg/mL

Infusion Rate: Over 15 min;
do not exceed 7 mL/min
No filter required

Central or peripheral
Vital signs, anaphylaxis.
See Non-Chemotherapy
Extravasation Guideline
Papaverine

Level 1
30 mg/mL IV Push rate: Over 2 min

Neonates: Administer via
intra-arterial catheter in
infusion solution of NS or ½
NS with heparin (1 unit/mL).
Infusion Rate: No
information
Central or peripheral Allergic reaction (pruritus,
rash), arrhythmias and apnea
(with rapid IV use), flushing,
cardiac status
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

54

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Pegaspargase
HIGH ALERT
MEDICATION

CHEMOTHERAPY
Hazardous Drug –
HIGH RISK

See UW Health Clinical
Policy 6.1.11
750 IU/mL Dilute in D5W or NS


IM route is preferred

If IV, give over at least 1-2
hr through a running IV
infusion line

IV Push not recommended
IM route is preferred

Central or peripheral
Anaphylaxis, signs and
symptoms of bleeding or
thrombosis

See Chemotherpeutic
Extravasation Guidelines
Pemetrexed
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
500 mg vial; 25
mg/mL after
reconstitution
Dilute to 100 mL in PF
NS
Over 10 minutes Pretreat with folic acid,
vitamin B12, and
corticosteroid

Central or peripheral
Rash

See Chemotherpeutic
Extravasation Guidelines
Penicillin G
Potassium

Penicillin G Sodium

Level 1
500,000 units/
mL

Special dilution:
• 25,000
units/mL
• 50,000
units/mL
Dilute in 100 mL D5W or
NS


Over 20-60 min

Neonates and infants:
100,000 to 500,000
units/mL over 15-60 min

May be administered as
continuous infusion

Consider the potassium or
sodium content when
determining rate. Penicillin
G potassium contains 1.7
mEq K/ million units

IV Push not recommended
Central or peripheral Hypersensitivity reactions,
vein irritation,
thrombophlebitis, CNS
changes, cardiac status.

See Non-Chemotherapy
Extravasation Guideline
Pentamidine

Level 1
300 mg/vial

Special dilution:
• 6 mg/mL
Dilute in D5W; max conc:
6 mg/mL


Over 60-120 min

IV Push not recommended
Central or peripheral

Avoid extravasation
Continuous blood pressure,
phlebitis, CNS changes

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

55

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Pentobarbital

Level 3

50 mg/mL Max conc: 50 mg/mL for
slow IV push; may dilute
with D5W, D10W, NS,
1/2NS, LR, D5LR and
D/NS combinations


IV push: 50 mg/min max

Over 10-30 min



Central or peripheral

Avoid extravasation
Blood pressure, pulse, and
respirations every 3-5
minutes.

If used for conscious
sedation see Hospital
Administration Policy 8.56:
Pediatric Sedation Policy for
monitoring requirements.

See Non-Chemotherapy
Extravasation Guideline
Pentostatin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
2 mg/mL May further dilute in 25-
50 mL NS or D5W
Over 20-30 min or IV bolus
over 5 min
Hydrate with fluid prior to and
after infusion
Cardiac status, CNS
changes, phlebitis, allergic
reaction

See Chemotherpeutic
Extravasation Guidelines
Peramivir

Level 1
200 mg /20 mL Dilute in NS, D5W, or LR
to conc ≤ 6 mg/mL
Max total volume 100 mL
Administer over 15-30 mins Central or peripheral Hypersensitivity reactions,
dermatologic reactions,
neuropsychiatric events and
unusual behavior
Phenobarbital

Loading - Level 2
Maintenance - Level 1
130 mg/mL

Special dilution:
• 2 mg/mL
• 10 mg/mL
IV Push Rate: No more
than 1 mg/kg/min; max rate:
30 mg/min
Neonates: Over 10-15
minutes, 2 mg/kg/min; max
rate: 30 mg/min

Infusion not recommended
Central or peripheral

Irritant, avoid extravasation
Vital signs every hour,
respiratory rate/ depth,
paradoxical stimulatory
response, irritant.

See Non-Chemotherapy
Extravasation Guideline
Phentolamine

Level 4
5 mg/mL Dilute in 100 mL NS

No information Central or peripheral Vital signs every 2 minutes
initially, cardiac status
Phenylephrine
HIGH ALERT
MEDICATION

Level 4

10 mg/mL Dilute in 250 mL D5W or
NS; usual cont infusion
conc: 20-60 mcg/mL

IV push: dilute 1 mL in 9 mL
SW, conc: 1 mg/mL over
20-30 seconds

Infusion: Children: 0.1-0.5
mcg/kg/min, titrated to
effect
Central or peripheral; Central
line preferred. Infuse into
large veins.

Vasoconstrictor - avoid
extravasation
continuous blood pressure
(invasive arterial line), heart
rate, ECG, urine flow, and
hypersensitivity reaction

Potent vasoconstrictor, avoid
extravasation.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

56

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Phenytoin

Loading - Level 4
Maintenance - Level 1

See Fosphenytoin and
Phenytoin Guideline
50 mg/mL

Special dilution:
• 5 mg/mL
Dilute in NS; dilute to a
conc of 1-10 mg/mL

min conc: 6.7 mg/mL


Neonates: infuse at 0.5 -1
mg/kg/min; max rate 1-3
mg/kg/min or 50 mg/min,
whichever is slower

Infants/children: do not
exceed rate of 1-3
mg/kg/min, max rate: 50
mg/min

Neonates: max rate 0.5
mg/kg/min
Central line preferable
Follow injections with NS
flushes to prevent local vein
irritation

Use in-line 0.2 or 0.22 micron
filter

Neonates: avoid using in
central lines due to risk of
precipitation

Avoid extravasation
Vital signs every 15 minutes,
cardiac status, vein irritation,
thrombophlebitis, purple
glove syndrome (edema and
pain in distal limb),
anaphylaxis, CNS changes,
avoid extravasation.

