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Intravenous Administration of Formulary Medications – Adult – Inpatient/Ambulatory

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1
Intravenous Administration of Formulary
Medications – Adult– Inpatient/Ambulatory –
Clinical Practice Guideline
Note: Active Table of Contents – Click to follow link
EXECUTIVE SUMMARY .............................................................................................................................................. 3
SCOPE ......................................................................................................................................................................... 3
METHODOLOGY ......................................................................................................................................................... 4
INTRODUCTION .......................................................................................................................................................... 4
RECOMMENDATIONS ................................................................................................................................................ 6
UW HEALTH IMPLEMENTATION ............................................................................................................................. 92
APPENDIX A. EVIDENCE GRADING SCHEME(S) .................................................................................................. 93
APPENDIX B. INFLIXIMAB INFUSION ALGORITHM .............................................................................................. 94
APPENDIX C. MEDICATIONS REQUIRING A CENTRAL LINE .............................................................................. 95
REFERENCES ........................................................................................................................................................... 97
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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2

Contact for Content:
Name: Philip Trapskin, PharmD, BCPS
Phone Number: (608) 265-0341
Email Address: ptrapskin@uwhealth.org

Contact for Changes:
Name: Carin Bouchard, PharmD, BCPS
Phone Number: (608) 263-8967
Email Address: cbouchard@uwhealth.org

Guideline Author(s)
Updated by Carin Bouchard, PharmD, BCPS

Coordinating Team Members:
B. Caponi, MD, Hospitalists
J. Hoch, MD, Vascular Surgery
M. Garren, MD, General Surgery
P. Kory, MD, Critical Care
E. Lalik, MD, Hospitalists
J. Medow, MD, MS, Neurosurgery
A. O’Connor, MD, Cardiology
A. O’Rourke, MD, Critical Care
J. Wells, MD, Critical Care
B. Larson, RN, BSN, Nursing
A. Mork, RN, MS, Nursing
D. Hager, PharmD, BCPS, Pharmacy
P. Trapskin, PharmD, BCPS, Drug Policy Program

Review Individuals/Bodies:
N. Bennett, CNS, MSN, RN; Stroke program
J. Descourouez, PharmD; Pharmacy
A. Hennes, PharmD, Pharmacy
V. Hubbard, MSN, RN; Nursing
G. Klinkner, CNS, MS, RN; Diabetes Management
M. Mably, RPh; Pharmacy
D. Dalsing, MSN, RN; Nursing
S. Kraus, CNS, MS, RN; Nursing
A. Krupp, CNS, MS, RN; Nursing
T. Ludwig, PharmD; TAC Pharmacy
J. McGrath, CNS, MS, RN; Nursing
A. Rose, PharmD; Pharmacy
L. Schulz, PharmD; Pharmacy
A. Steffenhagen, PharmD; Pharmacy
K. Stine, CNS, MS, RN, Nursing
J. Weber, CNS MS, RN, Nursing

Committee Approvals/Dates:
Pharmacy & Therapeutics Committee (Last review October 2016; Interim review October 2017)


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Release Date:
October 2016

Next Review Date:
October 2018
Executive Summary
Guideline Overview
This guideline directs the appropriate administration of intravenous medications to adult patients across
UW Health throughout inpatient, emergency, procedural, ambulatory and MedFlight settings. Necessary
elements include appropriate level of care, administration requirements and monitoring parameters.
Review of manufacturer labeling, primary literature and drug information databases was completed to
make recommendations.

Key Revisions (October 2017 Interim revision)
1. Update of hazardous medication status to align with UW Health Clinical Policy Number 6.1.11
2. Added bezlotoxumab
3. Removed droperidol
4. Addition of link to the Stroke clinical practice guideline for alteplase
5. Addition of neurotoxicity to monitoring parameters of ifosfamide, serum creatinine to monitoring
parameters of methotrexate
6. Updated administration rate of oxaliplatin
7. Updated sodium thiosulfate with HIPEC dosing and level of care information
8. Update thiotepa vial size
9. Updated vinblastine and vinorelbine dilution and administration rate information

Key Practice Recommendations
See Table of Recommendations

Companion Documents
Intravenous Administration of Formulary Medications – Pediatric/Neonatal Inpatient/Ambulatory
Guideline
Scope
Disease/Condition(s):
Intravenous medication administration

Extravasation of medications is not addressed in this guideline. Refer to Adult Clinical Practice Guideline
for the Extravasation of Antineoplastic Agents or 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 for this
information.

Intravenous echocardiography contrast agents are not address in this guideline. Refer to Nursing Care
Policy # 10.24 Administration of Echocardiography Contrast Agents for this information.


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

Intended Users:
Physicians, advanced practice providers, pharmacists and nurses
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Objective(s): To provide guidelines and monitoring parameters for the intravenous administration of
UWHealth formulary medications to adults.

Target Population:
Adults age 18 years or older

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

Major Outcomes Considered:
ξ 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.

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

Rating Scheme for the Strength of the Evidence/Recommendations:
See Appendix A for the rating scheme(s) used within this document.

Recognition of Potential Health Care Disparities:
No healthcare disparities were noted
Introduction
The following table presents guidelines and monitoring parameters for the intravenous administration of
UW Health formulary drugs to adults. Although some recommendations may exist to prevent serious
toxicities, the rates of administration or amount of diluent can be modified 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:

ξ What information exists regarding adverse events associated with faster rates (e.g., can cause
hypotension, cardiac arrhythmias, etc.) or more concentrated dilutions (e.g., thrombophlebitis, toxic peak
blood concentrations, precipitation etc.)?
ξ What is the incidence of adverse reactions associated with administration (i.e., is the reaction rarely
induced versus always induced)?
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ξ What is the benefit versus risk ratio for this particular patient?
ξ What parameters and what frequency of monitoring are required to identify adverse events if
administered outside of these recommendations? What other precautionary measures should be taken?

In accordance with UW Health Clinical Policy 6.1.8, Guidelines for Hospital Location Specific
Administration of IV Medications, 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, Ambulatory Clinics, UW
Health Infusion Center and Hemodialysis Center

Level 2 medications: May be administered on General Nursing Units with telemetry.

Level 3 medications: May be administered to IMC patients on B4/5, D4/5, D6/5, F4/4 and F4/5 IMC
units and all critical care areas. Some level 3 medications may be administered in the American Center
(TAC) IMC and will be listed as “Level 3 TAC” under each specific medication.

Level 4 medications: May be administered on Intensive Care Units, the Emergency Department,
Operating Room, Recovery Room, Cardiac Catheterization, Echocardiology Laboratories and MedFlight.
Ongoing continuous infusions of level 4 medications can be maintained in Interventional Radiology
based on appropriate competency assessment; however, bolus doses and titration must be administered
by patient unit critical care nurses. Some level 4 medications can be administered on select IMC units;
these units are listed under each specific medication.
At TAC, only one vasoactive infusion may be administered at a time in the ICU.

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

Chemotherapeutic agents administered for the treatment of cancer may only be administered by nurses
certified in chemotherapy and only on B6/6, AFCH PP41, Infusion Center, Oncology Clinic, and CTRC.
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.

Definition of a vesicant: A vesicant is an agent that can produce local irritation, necrosis, and sloughing of
tissues when inadvertently injected into subcutaneous or muscle tissue during intravenous administration.
For further information refer to Guidelines for the Treatment of Extravasation of Antineoplastic Agents;
Guidelines for the Prevention and Treatment of Extravasation of Peripherally Administered Non-
Chemotherapeutic Agents
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Recommendations
All recommendations within the guideline have been given a UW Health moderate quality evidence; strong recommendation based on information obtained
from initial clinical trials of the medications.1

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Abatacept2

Level 1

250 mg vial; 25
mg/mL after
reconstitution
Dilute in 100 mL NS Over 30 minutes Central, midline, or
peripheral
Administer in a separate
IV line and non-
pyrogenic, low-protein
binding 0.2-1.2 micron
filter

Infusion-related reactions; worsening
of respiratory status in COPD
patients

Abciximab2
HIGH ALERT
MEDICATION

Level 4


2 mg/mL Dilute in D5W or NS
UWHC standard
concentration: 9
mg/250 mL

PTCA or MI: 0.25 mg/kg bolus
followed by 0.125 mcg/kg/min
x 12 hr; maximum rate: 10
mcg/min
Angina: 0.25 mg/kg bolus
followed by 10 mcg/min x 18 -
24 hr
Central, midline, or
peripheral
Administer in a separate
IV line and non-
pyrogenic, low-protein
binding 0.2-0.22 micron
filter. Do not add other
drugs to the infusion bag.
Signs and symptoms of bleeding,
infusion reactions, blood pressure
Acetaminophen2

Level 1
1000 mg/100
mL single use
vial
Not recommended Over 15 minutes Central, midline, or
peripheral
Glass vials must be
vented with adapter
vented spike
(CS#9997527).
Formulation is
preservative free.
Analgesia or body temperature.
AcetaZOLAMIDE2

Level 1
500 mg vial;
100 mg/mL
after
reconstitution
Dilute in D5W or NS


Over 3 minutes


Central, midline, or
peripheral
large vein administration
Hypotension with too rapid
administration, vein irritation, risk of
thrombophlebitis –See Non-
Chemotherapeutic Extravasation
Guideline


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Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Acetylcysteine2

Level 1



See Acetylcysteine
Guideline
20% For APAP overdose:
Loading dose: 150
mg/kg in 200 mL D5W
2nd dose: 50 mg/kg in
500 mL D5W
3rd dose: 100 mg/kg in
1000 mL D5W


LD: Over 60 minutes
2nd dose: Over 4 hours
3rd dose: Over 16 hours
Central, midline, or
peripheral

Administer within 24
hours of acetaminophen
overdose.