See Non-Chemotherapy
Extravasation Guideline
Phosphate
(Potassium)

Level 1
3 mmoL
(Phos)/mL
Peripheral: max conc:
0.05 mmol/mL;

Central: max conc: 0.12
mmol/mL
Over 6 hrs for mild-
moderate
hypophosphatemia; over 8-
12 hrs for severe

Max infusion rate 0.06
mmol/kg/hr

IV Push not recommended
Do not infuse with calcium-
containing IV fluids.

Avoid extravasation

Cardiac status, vein irritation,
thrombophlebitis, avoid
extravasation.


Phosphate (Sodium)

Level 1
3 mmoL
(Phos)/ mL
Peripheral: max conc:
0.05 mmol/mL;

Central: max conc: 0.12
mmol/mL
Over 4-6 hrs for mild-
moderate
hypophosphatemia; over 8-
12 hrs for severe

Max rate of infusion: 0.06
mmol/kg/hr

IV Push not recommended
Do not infuse with calcium-
containing IV fluids.

Physostigmine
Salicylate

Level 4
1 mg/mL Do not dilute further IV Push: Infuse over 5
minutes. Max rate: 0.5
mg/min

Infusion not recommended
Central or peripheral Cardiac status, vital signs,
respiratory status,
hypersalivation
Phytonadione
(Vitamin K)

Level 1

See Procoagulant
Guideline
10 mg/mL

Special dilution:
• 1 mg/mL
Dilute in 5-10 mL D5W or
NS


Subcutaneous route
preferred

Infuse over 60 min, max
rate: 1 mg/min

Neonates: max rate 1
mg/min

IV Push not recommended

Oral route preferred

Central or peripheral
Fever/ chills, anaphylaxis,
blood pressure, respiratory
status, flushing, injection site
reactions

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

57

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Piperacillin

Level 1
1 g/5 mL Dilute in D5W or NS; max
conc ≤ 20 mg/mL


IV push: Over 3-5 min at
max conc: 200 mg/mL

Infusion Rate: Over 30-60
min
Central or peripheral

Avoid extravasation

Administer at least 1 hour
apart from aminoglycosides
Anaphylaxis, irritant, seizure,
avoid extravasation.

See Non-Chemotherapy
Extravasation Guideline
Piperacillin/
tazobactam

Level 1
2.25, 3.375 or
4.5 g/vial

Special dilution:
• 30-3.75
mg/mL
Dilute in D5W or NS


Over 30 min; max conc:
200 mg/mL (piperacillin),
conc ≤20 mg/mL are
preferred

Neonates: Infuse over at
least 30 minutes at a final
concentration of 10 -80
mg/mL (piperacillin
component)

IV push not recommended
Central or peripheral

Avoid extravasation
Anaphylaxis, irritant, avoid
extravasation.

See Non-Chemotherapy
Extravasation Guideline
Polymyxin B

Level 1
500,000 units/
10 mL
Dilute 500,000 units in
300-500 mL D5W

Over 60-90 min or cont
infusion or over 24 hrs at a
conc: 1000-1667 units/mL
IV Push not recommended
Avoid parenteral use when
possible

Central or peripheral
Respiratory status, CNS
changes, vein irritation,
thrombophlebitis
Posaconazole

Level 1
300 mg/16.7
mL
Diluted with 150 mL NS
or D5W
Infuse over 90 min

IV push not recommended
Central line only

May infuse through
peripheral line one time in
patient who will be receiving
central line

Must infuse through 0.2 or
0.22 micron in-line filter
Cardiac status and ECG,
CNS changes, rash
Potassium Acetate

K
+
rates less than 0.2
mEq/kg/hr – Level 1

K
+
rates greater than
0.2 mEq/kg/hr – Level 2

Special dilution:
• 0.1 mEq/mL
• 0.2 mEq/mL
Peripheral max conc: 8-
10 mEq/100 mL

Central max conc: 15
mEq/100 mL
0.3-0.5 mEq/kg/hr; max 1
mEq/kg/hr
Central or peripheral

Avoid extravasation

Rates ≥0.2 mEq/kg/hr require
cardiac monitor
Cardiac status, weakness,
parasthesias, irritant, avoid
extravasation
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

58

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Potassium Chloride

K
+
rates less than 0.2
mEq/kg/hr – Level 1

K
+
rates greater than
0.2 mEq/kg/hr – Level 2

2 mEq/mL

Special dilution:
• 0.1 mEq/mL
Peripheral: 8 mEq/100
mL

Central: 15 mEq/100 mL

Neonates
Peripheral: 4 mEq/100
mL
Central: 8 mEq/100 mL
Infusion: 0.3-0.5 mEq/kg/hr,
max 1 mEq/kg/hr up to 40
mEq/hr

Neonates: 0.5-1 mEq/kg
over 1 hour

IV Push not recommended
Central or peripheral

Rates ≥0.2 mEq/kg/hr require
cardiac monitor

Neonates: Continuous EKG
monitoring recommended,
especially with central IV
administration

Cardiac status, vein irritation,
thrombophlebitis, vesicant,
avoid extravasation.

See Non-Chemotherapy
Extravasation Guideline
Potassium Phosphate

K
+
rates less than 0.2
mEq/kg/hr – Level 1

K
+
rates greater than
0.2 mEq/kg/hr – Level 2
7.5 or 15
mmol/100 mL
bag

Special dilution:
• 0.12 mmol/mL
Peripheral: 0.05
mmol/mL

Central: 0.12 mmol/mL
Max 0.06 mmol/kg/hr Central or peripheral

Do not infuse with calcium-
containing IV fluids

Recommend using 0.2 or
0.22 micron in-line filter
Cardiac status, weakness,
parasthesias
Pralatrexate
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
20 mg/mL
40 mg/2 mL
Do not dilute Over 3-5 minutes into free-
flowing line of NS
Central or peripheral

Patients must be receiving
folic acid and
cyanocobalamin while
receiving pralatrexate
Dyspnea, mucositis, tumor
lysis syndrome, tachycardia

See Chemotherpeutic
Extravasation Guidelines
Pralidoxime

Level 4
50 mg/mL Dilute in NS to 10-20
mg/mL, max conc 50
mg/mL
Infusion: Over 15-30 min
IV Push Rate: Max: 200
mg/ min
Central or peripheral Continuous vital signs and
blood pressure, muscle
fasiculations and strength
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

59

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Procainamide
HIGH ALERT
MEDICATION –
continuous infusion

Level 3


100 mg/mL Dilute in D5W; conc: 2-4
mg/mL

Neonates
Loading dose: 20 mg/mL
Continuous infusion: 2-4
mg/mL


IV push: 3-6 mg/kg/dose
over 5 min, do not exceed
100 mg/dose

Infusion: Over 30-60 min;
cont infusion 20-80
mcg/kg/min; max dose: 2
g/day

Neonates: loading dose
over 30-60 min

Infants and children: IV
loading dose over 30 -60
min, not to exceed 50
mg/min

Adolescents: 20-50
mg/min, not to exceed 50
mg/min
Central or peripheral

Infusion rate should be
decreased if QT interval
becomes prolonged
Blood pressure and ECG
throughout treatment
Prochlorperazine

Level 1
5 mg/mL Dilute in D5W or NS


IV Push rate: 1-2 mL given
slowly; max rate: 5 mg/min

Infusion: Over 30 min
Central or peripheral

Consider pretreatment with
diphenhydramine
Blood pressure and pulse
before administration and
between doses, mental
status
Promethazine
HIGH ALERT
MEDICATION

Level 1

25 mg/mL

Special dilution:
• 2.5 mg/mL
Dilute in NS; max conc:
25 mg/mL


IV Push rate: 25 mg/min
into running IV

Infusion rate: Over 30 min
Central or peripheral
Central line required if
infusing by secondary IV line

Administer in large bore vein
(not hand or wrist)

Avoid extravasation; may
cause necrosis if
extravasated
Continuous vital signs,
respiratory rate/depth, irritant,
tissue injury

See Non-Chemotherapy
Extravasation Guideline
Propofol
HIGH ALERT
MEDICATION

Level 4

10 mg/mL Do not dilute


IV Push rate: induction
dose over 20-30 seconds

Infusion Rate: Titrate to
response;
50 mcg/kg/min to 300
mcg/kg/min
Central or peripheral Continuous blood pressure
and ECG, respiratory rate/
depth.

See Hospital Administration
Policy 8.56: Pediatric
Sedation Policy for
monitoring requirements.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

60

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Propranolol

Level 4
1 mg/mL

Special dilution:
• 0.1 mg/mL
IV Push rate: Over 10 min;
max rate: 1 mg/min

Infusion not recommended
Central or peripheral

Alternative IV agents
recommended due to risk
of severe arrhythmias with
IV propranolol use in
pediatric patients
Continuous blood pressure
and ECG, respiratory rate/
depth
Protamine Sulfate

Level 2

See Procoagulant
Guideline
10 mg/mL Do not further dilute


Inject over 10 min, not to
exceed 5 mg/min

Neonates: rate of undiluted
solution not to exceed 5
mg/min
Central or peripheral Observe patient
continuously, flushing, blood
pressure, coagulation tests
Pyridostigmine
Bromide

Level 4
5 mg/mL IV Push rate: Over 2-4 min

Infusion rate: no information
Central or peripheral Cardiac status, muscle
strength, cholinergic
reactions
Pyridoxine

Level 1
100 mg/mL Dilute in D5W or NS IV Push rate: 100 mg over
2-3 min

Infusion Rate: Give at any
convenient rate
Central or peripheral Respiratory rate, heart rate,
blood pressure, seizure (with
large doses), flushing
possible
Quinidine Gluconate

Level 2
80 mg/mL Dilute 800 mg in 50 mL
D5W; conc: 16 mg/mL


Infusion rate: Max rate:
0.25 mg/kg/min or 10
mg/min whichever is lowest
Central or peripheral

Use non-PVC tubing
Continuous blood pressure
and ECG, hypoglycemia
Ranitidine

Level 1

25 mg/mL

Special dilution:
• 2.5 mg/mL
Dilute in D5W or NS; cont
infusion: 150 mg/250 mL

IV Push: over at least 5
min; not to exceed 10
mg/min at max conc: 2.5
mg/mL

Intermittent infusion: over
at least 5 min, not to
exceed 10 mg/min; max
conc 2.5 mg/mL

Infusion: Single dose of 1
mg/kg, then 0.08 – 0.17
mg/kg/hr; max conc: 0.6
mg/mL

Neonates
Slow IV push or cont
infusion 0.04-0.1 mg/kg/hr
Central or peripheral

Intermittent infusion preferred
to IV Push
Vital signs, burning/itching at
injection site
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

61

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Ramucirumab

CHEMOTHERAPY

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
100 mg/10mL Dilute in 250ml NS Over 60 minutes Central or peripheral