Color may change to a
slight pink or purple but
this does not affect
quality of product
Blood pressure, bronchospasm,
wheezing, pruritus, acetaminophen
level (if used for overdose)
Acyclovir2

Level 1
50 mg/mL Dilute in D5W or NS;
maximum
concentration:
7 mg/mL



Over 1 hour Central, midline, or
peripheral

Concentrations ≥ 10
mg/mL through central
line only

Encephalopathic changes (lethargy,
tremors, confusion, agitation,
seizures), injection site reactions,
maintain adequate fluid intake, renal
function. Risk for thrombophlebitis –
rotate IV sites often if given
peripherally. See Non-
Chemotherapeutic Extravasation
Guideline

For high doses (≥10mg/kg) maintain
hydration to prevent urine
crystallization
Adenosine2

Level 2

Presence of advanced
practice provider (with
ACLS training) or
physician is required for
administration
6 mg/2 mL No information 6-12 mg as rapid bolus (over 1
second)
Central preferred or site
as proximal to trunk as
possible.

Follow each bolus with a
rapid normal saline flush.
Bedside continuous ECG, blood
pressure and heart rate monitoring
required. May cause
bronchoconstriction.


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Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Ado-Trastuzumab
Emtansine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
100 mg vial,
160 mg vial;
both 20 mg/mL
after
reconstitution
Dilute in 250 mL NS for
administration
Infuse first dose over 90
minutes. Subsequent doses
can be given over 30 minutes if
well tolerated.

.


Central, midline, or
peripheral

Use in-line 0.22 micron
filter for administration

Do not administer with
other medications
Hypersensitivity, infusion reactions
(fever, chills) – monitor for at least
90 minutes following first infusion
and 30 minutes after subsequent
infusions if well-tolerated.


Irritant: See Chemotherapy
Extravasation Guideline

Albumin2

Level 1

See Albumin Guideline
5% -250, 500
mL
25%- 50, 100
mL
No further dilution
needed. May dilute in
NS (preferred) or D5W


5%: 5-10 mL/min
25%: 2-3 mL/min; may
administer more rapidly if
hypovolemic
Central, midline, or
peripheral

Blood pressure, fluid balance
Aldesleukin2

(CHEMO)


22,000,000
unit vial; 18
million IU/mL
after
reconstitution
Dose < 60 million units
– dilute in 50 mL D5W

Dose ≥ 60 million units
– dilute in 100 mL
D5W

If final concentration is
< 0.5 million units/mL,
add albumin 1 mg/mL
to increase stability


Over 15 minutes Central, midline, or
peripheral

Do NOT filter

Flush with D5W before
and after infusion

Continuous ECG, vital signs,
respiratory status, pulse oximetry
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Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Alemtuzumab2
HIGH ALERT
MEDICATION

(CHEMO)


Campath: 30
mg/mL vial

Lemtrada: 12
mg/1.2mL vial
Dilute in 100 mL NS or
D5W


For transplant and CLL: Infuse
over 2 hours

For multiple sclerosis: Infuse
over 4 hours


Central, midline, or
peripheral

For multiple sclerosis:
Premedicate with
methylprednisolone or
other steroid
Observe patient for at
least 2 hours after
infusion complete

For CLL:
Premedicate with
diphenhydramine and
acetaminophen 30
minutes prior to
administration
Blood pressure, infusion reactions
(bronchospasm, chills/fever, rigors)
Alfentanil2
HIGH ALERT
MEDICATION

Level 4

500 mcg/mL Dilute in D5W or NS;
desired concentration:
40 mcg/mL


Over 3 minutes

Continuous infusion: 0.5 - 3
mcg/kg/min
Central, midline, or
peripheral

Continuous respiratory status, vital
signs, cardiac status
Allopurinol2

Level 1

500 mg vial; 20
mg/mL after
reconstitution
Dilute in D5W or NS;
max concentration: 6
mg/mL

Over ≥30 minutes Central, midline, or
peripheral

Nausea, vomiting, rash, symptoms
of hypersensitivity


Alpha 1-Proteinase
Inhibitor2

Level 1
25 mg/mL after
reconstitution
No further dilution


0.08 mL/kg/min Central, midline, or
peripheral

Patients should be
immunized against
hepatitis B before
administration
Signs and symptoms of volume
overload, vital signs

Alprostadil2

Level 4


500 mcg/mL Dilute in D5W or NS
500 mcg/250 mL


Pulmonary hypertension: 0.03
-0.15 mcg/kg/min

Post-operative liver transplant:
0.2 - 0.8 mcg/kg/hr
Central, midline, or
peripheral large vein
Continuous respiratory status and
cardiac status, vein irritation, risk of
thrombophlebitis. See Non-
Chemotherapeutic Extravasation
Guideline

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Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Alteplase –
Continuous Infusion2
HIGH ALERT
MEDICATION

Level 4 plus D4/5 IMC;

Not in TAC ICU

See Alteplase
Intravenous for the
Treatment of Stroke

Acute Stroke
Response for Adults
policy 5.1.5

UWHC
standard
concentrations:
Stroke/PE/
STEMI 100
mg/100 mL

Embolectomy
10 mg/100 mL

EKOS
10 mg/100 mL
20 mg/250 mL
No further dilution
necessary; or may
dilute to 0.5 mg/mL in
NS or 12.5 mg/25 mL
for DVT or pts with
arterial or venous clots


STEMI: 15 mg over 1-2
minutes, 50 mg over 30
minutes, then 35 mg over1 hr

Stroke: 10% of dose over 1
minute, then remainder over 1
hour

PE: 100 mg over 2 hr

EKOS: 0.5-1 mg/hr

DVT lysis catheter: 0.5-2 mg/hr
Central, midline, or
peripheral
Signs/symptoms of bleeding, blood
pressure every 15 minutes for 2
hours

Stroke: neurological assessment
every 15 minutes while infusing,
then every 30 minutes for 6 hours,
then hourly for 18 hours
Amifostine2

Level 1
500 mg vial; 50
mg/mL after
reconstitution
Dilute in NS;
concentration: 5-40
mg/mL

Dose <500 mg dilute in
50 mL NS

Dose 500 - 1250 mg
dilute in 100 mL NS

Dose >1250 mg dilute
in 250 mL NS
200 mg/m2 dose over 3
minutes, 15-30 minutes prior to
radiation

or

>740 mg/m2 dose over 15
minutes, 30 minutes prior to
chemotherapy
Central, midline, or
peripheral

Premedicate with 20 mg
dexamethasone and a
serotonin 5-HT3 receptor
antagonist to prevent
nausea, vomiting and
hypersensitivity reactions
Blood pressure every 5 minutes
during the infusion and as needed
after the infusion is complete.
Amikacin Sulfate2

Level 1

See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
250 mg/mL Dilute in D5W or NS;
concentration: 2.5 - 5
mg/mL
Administer over a minimum of
30 minutes
Central, midline, or
peripheral
Blood pressure, heart rate, cardiac
status, renal function, serum
concentrations
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Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Aminocaproic Acid2

Level 1

See Procoagulant
Guideline



250 mg/mL Loading dose: 4 - 5 g
in 250 mL D5W, NS,
then 1 g in 50 mL D5W
or NS
Loading dose 15-60 minutes

Maintenance dose via
continuous infusion or every
4hour dosing

Continuous infusions at 1 g/hr
Central, midline, or
peripheral

Rapid administration
should be avoided due to
hypotension,
bradycardia, and/or
arrhythmia
Blood pressure, heart rate
neurologic assessment based on
patient condition, signs of bleeding,
thromboembolism

Aminophylline2

Level 1


25 mg/mL Loading doses:
Dilute in 50 mL D5W

standard concentration
for continuous infusion:
500 mg/500 mL


Loading doses: over 30
minutes

Continuous: 0.2 - 0.7 mg/kg/hr
Central, midline, or
peripheral

Blood pressure, heart rate, breath
sounds, signs of toxicity – nausea,
vomiting, and headache.

If patient experiences acute adverse
effect with loading dose, stop for 5-
10 minutes or administer at a slower
rate

Risk of thrombophlebitis – rotate IV
sites often if given peripherally. See
Non-Chemotherapeutic
Extravasation Guideline
Amiodarone2
HIGH ALERT
MEDICATION

Level 3 plus F4/5
Cardiac & B4/5 general
care with telemetry

Level 3 TAC

50 mg/mL Loading dose:
150 mg/100 mL D5W

standard
concentrations for
continuous infusion:
600 mg/500 mL D5W,
non-PVC or 600 mg/
250 mL (central line
only)


Bolus dose: 150 mg over 10
minutes

Continuous infusion: 1 mg/ min
x 6 hours, then 0.5 mg/min x
18 hours

Pulseless Vfib/Vtach: 300 mg
rapid administration, may
follow with a second dose
of150 mg rapid administration
if remains pulseless
Central line whenever
possible

Use in-line 0.22 micron
filter for administration

Infusions lasting longer
than 2 hours must be
administered in glass or
polyolefin bottles

Administer though PVC
tubing
Continuous ECG, blood pressure
every 15 min for first hour after
initiation of therapy and rate
changes; then every four hours

Risk of thrombophlebitis increases
with repeat doses, especially with
concentrations greater than 2.5
mg/mL. See Non-
Chemotherapeutic Extravasation
Guideline

Ammonium Chloride2

Level 4
0.4 mEq/mL Dilute 100–200 mEq in
500-1000 mL NS


Max rate: 5 mL/min Central, midline, or
peripheral


Vein irritation/ thrombophlebitis,
signs of ammonia toxicity
(bradycardia, cardiac arrhythmias);
rapid administration may result in
hepatic encephalopathy.
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Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Amobarbital Sodium2
HIGH ALERT
MEDICATION

Level 4
100 mg/mL No information


Max rate: 50 mg/minute Central, midline, or
peripheral
Respiratory rate/ depth, blood
pressure
Amphotericin B
CONVENTIONAL
(Fungizone)2

Level 1


50 mg vial; 5
mg/mL after
reconstitution
Max concentration = 1
mg/mL; dilute with
D5W


Administer dose over 4-6
hours

First dose is typically
administered over 2 - 6 hours,
increase rate as patient
tolerates.
Central, midline, or
peripheral

Initiate therapy with slow
infusion and increase
rate as tolerated.