Use of 0.22 micron filter
recommended

Flush line with NS after
infusion complete

Premedicate with H
1

antagonist; If previous
infusion reaction noted, give
steroids and acetaminophen
Infusion related reactions,
blood pressure
Rasburicase

Level 1

See Rasburicase
Guideline
1.5 mg vial; 1.5
mg/mL after
reconstitution
Dilute in 50 mL NS Infuse over 30 min, do not
bolus
Central or peripheral

Pre-hydration is
recommended
Hypersensitivity reaction, uric
acid concentrations
Remifentanil
HIGH ALERT
MEDICATION

Level 4

1 mg/mL Dilute in D5W or NS to a
conc of 20, 25, 50 or 250
mcg/mL
IV push: 1 mcg/kg over 30-
60 seconds

Infusion: Usual rate: 0.1-0.2
mcg/kg/min

Neonates
IV Push over 60 seconds
Infusion: 0.4-1 mcg/kg/min
Central or peripheral Assess blood pressure,
pulse, and respirations
before and periodically during
administration.
Rho D Immune
Globulin

Level 1
1500 units/3 mL May further dilute in NS if
desired
Infuse over 3-5 min Central or peripheral Signs/symptoms of
intravascular hemolysis
(IVH), chills/shaking, observe
patient for side effects for 8
hours following
administration
Rifampin

Level 1
60 mg/mL

Special dilution:
• 6 mg/mL
Dilute in D5W or NS; max
conc: 6 mg/mL

Infusion rate:
100 mL: over 30 min 500
mL: over 3 hrs

IV Push not recommended

Neonates
IV infusion over 30 minutes
Central or peripheral

Avoid extravasation
Vein irritation, avoid
extravasation.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

62
Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Rituximab
HIGH ALERT
MEDICATION
Level 2
Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL Dilute in NS; conc: 1-4
mg/mL
50 kg or greater:
INITIAL INFUSION: Start
infusion at 50 mg/hour for
30 minutes. If no infusion
reactions occur, rate may
be increased by 50 mg/hour
every 30 minutes to a
maximum of 400 mg/hour.
SUBSEQUENT
INFUSIONS: (Only if initial
infusion well
tolerated) Start infusion at
rate of 100 mg/hour. If
infusion is well-tolerated,
rate may be increased by
100 mg/hour every 30
minutes to a maximum rate
of 400 mg/hour.
Fewer than 50 kg:
Start infusion at 1
mg/kg/hour for 30 minutes.
If no infusion reactions
occur, rate may be
increased by 1 mg/kg/hour
every 30 minutes to a
maximum of 7 mg/kg/hour.
IV Push not recommended
Premedicate with
acetaminophen and
diphenhydramine.
Central or peripheral
Blood pressure and heart
rate frequently, infusion
reaction, cardiac status
See Chemotherpeutic
Extravasation Guidelines
Rocuronium
HIGH ALERT
MEDICATION
Level 4
10 mg/mL
Special dilution:
• 0.5 mg/mL
• 2.5 mg/mL
NS, D5W, LR to conc of
0.5-1 mg/mL
IV push: Dose over 1-2 min
Infusion: 10-12 mcg/kg/min
Patient must be intubated.
Central or peripheral
Ensure patient is adequately
sedated prior to
administration of
neuromuscular blockade
Blood pressure, cardiac
status, respiratory rate/
depth, use neuromuscular
blockade monitor
Romidepsin
HIGH ALERT
MEDICATION
CHEMOTHERAPY
Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg vial; 5
mg/mL after
reconstitution
Dilute in 500 mL NS Infuse over 4 hrs Central or peripheral
May consider antiemetics
prior to administration
ECG and electrolytes at
baseline and periodically in
patients with prolonged QT
syndrome, significant
cardiovascular disease, or an
antiarrhythmic or QT-
prolonging medications
See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

63

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Sargramostim

Level 1
250 mcg/mL or
500 mcg/mL
Dilute in NS; if conc< 10
mg/mL, add 1 mL
albumin 5% to each 1of
IV fluid; add albumin to
NS prior to sargramostim

Prefer to keep conc ≥ 10
mcg/mL
Infusion rate: Over 2- 24
hrs

IV Push rate: not
recommended
Central or peripheral

Do not shake; avoid foaming

Albumin acts as carrier
molecule for medication
Flushing, blood pressure,
syncope (especially with first
dose)
Scopolamine

Level 1 for preop use
0.4 mg/mL Dilute with an equal
volume of sterile water
for injection
IV Push rate: Over 3-4 min

Infusion: no information
Central or peripheral Blood pressure
Secretin

Level 1
2 mcg/mL IV Push rate; Dose over 1
minute

Infusion rate: no information
Central or peripheral Allergic reactions (including
anaphylaxis)
Siltuximab
HIGH ALERT
MEDICATION

CHEMOTHERAPY
20 mg/mL Dilute to 250 mL with
D5W
Infuse over 1 hour Central or peripheral

Administer using sets lined
with PVC, polyurethane (PU),
or polyethylene (PE) with a
0.2-micron inline
polyethersulfone (PES) filter.

Do not administer with other
agents in the same IV line.

Complete infusion within 4
hours of dilution.
Monitor for signs of an
infusion related reaction or
hypersensitivity. Stop the
infusion if the patient
develops a mild to moderate
infusion reaction. If the
reaction resolves, the
infusion may be restarted at
a lower infusion rate.