Pre-medicate 30-60
minutes prior to
administration
Heart rate, blood pressure, fever,
chills, rigors, renal function, serum
electrolytes, and vein irritation risk of
thrombophlebitis. See Non-
Chemotherapeutic Extravasation
Guideline


Amphotericin,
LIPOSOMAL
(AmBisome) 2

Level 1


50 mg vial; 1-2
mg/mL after
dilution
Add sterile water to
yield 4mg/mL then
D5W to make 1-2
mg/mL


Infuse over 120 minutes; may
decrease infusion time to 60
minutes if well tolerated;
increase infusion time if patient
experiences discomfort during
infusion
Central, midline, or
peripheral

Initiate therapy with slow
infusion and increase
rate as tolerated.

Flush line with D5W prior
to administering

Heart rate, blood pressure, fever,
chills, rigors, renal function, serum
electrolytes, vein irritation risk of
thrombophlebitis. See Non-
Chemotherapeutic Extravasation
Guideline


Ampicillin Sodium2

Level 1
125 mg, 250
mg, 500 mg, 1
g, 2 g, 10 g
vials
Dilute in 50 mL NS


Infuse over 30 minutes Central, midline, or
peripheral
Anaphylaxis, rash, vein irritation,
thrombophlebitis – rotate peripheral
IV sites. See Non-
Chemotherapeutic Extravasation
Guideline
Ampicillin / sulbactam2

Level 1
1.5 and 3 g
vials
Dilute in 50 - 100 mL
D5W or NS


Infuse over 30 minutes Central, midline, or
peripheral
Anaphylaxis, venous irritation,
thrombophlebitis – rotate peripheral
IV sites. See Non-
Chemotherapeutic Extravasation
Guideline
Antithrombin III,
Human2

Level 1
Total units per
vial varies
(human blood
product)
No further dilution Infuse over a minimum of 10
minutes
Central, midline, or
peripheral

Dyspnea, chest tightness
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Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Antithymocyte
Globulin (ATG) –
Rabbit3
HIGH ALERT
MEDICATION

Level 1

5 mg/mL
after
reconstitution
Dilute each 25 mg in
50 mL NS and further
diluted to 250 mL

First dose over 6 hours, then
over at least 4 hours for
subsequent doses
Central line required for
doses diluted in < 500mL

Central, midline, or
Peripheral for doses
diluted in ≥ 500mL

Infuse into a high-flow
vein

Requires 0.22 micron
filter.

Premedicate with
acetaminophen,
diphenhydramine 30 min
prior to infusion
Anaphylaxis, abdominal pain, fever,
headache, dyspnea, dizziness



Antithymocyte
Globulin (ATG) –
Equine3
HIGH ALERT
MEDICATION

Level 1

50 mg/mL Dilute to a minimum
concentration of 4
mg/mL in NS,
D51/4NS, D51/2NS
(do NOT use D5 due to
precipitation risk)
Infuse over 4 hours Central, midline, or
peripheral

Requires 0.22 micron
filter.

First dose: premedicate
with diphenhydramine
PO 30 minutes before
and hydrocortisone IV 15
minutes before infusion.
Give acetaminophen 2
hours after starting
infusion.
Anaphylaxis, dyspnea, dizziness,
headache. Vein irritation if given
peripherally

Treat mild itching or erythema with
antihistamines
Antivenin, Latrodectus
Mactans (Black Widow
Spider Antivenin)2

Level 2
6000 units/2.5
mL after
reconstitution
Dilute in 10 - 50 mL NS


Over at least 15 minutes Central, midline, or
peripheral
Anaphylaxis, angioedema, frequent
blood pressure, heart rate, signs and
symptoms of shock
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

14

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Argatroban2
HIGH ALERT
MEDICATION

Level 1

See Heparin Induced
Thrombocytopenia
Guideline
250 mg vial Dilute in D5Wor NS

UWHC standard
concentration: 100
mg/100 mL


Initial rate: 0.5-2 mcg/kg/min
then adjust based on aPTT
Central, midline, or
peripheral
Blood pressure, signs and
symptoms of bleeding


Arginine (diagnostic)2,4

Level 2
100 mg/mL Dilute in D5W;
concentration: 100
mg/mL
Over 30 minutes Central, midline, or
peripheral

Flushing, nausea/ vomiting,
anaphylaxis, vein irritation.
Arsenic trioxide2
HIGH ALERT
MEDICATION

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 mg/10 mL
single use
ampules
Dilute with 100 - 250
mL D5W or NS



Over 1 - 2 hours, may extend
up to 4 hours for acute
vasomotor reaction
Central, midline, or
peripheral

Acute tachycardia, chest pain,
hypotension, fever, baseline and
weekly serial ECG, serum
electrolytes,

Irritant: See Chemotherapy
Extravasation Guideline



Ascorbic Acid2

Level 1
500 mg/mL Dilute in D5W or NS


Give slowly over 4 to 8 hours Central, midline, or
peripheral
Dizziness, faintness with rapid
injection, irritant, risk of
thrombophlebitis
Atezolizumab2

(CHEMO)


1200mg/20mL Dilute in 250 mL of NS
only
Infuse initial dose over 60
minutes.
If first infusion tolerated,
subsequent doses may be
given over 30 minutes.

Do not give IV push or bolus


Central, midline, or
peripheral

Do not coadminister
other drugs through
same IV line
Infusion related reactions
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

15

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Atracurium Besylate2
HIGH ALERT
MEDICATION

Level 4

See Continuous
Infusion
Neuromuscular
Blocker Guideline
10 mg/mL Dilute in D5W or NS;
usual concentration:
0.2 – 0.5 mg/mL


Bolus dose over 30 seconds

Continuous infusion: 4 - 15
mcg/kg/min
Central, midline, or
peripheral

Patient must be
intubated. Ensure patient
is adequately sedated
prior to administration of
a neuromuscular blocker.

Blood pressure, heart rate,
erythema, neuromuscular blockade
monitor with train of 4 or BIS monitor
Atropine Sulfate2

Level 1 (as preop)
Level 2 (all other
indications)
400 mcg/mL or
1 mg/mL
Not recommended No faster than 1 mg/min Central, midline, or
peripheral

Blood pressure, heart rate,
continuous ECG based in specific
conditions

Slow injection of atropine can cause
paroxysmal slowing of heart rate
Azacitidine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
100 mg vial: 10
mg/mL after
reconstitution
Dilute in 1000 mL NS Over 10 minutes Central, midline, or
peripheral

CBC, serum creatinine, rigors
Azathioprine2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
100 mg vial; 10
mg/mL after
reconstitution
Dilute in 50 - 100 mL
D5W or NS


Over 30 -60 minutes


Central, midline, or
peripheral

Blood pressure, GI hypersensitivity
reaction (severe nausea and
vomiting)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

16

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Azithromycin2

Level 1
500 mg vial;
100 mg/mL
after
reconstitution
Dilute in D5W or NS;
maximum
concentration: 2
mg/mL
Infuse over 1 hour Central, midline, or
peripheral

Vital signs, hypersensitivity, risk of
thrombophlebitis. Use large
peripheral vein and rotate sites
often. See Non-Chemotherapeutic
Extravasation Guideline
Aztreonam2

Level 1
1 g and 2 g
vials
Dilute in 50 - 100 mL
D5W or NS


Over 20 minutes.

Max rate: over a minimum of 3
minutes.
Central, midline, or
peripheral

Hypersensitivity, anaphylaxis, risk of
thrombophlebitis. Use large
peripheral vein and rotate sites
often. See Non-Chemotherapeutic
Extravasation Guideline
Basiliximab2
HIGH ALERT
MEDICATION

Level 1


20 mg vial; 4
mg/mL after
reconstitution
Dilute in 50 mL D5W or
NS


Administer over 20 -30
minutes.
Central, midline, or
peripheral

Bolus administration can cause
nausea, vomiting and local reactions


Belimumab2
HIGH ALERT
MEDICATION

Level 1


120 mg, 400
mg powder
vials for
reconstitution
Dilute reconstituted
solution in 250 mL NS
only
Over 1 hour Central, midline, or
peripheral

Dedicated IV line
required

Consider premedication
with antihistamine and
antipyretic
Infusion & hypersensitivity reactions
including anaphylaxis
Bendamustine
(BENDEKA brand)2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
100mg/4mL
vial
Dilute in 50 mL of NS
to a final concentration
of 1.85-5.6mg/mL


Administer over 10 minutes Central, midline, or
peripheral

Infusion reactions (anaphylaxis,
tumor lysis syndrome), skin
reactions

Irritant: See Chemotherapy
Extravasation Guideline

Note: Other formulations of
bendamustine exist; This entry only
applies to Bendeka brand
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

17

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Benztropine2,4

Level 1
1 mg/mL No information 1 mg/minute Central, midline, or
peripheral

Heart rate, blood pressure
Bevacizumab2,5
HIGH ALERT
MEDICATION

(CHEMO)


25 mg/mL Dilute to 100 mL NS


Dose dependent:
5mg/kg dose: Give over at
least 10 minutes

7.5-10mg/kg doses: Give first
dose over 60 minutes and
subsequent doses over 30
minutes

15mg/kg doses: Give first
dose over 90 minutes, second
dose over 60 minutes and third
dose over 30 minutes
Central, midline, or
peripheral

Infusion reactions (bronchospasm,
chills, dyspnea, fever, hypotension,
itching, rash)
Bezlotoxumab2
HIGH ALERT
MEDICATION

Level 1





1000 mg/40
mL vial
1-10 mg/mL Infuse over 60 minutes
Do not administer IV push
Central, midline, or
peripheral

Use in-line 0.22 micron
filter for administration

Allow to reach room
temperature before
administration
Infusion-related reactions (nausea,
fatigue, fever, headache, dizziness,
dyspnea, hypertension)
Bivalirudin2
HIGH ALERT
MEDICATION

Level 1

See Heparin Induced
Thrombocytopenia
Guideline
50 mg/mL Cardiac Cath Lab:
Dilute 250 mg in 50 mL
of D5W or NS

Heparin Induced
Thrombocytopenia
(HIT): Dilute 250 mg in
250 mL of D5W or NS
Cardiac Cath Lab:
Bolus 0.75 mg/kg over 1 min,
Continuous infusion: 1.75
mg/kg/hr for duration of
procedure
HIT: continuous infusion 0.05-
0.15 mg/kg/h
Central, midline, or
peripheral

aPTT, blood pressure, signs and
symptoms of bleeding
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

18

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Bleomycin Sulfate2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
15 units Dilute in 100 mL NS

Maximum
concentration: 3
units/mL

Over 10 minutes Central, midline, or
peripheral

Pre-medicate with
acetaminophen and
diphenhydramine.

Respiratory rate/ depth, anaphylaxis,
fever, chills, avoid extravasation
Blinatumomab2

(CHEMO)


35 mcg single
use vial.
Dilute to 240 mL Continuous infusion: over 24 to
48 hours
Central, midline, or
peripheral

Administer in a separate
IV line and non-
pyrogenic, low-protein
binding 0.2 - 1.2 micron
filter. Do not flush line.

Premedicate with
dexamethasone 20 mg
IV
Infusion reactions (hypersensitivity),
cytokine release syndrome (e.g.,
fever, headache, nausea,
hypotension)


Bortezomib2
HIGH ALERT
MEDICATION

(CHEMO)
As non-chemotherapy
– B4/6

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
3.5 mg
reconstituted to
1 mg/mL
Not recommended 3 - 5 second bolus Central, midline, or
peripheral


CBC, peripheral neuropathy, rash,
dyspnea, nausea/vomiting
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

19

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Brentuximab Vedotin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg
reconstituted to
5 mg/mL
Dilute in at least 100
mL NS, D5W or LR to
a final concentration of
0.4-1.8 mg/mL
Over 30 minutes Central, midline, or
peripheral



Infusion related reaction, CBC,
tumor lysis syndrome, CNS
abnormalities
Bumetanide2
HIGH ALERT
MEDICATION -
continuous infusion

Level 1
0.25 mg/mL Dilute in NS or D5W

standard
concentration: 25
mg/100 mL
Over 1 – 2 minutes

Continuous infusion: 0.5 – 2
mg/hr
Central, midline, or
peripheral

Blood pressure, anaphylaxis
Busulfan2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
6 mg/mL Dose <100 mg dilute in
100 mL NS

Dose 100 - 200 mg
dilute in 250 mL NS

Dose > 200 mg dilute
in 500 mL NS

Over 2 - 3 hours Central

Flush with 5 mL NS or
D5W before and after
infusion

Confusion, somnolence

Irritant: See Chemotherapy
Extravasation Guideline

Cabazitaxel2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
60 mg/1.5 mL
vial; 10 mg/mL
after
reconstitution
Dose ≤65 mg in 250
mL D5W or NS non-
PVC container

Doses >65 mg should
500ml D5W
Over 1 hour Central, peripheral, or
midline

Use a 0.22 micron in-line
filter and non-PVC tubing

Premedicate at least 30
minutes prior to each
dose with IV
diphenhydramine,
dexamethasone, and
ranitidine. An antiemetic
is also recommended.
CBC, Hypersensitivity
(rash/erythema, hypotension,
bronchospasm)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

20

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
C1 esterase inhibitor
(Human)2

Level 1
500 unit vial No further dilution
required.
1 mL/min (over 10 min) Central, peripheral, or
midline
Hypersensitivity reaction.
Epinephrine should be available
during administration

Solution will be colorless or slightly
blue.
Caffeine -Sodium
Benzoate2

Level 1
250 mg/mL

(125 mg/mL
caffeine)
Dilute in D5W or NS Over 60 minutes Central, midline, or
peripheral

Respiratory rate, heart rate, blood
pressure
Calcitriol2,4

Level 1
1 mcg/mL No information


2 - 3 mL/min Central, midline, or
peripheral

Signs and symptoms of vitamin D
intoxication (bone pain, dry mouth,
headache, metallic taste, muscle
pain)
Calcium CHLOride2

Level 1

See Concentrated
Electrolyte Guideline
100 mg/mL
(1.36 mEq/mL)
Dilute in 50 - 100 mL of
NS or D5W


Administer over 30 - 60
minutes.

Hyperkalemia causing
cardiotoxicity: may give 500-
1000 mg over 2-5 minutes
Central line preferred Vital signs, cardiac status, hot
flashes, palpitations, extreme irritant

Risk of extravasation and associated
tissue necrosis. See Non-
Chemotherapeutic Extravasation
Guideline
Calcium GLUConate2

Level 1

See Concentrated
Electrolyte Guideline
100 mg/mL
(0.46 mEq/mL)
Dilute in 50 - 100 mL of
NS or D5W


2 grams over 2 hours; 4 grams
over 4 hours

Do not exceed 200 mg/minute
Central, midline, or
peripheral

Cardiac status, hot flashes,
palpitations, vital signs, vein irritation
– use large veins

Risk of extravasation and associated
tissue necrosis. See Non-
Chemotherapeutic Extravasation
Guideline
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

21

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
CARBOplatin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
Carboplatin Guideline
10 mg/mL Dilution as follows:

Dose < 250 mg dilute
in 250 mL D5W

Dose > 250 mg dilute
in 500 mL D5W


over 30 -60minutes, Central, midline, or
peripheral

Anaphylaxis, irritant at concentration
of > 10 mg/mL, risk of extravasation.
Irritant: See Chemotherapy
Extravasation Guideline

Carfilzomib2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
60 mg vial; 2
mg/mL after
reconstitution
May dilute in 50 mL
D5W
2-10 minutes; flush line with
NS or D5W before and after
Central, midline, or
peripheral

Recommend hydrate with
250-500 mL NS (or other
fluid) predose and post-
dose if needed.

Premedicate with
dexamethasone 4 mg PO
or IV for infusion reaction
prior to all doses in cycle
1, during first dose
escalation cycle, and as
needed in future cycles
Dyspnea, infusion reaction, cardiac
complication (worsening congestive
heart failure, decreased left
ventricular dysfunction, myocardial
ischemia, pulmonary hypertension),
fluid overload
Carmustine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 mg vial; 3.3
mg/mL after
reconstitution
Dilution as follows:

Dose < 400 mg dilute
in 250 mL D5W in
glass bottle

Dose > 400 mg dilute
in 500 mL D5W in
glass bottle
Infuse over a minimum of 2
hours into a free-flowing
infusion of D5 or NS
Diluted drug via central,
midline, or peripheral

Undiluted via central line
only. Doses ≥300 mg/m2
require a central line

Use non-PVC infusion
bags and IV tubing
Flushing, irritant, risk of
extravasation.

Irritant: See Chemotherapy
Extravasation Guideline


Cefazolin2

Level 1
1 G/3 mL after
reconstitution
Dilute in 50 mL NS or
D5W


Over 30 minutes

Max rate: over 5 minutes
Central, midline, or
peripheral

Hypersensitivity (anaphylaxis, rash),
vein irritation, thrombophlebitis
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

22

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Cefepime2,6

Level 1

See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
500 mg, 1 or 2
g vials; 280
mg/mL after
reconstitution
Dilute in 50 - 100 mL
NS or D5W



Over 30 minutes

Extended infusion: run over 4
hours
Central, midline, or
peripheral

Hypersensitivity (anaphylaxis, rash),
phlebitis
Cefoxitin2

Level 1
1 or 2 g vials Dilute in NS or D5W


Over 30 minutes

Max rate: over 3-5 minutes at
concentration of 100 mg/mL
Central, midline, or
peripheral

Hypersensitivity (anaphylaxis, rash),
phlebitis
Ceftaroline2

Level 1
400 mg, 600
mg vials;
reconstitute
with 20 mL
sterile water
Dilute in 50-250 mL in
1/2NS, D5W, D2.5W,
or LR
Over 60 minutes Central, midline, or
peripheral
Hypersensitivity (anaphylaxis, rash)
Ceftazidime2

Level 1
500 mg, 1g, 2
g vials
Dilute in 50mL D5W or
NS
Over 30 minutes

Max rate: over 3-5 minutes at
concentration of 100-200
mg/mL
Central, midline, or
peripheral
Hypersensitivity (anaphylaxis, rash),
phlebitis
Ceftazidime-
avibactam2

Level 1
2.5 gram vial Dilute in 50 - 250 mL
D5W or NS
Infuse over 2 hours Central, midline, or
peripheral
Hypersensitivity (anaphylaxis, rash),
phlebitis, seizures or other
neurologic activity (especially in
patients with renal impairment)
Ceftolozane-
tazobactam2

Level 1
1.5 g vial
(ceftolozane 1
g, tazobactam
0.5 g)
Dilute in 100 mL of NS
or D5W
Over 60 minutes Central, midline or
peripheral
Hypersensitivity (anaphylaxis, rash),
Ceftriaxone2

Level 1
250 mg, 500
mg, 1 g, 2 g
vials
Dilute in 50 mL NS or
D5W

Over 30 minutes Central, midline, or
peripheral

Hypersensitivity (anaphylaxis, rash)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

23

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Cefuroxime2

Level 1
750 mg and
1.5 g vials
Dilute in 50 mL NS or
D5W
Over 30 minutes.