See Chemotherpeutic
Extravasation Guidelines
Sincalide

Level 1
1 mcg/mL Dilute in 50 mL NS IV push: Dose over 30-60
seconds

Infusion: Over 30 min
Central or peripheral

Infusion may improve GI
tolerance
Abdominal pain/ discomfort
Sodium Acetate

Level 2
2 mEq/mL Dilute in D5W or NS Infusion: Max rate: 1
mEq/kg/hr

IV Push not recommended
Central or peripheral Cardiac status
Sodium Bicarbonate

Level 1


1 mEq/mL Dilute in D5W or sterile
water for injection

Neonates and infants: 0.5
mEq/mL

Children: 1 mEq/mL


IV push: over 1-2 min

Infusion: conc of 0.5
mEq/mL over 2 hrs; max
rate: 1 mEq/kg/hr

Neonates and infants: max
rate 10 mEq/min
Central or peripheral
Central line preferred if
undiluted, however,
peripheral/intraosseous
access may be used when
benefit outweighs risks

Avoid extravasation
Cardiac status, extreme
irritant, avoid extravasation.

See Non-Chemotherapy
Extravasation Guideline
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

64

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Sodium Chloride 1.8%
HIGH ALERT
MEDICATION

Level 3

See Hypertonic Sodium
Chloride Guideline
308 mEq/L No further dilution No information Central or peripheral Vital signs, extravasation,
sodium concentration, ICP
Sodium Chloride 3%
HIGH ALERT
MEDICATION

Level 4

See Hypertonic Sodium
Chloride Guideline
513 mEq/L No further dilution


Max rate: 1 mEq/kg/hr

IV Push not recommended
Central line only

Avoid extravasation
Vital signs, extravasation,
sodium concentration, ICP

See Non-Chemotherapy
Extravasation Guideline
Sodium Phosphate

Level 1


Special dilution:
• 0.05 mmol/mL
Peripheral: 0.05
mmol/mL

Central: 0.12 mmol/mL
Max rate: 0.06 mmol/kg/hr

IV Push not recommended
Central or peripheral

Do not infuse with calcium-
containing IV fluid

Recommend using 0.2 or
0.22 micron in-line filter
Cardiac status, weakness,
parasthesias
Sodium Thiosulfate

Level 3
25% No dilution required Infuse over at least 10 min

Infusion: no information
Central or peripheral Vital signs, hypotension,
respiratory rate
Streptozocin
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 g vial; 100
mg/mL after
reconstitution
May dilute in D5W or NS No information Central or peripheral

Avoid extravasation
Vesicant, risk of
extravasation

See Chemotherpeutic
Extravasation Guidelines
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

65

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Succinylcholine
HIGH ALERT
MEDICATION

Level 4
20 mg/mL Neonates: may dilute in
compatible solution to
conc 1-2 mg/mL
Dose over 30 seconds
undiluted

Cont infusions not
recommended
Patient must be intubated.

Central or peripheral

Use with caution in patient
with severe trauma,
severe/extensive burns,
skeletal muscle denervation,
degenerative/dystrophic
neuromuscular disease due
to hyperkalemia risk

Use with caution in patients
with fractures or muscle
spasms as initial fasiculations
may cause additional trauma
Blood pressure, cardiac
status, respiratory rate/
depth, serum potassium, use
neuromuscular blockade
monitor
Sufentanil
HIGH ALERT
MEDICATION

Level 4
50 mcg/mL IV Push rate: Over 30
seconds

Infusion: no information
Central or peripheral Assess blood pressure,
pulse, and respirations
before and periodically during
administration, neurologic
status
Sugammedex

Level 4
500 mg/5 mL Two years and older: No
dilution required

Younger than two years:
Dilute in NS to 25 mg/mL
Over 10 seconds Central, midline, or peripheral

Flush lV line with NS before
and after administration of
sugammadex
Hypersensitivity and
anaphylaxis, bradycardia,
recurrence of neuromuscular
blockade, respiratory
function, skeletal muscle tone

Drug interaction with
hormonal contraceptive
agents
Tacrolimus

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
5 mg/mL Dilute in D5W or NS;
conc: 0.004-0.02 mg/mL

IV Push not recommended Avoid PVC-containing
containers and tubing

Central or peripheral
Blood pressure, anaphylaxis,
tacrolimus concentrations
TBO-filgrastim

Level 1
300 mcg, 480
mcg
Final conc 15 mcg/mL

If final conc 5 to <15
mcg/mL, add albumin to
a final conc of 2 mg/mL

Avoid conc <5 mcg/mL
Infusion over 15-30 min or
continuous infusion or 4- or
24-hr infusion
Do not shake; avoid foaming Temperature, CBC, cardiac
status, hypersensitivity
reaction
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66

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Telavancin

Level 1
250, 750mg
vials;
reconstituted to
15 mg/mL
For doses 150-800mg,
add to 100-250 mL of NS
or D5W

For doses <150 mg or
>8005 mg, add to NS or
D5W to achieve final
conc of 0.6-8 mg/mL
Infuse over 60 min Central or peripheral

May slow reaction if infusion
reaction develops
Infusion reaction, histamine
release syndrome
(hypotension, rash) if rapid
infusion
Temsirolimus
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
25 mg/mL;
diluted with
provided diluent
to concentration
of 10 mg/mL
No information No information Central or peripheral

Administer via non-PVC
tubing and 0.2 or 0.22 micron
non-PVC in-line filter

Premedicate with
diphenhydramine
Hypersensitivity reactions

See Chemotherpeutic
Extravasation Guidelines
Terbutaline

Level 4

1 mg/mL Dilute 5 mg in NS; max
conc for infusion: 1
mg/mL
IV push: Undiluted over 5-
10 min

Infusion rate: Over 12-24
hrs
Central or peripheral Blood pressure, heart rate
Thiamine

Level 1
100 mg/mL Dilute in D5W, NS, or LR

IV push: 10-25 mg over 3-5
min

Infusion rate: Give at any
convenient rate. Use
longer infusion for dose
≥100 mg
Central or peripheral Anaphylaxis, hypersensitivity
reactions
Thiotepa
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL Dilute in NS; max conc: 1
mg/mL



Low doses infuse over 5
min

High doses infuse over 2-4
hr
Central line only Vein irritation,
thrombophlebitis

See Chemotherpeutic
Extravasation Guidelines
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67

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Ticarcillin/ clavulanic
acid
(Timentin®)

Level 1
3.1 g/10 mL

Special dilution:
• 51.7 mg/mL
Dilute in D5W or NS; max
conc: 100 mg/mL of
ticarcillin

Neonates
Final concentration of 10-
100 mg/mL

Infusion rate: Over 30 min

Neonates
Administer over 30 min

IV Push not recommended
Central or peripheral Hypersensitivity, rash,
anaphylaxis,
thrombophlebitis
Tigecycline

Level 1
10 mg/mL Dilute in D5W or NS; max
conc: 1 mg/mL
Infuse over 30-60 min Central or peripheral Hypersensitivity, infection,
nausea/vomiting
Tobramycin

Level 1
40 mg/mL,
20 mg/2 mL

Special dilution:
• 4 mg/mL
• 10 mg/mL
Dilute in D5W or NS; max
conc: 10 mg/mL
Infusion rate: Over 30-60
min
Central or peripheral

Administer beta-lactam
antibiotics at least one hour
before or after tobramycin
Respiratory rate/ depth
Tocilizumab

Level 2
80mg/4mL, 200
mg/10 mL,
400mg/20mL
vials
Dilute with NS:
• < 30 kg: dilute dose to
50 mL
• ≥ 30 kg: dilute dose to
100 mL
Infuse over 60 min

Do not administer as IV
push or IV bolus
Use dedicated line

Central or peripheral
Infusion-related reactions,
including hypersensitivity/
anaphylaxis; hypertension
Topotecan
HIGH ALERT
MEDICATION

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Dilute in D5W or NS


Infusion Rate: Over 30 min
or cont infusion with conc
not to exceed 0.5 mg/mL

IV Push not recommended
Central or peripheral

Avoid extravasation, irritant
Vital signs, extravasation

See Chemotherpeutic
Extravasation Guidelines
Trace elements

Level 1
3 mL Dilute in D5W or NS

Give at convenient rate,
usually included in
parenteral nutrition

IV Push: no information
Central or peripheral
Tranexamic Acid

Level 1

See Procoagulant
Guideline
100 mg/mL Dilute single dose in at
least 50 mL D5W or NS

Neonates
50-100 mg/mL
Max rate 100 mg over 1
min

Neonates
Max rate 100 mg/min
Central or peripheral Giddiness, skin reaction, risk
of thromboembolic events

Rapid administration may
cause hypotension
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68

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Treprostinil
HIGH ALERT
MEDICATION

Level 4
5 mg/mL; 10
mg/mL
Dilute in NS

UWHC standard
concentrations: 500
mcg/100 mL, 1000
mcg/100 mL
Initiate at 1.25 ng/kg/min Infuse through a permanent
indwelling central venous
catheter. A peripheral IV
(preferably in large vein) may
be used temporarily until
central line can be
established.

Must have immediate backup
line
BP, heart rate, headache,
fainting

Abrupt withdrawal can cause
immediate deterioration of
patient’s condition
Trimethoprim/
sulfamethoxazole

Level 1
80 mg TMP/
400 mg Sulfa/
5 mL

Special dilution:
• 1 mg TMP/5
mg Sulfa/mL
Dilute each 5 mL in 50-
125 mL D5W or NS, NS
preferred
Infusion rate: Over 60-90
min

IV Push: not recommended
Central or peripheral

Avoid extravasation
Phlebitis, CNS changes,
allergic reaction, nausea,
vomiting, rash

See Non-Chemotherapy
Extravasation Guideline
Tromethamine
HIGH ALERT
MEDICATION –
continuous infusion

Level 4
3.6 g/100 mL Max conc: 0.3 molar


Infusion Rate: Over 1 hr, or
3-16 mL/kg/hr up to 33-40
mL/kg/day

IV Push not recommended

Neonates
Infuse over at least 30 min
Central line only

Avoid extravasation
ECG, extravasation

See Non-Chemotherapy
Extravasation Guideline
Valproic Acid

Level 1
500 mg/5 mL

Special dilution:
• 25 mg/mL
• 50 mg/mL
Dilute in 50 mL D5W or
NS

Rapid IV loading doses:
dilute 1:1 with NS or
D5@
Infusion rate: Over 60 min;
max rate: 20 mg/min


Rapid IV loading dose may
be considered at 1.5-3
mg/kg/min
Central or peripheral Abdominal pain, nausea,
vomiting

Rapid infusions related to
increased adverse events
Vancomycin

Level 1
100 mg/mL

Special dilution:
• 5 mg/mL
Dilute in D5W or NS; max
conc: 5 mg/mL
Neonates
Max conc: 5 mg/mL


Infusion rate: Over at least
60 min

IV Push not recommended
by the manufacturer

Neonates
Max rate: 10 mg/min
Central or peripheral

Slow infusion to 90-120 min
and increase dilution volume
if histamine-like reaction
occurs
Extreme vein irritation, avoid
extravasation, continuous
blood pressure, histamine-
like reaction or flushing,
hypotension.