Max rate: over 3 - 5 minutes
Central, midline, or
peripheral

Hypersensitivity (anaphylaxis, rash),
phlebitis
Cetuximab2

(CHEMO)

Hazardous Drug –
MODERATE RISK

See Hospital
Administrative Policy
8.89
2 mg/mL

No further dilution


First dose: over 2 hours,
subsequent doses: over 60
min; max rate: 5 mL/min (10
mg/min)
Central, midline, or
peripheral

Use low protein binding,
0.22 micron filter.
Premedicate with
diphenhydramine.
Frequent vital signs, infusion
reaction (chills, fever, dyspnea,
hypotension, bronchospasm)
ChlorAMPHENICOL2

Level 1


1 g vial; 100
mg/mL after
reconstitution
Dilute in 50 - 100 mL
D5W


Over 30 minutes.

Max rate: over at least 1
minute
Central, midline, or
peripheral
CBC
Chlorothiazide2

Level 1
500 mg vial May be diluted with NS
or D5W


Over at least 10 minutes Central, midline, or
peripheral large vein
administration

Electrolytes, glucose, cutaneous
reactions

Risk of extravasation – See Non-
Chemotherapeutic Extravasation
Guideline

ChlorPROMAZINE2

Level 1
25 mg/mL Dilute in 50 mL NS or
D5W
maximum
concentration: 1
mg/mL


Max rate 1 mg/min Central, midline, or
peripheral

Keep patient in supine
position for 30 min after
administration to avoid
hypotension
Orthostatic hypotension, heart rate
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

24

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Cidofovir2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
75 mg/mL; 5
mL vial
Dilute in 100 mL NS


Over 60 minutes


Central, midline, or
peripheral

Hydrate with 1 L NS prior
to infusion
Flushing, rash, acid/base status,
renal function
Ciprofloxacin2

Level 1

See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
10 mg/mL vial
or 400 mg/200
mL bag, 200
mg/100 mL
bag
Dilute in D5W, NS, LR
to final concentration: 1
- 2 mg/mL

Over 60 minutes Central, midline, or
peripheral large vein

Skin reaction at infusion site, risk of
thrombophlebitis. See Non-
Chemotherapeutic Extravasation
Guideline


Cisatracurium2
HIGH ALERT
MEDICATION

Level 4

See Continuous
Infusion
Neuromuscular
Blocker Guideline
2 mg/mL (PF)
or 10 mg/mL
Dilute in D5W or NS

UWHC standard
concentration: 260
mg/130 mL


Bolus dose over 5 seconds

Continuous infusion: 0.3 - 10.
mcg/kg/min


Central, midline, or
peripheral

Patient must be intubated
and sedated. Ensure
patient is adequately
sedated prior to
administration of a
neuromuscular blocker.

Continuous vital signs and ECG,
peripheral nerve stimulation
CISplatin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
1 mg/mL Dilute in 1000 mL NS


Administer over 2 - 24 hours; Central, midline, or
peripheral

Prehydration
recommended.

Nausea/ vomiting, renal function,
urine output, infusion reactions
(facial edema, hypotension,
tachycardia, wheezing), irritant, risk
of extravasation.
Irritant: See Chemotherapy
Extravasation Guideline

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

25

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Cladribine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
1 mg/mL Dilute in 500 mL NS for
each single daily dose;
7 day dose diluted in
NS to total volume of
100 mL



Continuous infusion over 1 - 7
days

Intermittent infusion: 30 mins
– 2 hours
Central, midline, or
peripheral; central line
required for outpatient
continuous infusion

Fever, injection site reactions
Clindamycin2

Level 1
150 mg/mL,
600 mg/50 mL,
900 mg/50 mL
bags
Dilute in 50 - 100 mL
NS or D5W; must be
administered with an
IV infusion pump

Max rate: 30 mg/min

Do not exceed 1200 mg/hour
Central, midline, or
peripheral
Phlebitis, diarrhea, cardiovascular
status with high dose (>900mg)

Clofarabine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital 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

Colistimethate2

Level 1
150 mg vial Dilute in NS or D5W


Over 30 minutes

Max rate: 3-5 minutes
Central, midline, or
peripheral

Tingling of extremities
Cosyntropin2

Level 1
250 mcg/mL Dilute in D5W or NS


Stim test dose over 2 minutes.
May give over 6 hours for
greater stimulation.
Central, midline, or
peripheral

Continuous observation for at least
first 30 minutes, blood pressure

Crotalidae Polyvalent
Immune Fab (Ovine)2

Level 1
1 gram vial Dilute in 250 mL NS


Give at 25 - 50 mL/hr for 10
minutes, then may increase to
250 mL/hr
Central, midline, or
peripheral

Anaphylaxis, pruritus
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26

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Cyclophosphamide2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
2 gram vial; 20
mg/mL after
reconstitution
Dilution as follows:

Dose < 2 g dilute in
250 mL NS, D5W, LR

Dose > 2 g -
administer undiluted


Administer over a minimum of
30 minutes or per protocol

Max rate: 100 mg/min for
doses up to 500 mg
Central, midline, or
peripheral

Pre-hydration
recommended for high
dose regimens

Lightheadedness, anaphylaxis
Cyclosporine2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg/mL Dilute each 50 mg in
20 - 100 mL D5W or
NS

Renal transplant:
Dilute in 250 mL D5W
Excel bag


Infuse over a minimum of 2
hours; may give as continuous
infusion
Central, midline, or
peripheral

Blood pressure, anaphylaxis
Cytarabine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
100 mg, 500
mg, 1 g or 2 g
vial
Less than 24 hr
infusion – dilute in 250
mL NS

24 hour infusion –
dilute in 500 mL NS


Rate determined by protocol
(over 1 - 3 hours) or
continuous over 24 -30 hours
Central, midline, or
peripheral

Avoid extravasation.

Hypersensitivity, signs and
symptoms of bleeding; early signs of
neurotoxicity (ataxia, confusion,
lethargy)
Cytomegalovirus
immune globulin2

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


Start at 15 mg/kg/hr for 30
minutes, then 30 mg/kg/hr for
30 minutes, then 60 mg/kg/hr

Maximum rate: 75 mL/hr
Central, midline, or
peripheral

Use in-line filter – 15
micron preferred
Flushing, fever, chills, nausea,
vomiting, shortness of breath, vital
signs prior to infusion and at each
rate change

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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27

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Dacarbazine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
200 mg vial; 10
mg/mL after
reconstitution
Dilute in 250 mL NS


Over 30-60 minutes or as
continuous infusion.


Central, midline, or
peripheral


Vein irritation, thrombophlebitis,
anaphylaxis

Irritant: See Chemotherapy
Extravasation Guideline

Daclizumab2
HIGH ALERT
MEDICATION

Level 1
5 mg/mL Dilute in 50 mL NS


Over 15 minutes Central, midline, or
peripheral

Vital signs, chills, fever, dyspnea,
hypersensitivity
DACTINOmycin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
500 mcg/mL Not recommended


Over 10-15 minutes, or over 1
minute into running IV


Central, midline, or
peripheral

Pre-medicate with an
anti-emetic
Risk of extravasation.
Vesicant: See Chemotherapy
Extravasation Guideline

Dantrolene2

Level 2
1 mg/3 mL No further dilution


Malignant hyperthermia crisis
initial dose: Over 2 minutes

Prevention of malignant
hyperthermia and follow-up
doses: administer over 60
minutes
Central, midline, or
peripheral

Respiratory rate, ECG, vital signs,
and urine output continuously, avoid
extravasation
DAPTOmycin2

Level 1
500 mg vials,
50 mg/mL
following
reconstitution
Dilute in 50 - 100 mL
NS


Over 30 minutes.

Max rate: over 2 minutes
Central, midline, or
peripheral

Muscle pain or weakness
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28

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Daratumumab2

(CHEMO)


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 infusion: 50 mL/hour for
first hour. If no infusion
reactions occur, increase by 50
mL/hour every hour to a
maximum rate of 200 mL/hour

Second infusion: 50 mL/hour
for first hour. If no grade 1
infusion reactions occurred
during the first 3 hours of the
first infusion, increase by 50
mL/hour every hour to a
maximum rate of 200 mL/hour

Subsequent infusions: If no
grade 1 infusion reactions
noted in the first 2 infusions at
a final rate of ≥100mL/hr,
infuse at 100 mL/hour for first
hour, then increase by 50
mL/hour every hour to a
maximum rate of 200 mL/hour

Central, midline, or
peripheral

Premedicate with an IV
corticosteroid, oral
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
Darbepoetin2,4

Level 1
25, 40, 60,
100, 150, 200,
300, 500 mcg
No additional dilution Over at least 1 minute Central, midline, or
peripheral

Blood pressure
DAUNOrubicin HCl2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
20 mg vial May dilute in 100 mL
D5W or NS or give
undiluted
Into rapid running IV over 3
minutes

May dilute further and infuse
over 15-30 minutes
Central, midline, or
peripheral

ECG, signs and symptoms of
hemorrhage, risk of extravasation.