See Non-Chemotherapy
Extravasation Guideline
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69

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Vasopressin Aqueous
HIGH ALERT
MEDICATION –
continuous infusion

Level 4


20 units/mL Dilute in D5W or NS;
conc: 0.1-1 unit/mL


Pulseless Vtach: 40 units
over 15-30 seconds
Diabetes insipidus,
children: 0.0005 units/kg/hr,
max 0.01 units/kg/hr;
Hemorrhage, children:
0.002-0.005 units/kg/min,
max 0.01 units/kg/min;
Vasoconstriction, infants
& children: 0.018-0.12
units/kg/hr
Central line preferred,
however,
peripheralintraosseous
access may be used when
benefit outweighs risks
Continuous ECG and vital
signs, fluid and electrolyte
status, extravasation

See Non-Chemotherapy
Extravasation Guideline
Vecuronium
HIGH ALERT
MEDICATION

Level 4

1 mg/mL Dilute in D5W or NS; use
SWFI for neonates max
conc: 1 mg/mL


IV push: 0.1 mg/kg/dose
over 15-30 seconds

Infusion rate:
Infants: >7 weeks to 1 yr: 1-
1.5 mcg/kg/min

Children >1 yr: 1.5-2.5
mcg/kg/min
Patient must be intubated

Central or peripheral
Ensure patient is adequately
sedated prior to
administration of
neuromuscular blockade
Blood pressure, cardiac
status, respiratory rate/
depth, use neuromuscular
blockade monitor
Vedolizumab
HIGH ALERT
MEDICATION

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
300 mg vial; 60
mg/mL after
reconstitution
Dilute in 250 mL of NS Infuse over 30 minutes Central or peripheral

Flush line with 30 mL of NS
after infusion complete
Hypersensitivity and infusion
reactions
Verapamil
HIGH ALERT
MEDICATION –
continuous infusion

Level 4
2.5 mg/mL Dilute in D5W or NS;
max conc: 2.5 mg/mL


Infuse over 2-3 min; Infuse
over 3-4 min if BP on lower
range of normal


Not recommended for infants
younger than 1 year

Central or peripheral
ECG for infusion, blood
pressure and heart rate every
5 minutes until stable, then
every 15 minutes for 1 hour,
then at least every hour
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70

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Verteporfin

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
2 mg/mL Dilute in D5W to a total
volume of 30 mL
Infuse at 3 mL/min Central or peripheral

Establish patency of large
vein if given peripherally

Use 0.2-1.2 micron filter

Avoid extravasation

Light therapy to begin 15
minutes following the start of
10-minute infusion
Extravasation

See Non-Chemotherapy
Extravasation Guideline
VinBLAStine

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Dilute in D5W or NS for
cont infusion


IV push: Over 1 minute into
running IV line as 1mg/mL
conc

Infusion rate: Daily dose
over 24 hrs
Central or peripheral

Avoid extravasation
Vesicant, avoid
extravasation, neurologic
status

See Chemotherpeutic
Extravasation Guidelines
VinCRIStine
CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
1 mg/mL Dilute in D5W or NS


IV push: Over 5 minutes
into running IV line as
1mg/mL conc

Infusion rate: no information
Central or peripheral

Avoid extravasation
Vesicant, avoid extravasation

See Chemotherpeutic
Extravasation Guidelines
VinCRIStine
Liposomal
CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
Dose in 100 mL
NS or D5W
infusion bag
No further dilution Infuse over 1 hour

Do not give as IV push or
bolus

Must complete infusion
within 12 hours of
preparation

Central or peripheral

Avoid extravasation
Vesicant, avoid extravasation

See Chemotherpeutic
Extravasation Guidelines
Vinorelbine

CHEMOTHERAPY

Hazardous Drug –
HIGH RISK
See UW Health Clinical
Policy 6.1.11
10 mg/mL Dilute in D5W or NS;
conc: 0.5-2 mg/mL


IV push: Dose over 6-10
min into side port of free
flowing IV line

Infusion rate: Over 20 min
Central or peripheral Phlebitis, irritant, avoid
extravasation

See Chemotherpeutic
Extravasation Guidelines
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71

Drug Concentration
Supplied
Dilution Infusion Administration
Rate
Considerations For IV
Administration and
Comments
Monitoring
Von Willebrand Factor

Level 1
No further dilution


IV Push rate: Slowly, max 4
mL/min

Infusion rate: no information
Use infusion kit

Central or peripheral

Voriconazole

Level 1
10 mg/mL

Special dilution:
• 4 mg/mL
Dilute in D5W or NS;
conc: 0.5-5 mg/mL
Over 1-2 hrs;
max rate: 3 mg/kg/hr

IV Push not recommended
Central or peripheral Hypersensitivity reactions,
anaphylaxis, tachycardia
Warfarin Sodium

Level 1
2 mg/mL Not recommended IV push: over 1-2 min

Infusion not recommended
INR, bleeding
Zinc trace metal

Level 1
1 mg/mL, and
5mg/mL as
sulfate
Dilute in D5W or NS


Infusion rate: Give at
convenient rate

IV Push not recommended
Central or peripheral
Zidovudine

Level 2
10 mg/mL

Special dilution:
• 1 mg/mL
• 4 mg/mL
Dilute with D5W, max
conc: 4 mg/mL
Infuse over 60 min

Neonates
Infuse over 60 min
Cardiac status (ECG), chills,
fever, CNS changes, rash,
allergic reactions
Zoledronic Acid

Level 1

Hazardous Drug –
MODERATE RISK
See UW Health Clinical
Policy 6.1.11
4 mg/5 mL Dilute in NS or D5W


Infusion rate: Over at least
15 min

IV Push not recommended
Avoid extravasation

See Non-Chemotherapy
Extravasation Guideline
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72

UW Health Implementation
Potential Benefits:
• Safety and efficacy through standardizaton of intravenous administration of medications
• Direction on important monitoring areas

Potentail Harms:
• Standardized intravenous administration may not optimize medication therapy for all patients

Qualifying Statements
Recommendations in this guideline are based on available evidence. Administration of medications should be
evaluated in a patient-specific manner and should take into account the urgency of a given situation when
determining administration rate and route.

Pertinent UWHC Policies and Procedures
• Policy 8.31 Guidelines for Hospital Location Specific Administration of IV Medications
• Policy 8.33 High Alert Medication Administration
• Policy 8.56 Pediatric Sedation
• Policy 8.89 Preventing Non-therapeutic Exposure to Hazardous Drugs
• Factor 7a Recombinant Operating Procedure
• Factor 9 Complex Concentrate (PCC) Operating Procedure
• Policy 10.18 Parenteral Lidocaine for Neuropathic Pain

Patient Resources
None

Guideline Metrics
Patient Safety Net reports can be monitored for errors or adverse events associated with IV medication
administration.

Implementation Plan/Clinical Tools
1. Guideline will be posted on uConnect in a dedicated location for Clinical Practice Guidelines.
2. Release of the guideline will be advertised in the Physician/APP Briefing newsletter.
3. Content and hyperlinks within clinical tools, documents, or Health Link related to the guideline
recommendations will be reviewed for consistency and modified as appropriate.

Disclaimer
Clinical practice guidelines assist clinicians by providing a framework for the evaluation and treatment of
patients. This guideline outlines the preferred approach for most patients. It is not intended to replace a
clinician’s judgment or to establish a protocol for all patients. It is understood that some patients will not fit the
clinical condition contemplated by a guideline and that a guideline will rarely establish the only appropriate
approach to a problem.

References
1. Jacobs AK, Kushner FG, Ettinger SM, et al. ACCF/AHA clinical practice guideline methodology summit
report: a report of the American College of Cardiology Foundation/American Heart Association Task Force
on Practice Guidelines. Journal of the American College of Cardiology. 2013;61(2):213-265.
2. Lexi-Comp Online™, Lexi-Drugs Online™ Hudson, OH: Lexi-Comp,Inc; Accessed July 2016.
3. Neofax Online
®
. Micromedex
®
Ann Arbor, MI: Truven Health Analytics™: Accessed July 2016.
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74

Appendix A. Evidence Grading Scheme
1
Figure 1. GRADE Methodology adapted by UWHealth



GRADE Ranking of Evidence
High We are confident that the effect in the study reflects the actual effect.
Moderate
We are quite confident that the effect in the study is close to the true effect, but it is also
possible it is substantially different.
Low The true effect may differ significantly from the estimate.
Very Low The true effect is likely to be substantially different from the estimated effect.

GRADE Ratings for Recommendations For or Against Practice
Strong
The net benefit of the treatment is clear, patient values and circumstances are
unlikely to affect the decision.
Weak/conditional
Recommendation may be conditional upon patient values and preferences, the
resources available, or the setting in which the intervention will be implemented.


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75

Appendix B. Medications Requiring Central Lines
1. Acyclovir – Central line for concentrations ≥ 10 mg/mL
2. Adenosine – Central line preferred (or site as proximal to trunk as possible)
3. Amiodarone – Central line preferred. Central line required for 600 mg/250 mL or any infusion
concentrations ≥2 mg/mL
4. Anti-thymocyte globulin RABBIT – Central line required for doses diluted in <500 mL
5. Busulfan
6. Calcium chloride – Central line preferred
7. Carmustine – Central line if undiluted or doses ≥ 300 mg/m
2

8. Copper-selenium-zinc
9. Continuous renal replacement therapy (CRRT) – all bags
10. Dobutamine – Central line preferred, however, peripheral/intraosseous access may be used when benefit
outweighs risks
11. Dopamine – Central preferred, however, peripheral/intraosseous access may be used when benefit
outweighs risks
12. Doxorubicin conventional – central line required for continuous infusion
13. Epinephrine – Central line preferred, however, peripheral/intraosseous access may be used when benefit
outweighs risks
14. Epoprostenol – Central line required for continuous infusion; may give peripherally on a temporary basis
until central line placed
15. Esmolol – Central line preferred for concentrations ≥ 20 mg/mL
16. Etoposide – Central line required if undiluted
17. Foscarnet – Central line required if undiluted
18. Melphalan – Central line required if undiluted; central line preferred when diluted, however or peripheral
infusion is acceptable
19. Micafungin – Central line required for concentrations >1.5 mg/mL
20. Nicardipine – Central line required for concentrations >0.5 mg/mL
21. Norepinephrine – Central line preferred, however, peripheral/intraosseous access may be used when
benefit outweighs risks
22. Phenylephrine – Central line preferred, however, peripheral/intraosseous access may be used when
benefit outweighs risks
23. Posaconazole – Central line preferred, however, if unavailable, may administer one dose through a
peripheral catheter (over 30 min)
24. Potassium acetate – Central line for concentrations ≥20 mEq/100 mL
25. Potassium chloride – Central line for concentrations ≥ 20 mEq/100 mL
26. Potassium phosphate – Central line recommended for concentration >15 mMol/100 mL. Central line
required for rate >10 mEq/hr
27. Promethazine – Central line required if infusing by secondary IV line
28. Sodium Bicarbonate – Central line preferred if undiluted, however, peripheral/intraosseous access may
be used when benefit outweighs risks
29. Sodium Chloride 3% – Central line preferred, however, peripheral/intraosseous access may be used
when benefit outweighs risks
30. Thiotepa
31. TPN
32. Treprostinil – Central line preferred, however, peripheral administration on a temporary basis has been
documented
33. Vancomycin – Central line for concentrations ≥10 mg/mL
34. Vasopressin – Central line preferred, however, peripheral/intraosseous access may be used when benefit
outweighs risks

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org