Vesicant: Chemotherapy
Extravasation Guideline

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29

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Decitabine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg vial; 5
mg/mL after
reconstitution
Dilution as follows:

Dose < 100 mg dilute
in 100 mL NS

Dose > 100 mg dilute
in 250 mL NS
3 day regimen: Over 3 hours

5 day regimen: Over 1 hour
Central, midline, or
peripheral

Pre-medicate with an
antiemetic
CBC, signs and symptoms of
hypersensitivity
Deferoxamine2

Level 2

500 mg vial Dilute in D5W, NS,
D10W or LR


Max: 15 mg/kg/hr Central, midline, or
peripheral
Rapid IV infusion can cause
hypotension, tachycardia, urticarial,
transient CNS disturbances and
acute renal dysfunction

Blood pressure, telemetry
Defibrotide2

Level 1


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

Flush IV line with NS or
D5W before and after
administration

0.2 micron in-line filter
required
Signs and symptoms of
hypersensitivity, bleeding
Desmopressin2

Level 1

See Procoagulant
Guideline

4 mcg/mL May dilute in 50 mL NS


Over 1 minute for diabetes
insipidus

Over 15 - 30 minutes for
hemophilia A, von Willebrand’s
disease

Surgical procedure:
Administer 30 minutes prior to
procedure
Central, midline, or
peripheral

Blood pressure and pulse during
infusion
Dexamethasone
Sodium Phosphate2

Level 1
4 mg/mL or
10 mg/mL
Dilute in 50 - 100 mL
D5W or NS


Over 30 minutes.

Max rate: 3 minutes
Central, midline, or
peripheral

Burning sensation, hypersensitivity
(anaphylaxis)
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30

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Dexmedetomidine2
HIGH ALERT
MEDICATION

Level 4 for all indications
EXCEPT alcohol
withdrawal

For alcohol withdrawal:
Level 3 (F4/4 and D6/5
IMC only) once
stabilized on a
maintenance infusion
initiated in an ICU

Adult Pain, Agitation
and Delirium ICU
Guideline

100 mcg/mL Dilute in NS

UWHC standard
concentration: 200
mcg/50 mL
Loading dose over 10 minutes

0.2 - 0.7 mcg/kg/hr
Central, midline, or
peripheral

Continuous vital signs, oxygenation,
fluid status
Dexrazoxane2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
250 mg, 500
mg vials, 10
mg/mL after
reconstitution
Dilute in NS or D5W to
a final concentration of
1.3 - 5 mg/mL


Over 1 - 2 hours Central, midline, or
peripheral large vein

Administer through a
large bore IV

For extravasation
management, administer
at IV site remote form
extravasation site. Do not
use for infiltration.
CBC, liver function tests


Dextrose 50%2

Level 1
500 mg/mL Not to be diluted when
used for treatment of
hypoglycemia

.
1500 mg (3 mL) per minute Central, midline, or
peripheral

Use large vein if
administering
peripherally and confirm
patency frequently.
Blood glucose, electrolyte
concentrations

Risk of extravasation and tissue
damage. See Non-
Chemotherapeutic Extravasation
Guideline


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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31

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Diazepam2

Level 1
5 mg/mL Dilute in D5W

.
Max rate 5 mg/min Central, midline, or
peripheral large vein

Blood pressure, respiratory
rate/depth. If used for conscious
sedation, see Hospital
Administrative Policy 8.38 for
monitoring requirements.

Risk of extravasation and
thrombophlebitis – avoid small veins
if given peripherally. See Non-
Chemotherapeutic Extravasation
Guideline

Digoxin2

Level 1
250 mcg/mL,
100 mcg/mL
Undiluted or diluted in
D5W or NS to no less
than 4-fold dilution
Over 5 minutes Central, midline, or
peripheral


Heart rate, blood pressure, baseline
ECG

Risk of extravasation and tissue
damage. See Non-
Chemotherapeutic Extravasation
Guideline
Digoxin Immune FAB2

Level 2

38 mg vial; 9.5
mg/mL after
reconstitution
Each vial diluted with 4
mL sterile water for
injection. May further
diluted with desired
amount of normal
saline
Over 30 minutes

If cardiac arrest is imminent,
may administer as bolus over 2
minutes
Central, midline, or
peripheral

Administer via 0.22
micron in-line filter

Vital signs, ECG, signs and
symptoms of acute allergic reaction
(angioedema, bronchospasm,
tachycardia)
Dihydroergotamine2

Level 2
1 mg/mL Not recommended Over 2-3 minutes Central, midline, or
peripheral

Administration of an
antiemetic prior to
administration is
recommended
Vital signs, localized edema

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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32

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Diltiazem2
HIGH ALERT
MEDICATION -

Level 2 Push:
Scheduled doses not
recommended. If
adequate clinical
response achieved after
a maximum of 2-3 doses
IV push, transition to
continuous infusion.

Level 3 - Continuous
infusion - F4/5, B4/5
general care

Level 3 TAC

Vasoactive
Continuous Infusion
Guideline
5 mg/mL UWHC standard
concentration: 125
mg/125 mL


Over 2 minutes

Continuous infusion: initially 5
- 10 mg/hr; maximum rate
20mg/hr
Central, midline, or
peripheral

Blood pressure, heart rate, ECG
during administration preferred,
respiratory rate/depth
Dinutuximab2

(CHEMO)


17.5mg/5mL Dilute in 100 mL NS Initiate infusion at a rate of
0.875 mg/m2/hour for 30
minutes

Increase infusion rate
gradually as tolerated to a
maximum rate of 1.75
mg/m2/hour to infuse over 10
to 20 hours

Do not administer as IV push
or IV bolus
Central, Midline,
Peripheral

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

Premedicate with
antiemetics

Premedicate with
analgesic, and
antihistamine, and an
antipyretic prior to
administration
Infusion reactions (during and for at
least 4 hours after the end of
infusion)

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

Electrolytes, CBC, BP, systemic
infection
Diphenhydramine2

Level 1
50 mg/mL Dilute in 50 mL D5W or
NS

Over 20 minutes; Max rate: 25
mg/minute
Central, midline, or
peripheral

Vital signs
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33

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Dipyridamole2
(diagnostic)

Level 2

5 mg/mL Each 5 mg should be
diluted with a minimum
of 2 mL D5W, 0.45NS
or NS

Loading dose over 4 minutes

Continuous infusion: 10 mg/hr
as platelet aggregation
inhibitor
Central, midline, or
peripheral

Continuous vital signs and ECG
during administration and for at least
15 minutes after
Dobutamine2
HIGH ALERT
MEDICATION

Level 4 plus B4/5 IMC,
D4/5 IMC , D6/5 IMC,
F4/5 IMC

Vasoactive
Continuous Infusion
Guideline
12.5 mg/mL UWHC standard
concentration: 1000
mg/250 mL


Continuous infusion:
Initial: 0.5 - 1 mcg/kg/min

Titrate by 2.5 mcg/kg/min
every 5 – 15 minutes

Usual Maximum Rate:
20 mcg/kg/min.
Central line preferred,
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks
Continuous blood pressure, heart
rate, ECG, and urine output;
pulmonary wedge pressure and
cardiac output if available.

Risk of extravasation. See Non-
Chemotherapeutic Extravasation
Guideline

Docetaxel2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
20 mg/mL Dose 30 - 75 mg: 100
mL D5W
Dose 75 - 200 mg: 250
mL D5W
Dose > 200 mg: 500
mL D5W

Final concentration
0.3-0.74mg/mL

Use non-PVC bag
Over 1 hour Central, midline, or
peripheral

Premedication with
steroids is recommended
CBC, LFTs, hypersensitivity
reaction; extravasation risk

Irritant: See Chemotherapy
Extravasation Guideline

Dopamine2
HIGH ALERT
MEDICATION

Level 3 plus B4/5
general care

Level 3 TAC

Vasoactive
Continuous Infusion
Guideline
80 mg/mL

800mg/250mL
UWHC standard
concentration: 800 mg
/250 mL.
Continuous infusion:
Initial: 2 - 5 mcg/kg/min

Titrate by 1 - 5 mcg/kg/min
every 1 - 15 minutes

Usual Maximum Rate:
20 mcg/kg/min
Central preferred,
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks
Blood pressure, ECG, heart rate

Risk of extravasation. See Non-
Chemotherapeutic Extravasation
Guideline

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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34

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Doripenem2

Level 1

See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
250 mg & 500
mg vials
Dilute in 100 mL NS or
D5W
Over 1 hour Central, midline, or
peripheral

Dermatologic reactions and
neuropsychiatric events

May cause thrombophlebitis. See
Non-Chemotherapeutic
Extravasation Guideline
Doxercalciferol2

Level 1
2 mcg/mL May give undiluted No information on rate
available

Central, midline, or
peripheral

iPTH, serum calcium, and serum
phosphorus
Doxorubicin,
CONVENTIONAL
(Adriamycin)2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
2 mg/mL Continuous infusion -
dilute in 500 mL D5W
or NS


Over 3-5 minutes into running
IV

Continuous infusion over 24
hours
Central line required for
continuous infusion

Central, midline, or
peripheral for intermittent
administration

Cardiac status, vesicant, risk of
extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline

Doxorubicin,
LIPOSOMAL (Doxil)2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
2 mg/mL Dose ≤ 90 mg dilute in
250 mL D5W

Dose > 90 mg dilute in
500 mL D5W


Kaposi sarcoma: over 30
minutes

Ovarian/Breast CA: initial 1
mg/min, then over 1 hour
Central, midline, or
peripheral

Heart rate, infusion reaction
(bronchospasm, flushing), risk for
extravasation.

Irritant: See Chemotherapy
Extravasation Guideline

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

35

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Doxycycline2

Level 1
100 mg vial; 10
mg/mL after
reconstitution
Dilute in 100 - 1000 mL
D5W or NS

Over 1-4 hours. Avoid rapid
administration
Central, midline, or
peripheral

Vein irritation, risk of
thrombophlebitis and extravasation.
Confirm patency of IV line. See Non-
Chemotherapeutic Extravasation
Guideline

Eculizumab2
HIGH ALERT
MEDICATION

Level 1


10 mg/mL Dilute to concentration
of 5 mg/mL in D5W,
NS, 1/2NS, or LR
Over 35 minutes

May give over up to 2 hours if
needed due to infusion
reactions
Central, midline, or
peripheral
Infusion reactions

Monitor for infusion reaction for 1
hour after infusion
Edetate calcium
disodium2

Level 2
200 mg/mL Dilute in 250 - 500 mL
D5W or NS to a
concentration of 5
mg/mL or less
Over 8 -12 hours

May give continuously over 24
hours
Central, midline, or
peripheral

ECG and vital signs, renal and
hepatic function
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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36

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Elotuzumab2

(CHEMO)


300 mg, 400
mg vial
reconstituted to
25 mg/mL
Dilute with 230 mL of
0.9% Sodium Chloride
or D5W 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, Midline,
Peripheral

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

Premedication with
dexamethasone,
acetaminophen, and an
H1- and H2- 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)
Enalaprilat2

Level 1
1.25 mg/mL Dilute in 50 mL D5W or
NS

Over 5 minutes Central, midline, or
peripheral

Vital signs frequently
EpHEDRINE2
HIGH ALERT
MEDICATION

Level 1 for treatment of
transient hypotension
secondary to epidural
(see notation), otherwise

Level 4
50 mg/mL Dilute to 5-10 mg/mL in
D5W or NS
Intermittent dose: 10 mg/min Central, midline, or
peripheral

Blood pressure and heart rate, ECG.
If used for treatment of transient
hypotension secondary to epidural,
patient must be monitored by
Anesthesia staff after administration

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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37

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
EpINEPHrine2
HIGH ALERT
MEDICATION

Level 4

Vasoactive
Continuous Infusion
Guideline
1 mg/mL or
1 mg/10 mL
Dilute in D5W or NS

UWHC standard
concentrations: 4
mg/250 mL, 8 mg/250
mL, 16 mg/250 mL



Continuous infusion:
Range: 0.01 - 0.4 mcg/kg/min

Start: 0.01 mcg/kg/min

Titrate by 0.01 – 0.05
mcg/kg/min every 5 minutes
Central line preferred,
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks
Blood pressure and heart rate every
5 minutes, ECG

Risk of extravasation and tissue
damage. See Non-
Chemotherapeutic Extravasation
Guideline

Epirubicin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
2 mg/mL Further dilution not
required


Over 15-20 minutes

Reduced doses can be
proportionally decreased but
not less than 3 min
Central, midline, or
peripheral large vein

Slow infusion rate if
erythematous streaking
along the vein or facial
flushing

Signs of cardiac toxicity – rapid HR,
SOB
Risk of extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline


Epoetin Alpha2,4

See Darbepoetin and
Epoetin Guideline for
non –nephrology

See Anemia
management in
chronic kidney disease

Level 1
2000, 3000,
4000, 10,000,
20,000 or
40,000
units/mL
No information Over at least 1 minute Central, midline, or
peripheral

Blood pressure, signs and
symptoms of hypersensitivity
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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38

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Epoprostenol2
HIGH ALERT
MEDICATION

Level 4 (TLC) and D6/5
IMC , B4/5 pre-surgical
transplant on home
pump)

Not in TAC ICU

See Epoprostenol
Guideline for Infusion

500 mcg and
1.5 mg vials
Dilute with sterile
diluent provided by the
manufacturer

UWHC standard
concentration: 500
mcg/100 mL


Continuous infusion:
1 – 45 ng/kg/min
Central line required for
continuous infusion; may
give peripherally on a
temporary basis until
central line placed

Do NOT administer other
medications through the
same lumen
Do NOT infuse with any
other fluids or flushes
Do NOT flush the lumen
that epoprostenol is
infusing through
Do NOT pause the
infusion except to change
bags
Prime and use new IV
tubing and filter every 24
hours
Administer using a
CareFusion 0.2 micron
in-line filter
Chest pain, syncope, flushing,
nausea/vomiting, hypotension,
oxygen saturation, dyspnea; ECG
monitoring during dose titration

Eptifibatide2
HIGH ALERT
MEDICATION

Level 4 and F4/5 IMC,
D4/5 IMC

Not in TAC ICU
2 mg/mL UWHC standard
concentration: 75
mg/100 mL




Initial bolus dose over 2
minutes followed by
continuous infusion: 2
mcg/kg/min
(Max: 15 mg/hr)
Central, midline, or
peripheral

Administer with vented
infusion set

Vital signs, signs and symptoms of
bleeding, frequent neuro checks
Eribulin mesylate2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
1 mg/2 mL May dilute in 100 mL
NS
Over 2-5 minutes

Do not administer
through an IV line
containing dextrose
ECG/QT prolongation (in patients
with heart failure, bradycardia, use
of QT prolonging medication,
electrolyte abnormality)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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39

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Ertapenem2

Level 1
1 g vials, 100
mg/mL after
reconstitution
Dilute with 50 mL NS Over 30 minutes Central, midline, or
peripheral
Anaphylaxis
Erythromycin2

Level 1
500 mg vials;
50 mg/mL after
reconstitution
Dilute in at least 100
mL NS; concentration
1 - 5 mg/mL

Over 20 - 60 minutes Central, midline, or
peripheral

Vital signs, QT prolongation, if vein
irritation/ thrombophlebitis, decrease
rate of infusion or increase volume
of dilution. Ototoxicity with doses >
4g/day. Risk of phlebitis - See Non-
Chemotherapeutic Extravasation
Guideline
Esmolol2
HIGH ALERT
MEDICATION

Level 4 plus D4/5 IMC,
F4/4 IMC, D6/5 IMC

Vasoactive
Continuous Infusion
Guideline
10 mg/mL, 2.5
g/250 mL and
2 g/100 mL
UWHC standard
concentrations: 2
g/100 mL, 2.5 g/250
mL

Intermittent dose over 1 minute

Continuous infusion: 50 - 300
mcg/kg/min
Central preferred for
concentrations ≥20
mg/mL. Midline or
peripheral for
concentrations < 20
mg/mL


Continuous blood pressure,
respiratory rate, heart rate and
continuous ECG.

May cause thrombophlebitis. See
Non-Chemotherapeutic
Extravasation Guideline


Estrogens,
conjugated2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
25 mg vial; 5
mg/mL after
reconstitution
No further dilution
necessary
1 mL/min Central, midline, or
peripheral

Flushing, blood pressure,
thromboembolism
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40

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Ethacrynic acid2

Level 1
50 mg vial; 1
mg/mL after
reconstitution
No further dilution
necessary
Doses < 50 mg: may be given
IV push at a rate not to exceed
10 mg per minute

Doses ≥ 50 mg: will be
delivered in a bag to be
infused at a rate no to exceed
10 mg per minute


Central, midline, or
peripheral

Give slowly through
tubing of running infusion

If a second injection is
required, rotate the
injection site to avoid
thrombophlebitis
Blood pressure, electrolytes,
ototoxicity

Etomidate2
HIGH ALERT
MEDICATION

Level 4
2 mg/mL No further dilution Over 30 - 60 seconds Central, midline, or
peripheral
Patient should be
intubated
Avoid use of wrist and
hand veins
Airway and vital signs
Etoposide2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
20 mg/mL Dilute in NS (for
stability)

Dose < 300 mg dilute
in 500 mL of NS

Dose 300 - 600 mg
dilute in 1000 mL of
NS

Dose > 600 mg dilute
in appropriate amount
of diluent to achieve
concentration ≤ 0.4
mg/mL
Over 30 - 60 minutes. Rapid
infusion may cause marked
hypotension.
Diluted via central,
midline, or peripheral

Undiluted administer in
non-PVC IV bag and
tubing via central line
only

Blood pressure, irritant if large
volume or high concentration, risk of
extravasation.

Irritant: See Chemotherapy
Extravasation Guideline

Factor 7a2

Level 1

See Procoagulant
Guideline
and Operating
Procedure
1 mg vial; 1
mg/mL after
reconstitution
Dilute with supplied
diluent to final
concentration of 1
mg/mL


Over a minimum of 2 minutes Central, midline, or
peripheral

Platelets, fibrinogen, PT and aPTT.
Monitor for clinical signs of bleeding
such as pain, swelling, joint
circumference, as well as signs of
thrombosis.

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41

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Factor 8, Monoclonal2

Level 1

Factor Products
Operating Procedure
Total units per
vial varies from
lot to lot

Use diluent supplied by
manufacturer.


Begin at 2 mL/min and
gradually increase to 10
mL/min
Central, midline, or
peripheral

Anaphylaxis, chest tightness, pulse
before and during treatment
Factor 8,
Recombinant2

Level 1

Factor Products
Operating Procedure
Total units per
vial varies from
lot to lot

Use diluent supplied by
manufacturer


Begin at 2 mL/min and
gradually increase to 10
mL/min
Central, midline, or
peripheral

Anaphylaxis, chest tightness, pulse
before and during treatment
Factor 9, Recombinant
(Benefix®)
Hemophiliac
treatment2

Level 1

Factor Products
Operating Procedure
Total units per
vial varies from
lot to lot

Use diluent supplied by
manufacturer


Begin at 2 mL/min and
gradually increase to 10
mL/min
Central, midline, or
peripheral

Anaphylaxis, chest tightness, pulse
before and during treatment
Famotidine2

Level 1

20 mg/2 mL Dilute famotidine with
NS to a total of 5 to 10
mL OR may be
administered undiluted
IV push over at least 2 minutes Central, midline, or
peripheral

ECG changes: Prolonged QT
interval has been reported in
patients with renal dysfunction
Fat Emulsion 20%2

Level 1
100 mL, 250
mL, and 500
mL
No further dilution


Initiate infusion at 0.5
mL/minutes for 15-30 minutes,
then may increase to 1
mL/minute
Central, midline, or
peripheral

Use a 1.2 micron filter for
any infusion containing
IV fat emulsion
Anaphylaxis, chest pain,
hyperlipidemia
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42

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Fenoldopam2
HIGH ALERT
MEDICATION

Level 4
10 mg/mL Dilute in D5W or NS

UWHC standard
concentration: 10
mg/250 mL
Continuous infusion: 0.03 - 0.1
mcg/kg/min (max 1.6
mcg/kg/min)
Central, midline, or
peripheral

Blood pressure and heart rate every
15 minutes. Risk of extravasation –
use large vein for peripheral
administration and confirm vein
patency. See Non-
Chemotherapeutic Extravasation
Guideline

FENTanyl Citrate2
HIGH ALERT
MEDICATION

Level 1

Adult Pain, Agitation
and Delirium ICU
Guideline

50 mcg/mL Dilute in D5W or NS


Intermittent dose: Over 1-2
minutes

Continuous infusion: Titrate to
response
Central, midline, or
peripheral

Respiratory rate/ depth, sedation
level, vital signs. If used for
conscious sedation, see Hospital
Administrative Policy 8.38 for
monitoring requirements.
Ferumoxytol2

Level 1

510 mg/17 mL Dilute dose in 50 – 200
mL of D5W or NS
Over 15 minutes Central, midline, or
peripheral

Place patient in
recumbent or semi-
recumbent position
Hypersensitivity and anaphylactic
reactions for at least 30 minutes
after the infusion.
Ferric Sodium
Gluconate2

Level 1
12.5 mg/mL May dilute in 100 mL
NS


Undiluted dose: 12.5 mg per
min

Diluted: over at least 1 hour
Central, midline, or
peripheral

Vital signs, allergic reaction
(anaphylaxis)
Filgrastim2

Level 1


See Granulocyte
colony stimulating
factor guideline
300 mcg/mL Dilute in D5W to a
concentration of 5 - 15
mcg/mL


Intermittent infusion: Over 15 -
30 minutes


Central, midline, or
peripheral

Signs and symptoms of
hypersensitivity

.

>15 mcg/mL - no albumin needed
5 - 15mcg/ mL - add 2mL of 5%
albumin to each 50 mL of D5W to
prevent adsorption to plastic
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43

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Fluconazole2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
400 mg/200
mL NS or 200
mg/100 mL NS
bag
No further dilution


Maximum rate of 200 mg/hr Central, midline, or
peripheral

Signs and symptoms of
hypersensitivity; consider ECG
monitoring in patients at risk for QT
prolongation
Fludarabine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg vial; 25
mg/mL after
reconstitution
Non 24 hr infusions -
dilute in 100 mL NS

24 hr infusions -dilute
in 500 mL NS


Intermittent dose over 30
minutes

Continuous infusion over 24
hours.
Central, midline, or
peripheral

Infusion reactions, renal function
Flumazenil2

Level 1

100 mcg/mL
No dilution required

Over 15 seconds into freely
running IV
Central, midline, or
peripheral
(large vein preferred)
Blood pressure, heart rate, and
respiratory status
Fluorescein Sodium2

Level 1

10% No dilution required

Over 5-10 seconds Central, midline, or
peripheral
(large vein preferred)
Avoid extravasation; high pH of
solution can result in significant
tissue damage; nausea;
hypersensitivity

Flush IV before and after to avoid
incompatibilities


Patient’s skin and urine will take on
yellow color and fluorescence after
administration
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44

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Fluorouracil2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg/mL Undiluted or may dilute
in 50-1000 mL NS or
D5W



Intermittent dose over 1 minute

Continuous infusion: over 24
hours
Central, midline, or
peripheral

Avoid extravasation

Irritant: See Chemotherapy
Extravasation Guideline

Folic Acid2

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

Over 30 minutes

Max rate: 5 mg /min
Central, midline, or
peripheral

Slight flushing possible
Fomepizole2

Level 2
1 g/mL Dose should be diluted
in at least 100 mL
D5W or NS
Over 30 minutes Central, midline, or
peripheral

Nausea, dizziness, headache
Fosaprepitant2

Level 1

See Chemotherapy-
Induced Nausea and
Vomiting in Adults
150 mg vial Dilute in NS to
concentration of at
least 1 mg/mL
Over 20-30 minutes Central, midline, or
peripheral

Flushing, erythema, dyspnea,
anaphylactic reactions
Foscarnet2

Level 1
24 mg/mL Central line: no further
dilution necessary

Peripheral line: dilute
in D5W or NS to
concentration of at
least 12 mg/mL
40 mg/kg: over 60 minutes;
60 mg/kg: over 60 minutes
90 mg/kg: over 90 - 120
minutes

Max rate: 1 mg/kg/minute
Central for UNdiluted
drug

Central, midline, or
peripheral for DILUTED
drug

Use large vein for
peripheral administration
and confirm vein
patency.
Hypersensitivity; Use with caution in
patients with a history of QT
prolongation or those at increased
risk for QT prolongation; Monitor
serum creatinine and electrolytes at
baseline, 2-3 times per week during
induction therapy, and every 2
weeks during maintenance therapy.
Hydration necessary prior to each
dose.

Risk of thrombophlebitis. See Non-
Chemotherapeutic Extravasation
Guideline


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45

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Fosphenytoin2

Level 1 for maintenance
dose
Level 2 for loading dose

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11

See Fosphenytoin
Guidelines
50 mg
phenytoin
equivalents
(PE)/ 1 mL
Dilute in D5W or NS to
concentration of 1.5 -
25 mg PE/mL


Maximum 150 mg PE/min Central, midline, or
peripheral

Confirm vein patency
when giving peripherally
Heart rate, blood pressure, ECG,
and respiratory rate during load and
30 minutes after complete.

Risk of extravasation –See Non-
Chemotherapeutic Extravasation
Guideline

Furosemide2
HIGH ALERT
MEDICATION -
continuous infusion

Level 1


10 mg/mL Dilute in D5W or NS

UWHC standard
concentration: 1 g/100
mL



Maximum intermittent
administration rate: 10
mg/minute
Doses > 100 mg should be
administered as an infusion at
maximum rate of 4 mg/min
Central, midline, or
peripheral


Blood pressure, electrolytes,
ototoxicity


Ganciclovir2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
500 mg vial; 50
mg/mL after
reconstitution
Dilute in 100 mL D5W
or NS to a
concentration no more
than 10 mg/mL


Minimum over 60 minutes Central, midline, or
peripheral

CBC with platelets; pain at site of
infusion, risk of thrombophlebitis –
confirm vein patency when given
peripherally. See Non-
Chemotherapeutic Extravasation
Guideline

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46

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Gemcitabine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
200 mg, 1 g
vial;
reconstitute to
maximum 40
mg/mL
Dilute in 100 mL NS


Over 30 minutes

Do not extend infusion time
beyond 60 minutes; will
increase toxicity
Central, midline, or
peripheral

Vital signs, pulmonary function; CBC
Gentamicin2

Level 1

See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
40 mg/mL, 10
mg/mL
Dilute in 50 - 200 mL
D5W or NS


Doses < 250 mg administer
over 30 minutes

Doses ≥ 250 mg administer
over 60 minutes
Central, midline, or
peripheral

Respiratory rate/ depth; serum
concentrations; renal function
Glucagon2

Level 1 for IV push
Level 4 for infusion
1 mg/vial; 1
mg/mL after
reconstitution
May be diluted with
D5W or NS for infusion


1 mg/minute

To reverse effects of beta
blockade: loading dose may be
followed by infusion 1-5 mg/hr
Central, midline, or
peripheral

Blood pressure, ECG, heart rate,
mentation, blood glucose
Glucarpidase2

Level 1
1000 units/vial;
1000 units/ml
after
reconstitution
undiluted Over 5 minutes Flush IV line before and
after administration of
bolus with NS

Serum methotrexate concentrations,
CBC with differential, bilirubin, ALT,
AST, serum creatinine, signs and
symptoms of methotrexate toxicity
Glycopyrrolate2

Level 1
200 mcg/mL May be given undiluted 200 mcg/min into a running IV
line

Central, midline, or
peripheral

Apical pulse; may cause urinary
retention
Granisetron2

Level 1

See Chemotherapy-
Induced Nausea and
Vomiting in Adults
1mg/mL May be diluted with 50
mL D5W or NS for
infusion

Undiluted over 30 seconds
Diluted over 5-60 minutes
Central, midline, or
peripheral

EKG changes including QT
prolongation


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47

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Haloperidol Lactate2

Level 1

Haloperidol decanoate is
not for IV use.

Adult Pain, Agitation
and Delirium ICU
Guideline
5 mg/mL Dilute in D5W, usual
concentration: 1
mg/mL

Over 30 minutes. Max rate 5
mg/ minute
Central, midline, or
peripheral

Blood pressure; risk of torsades de
pointes and QT prolongation;
respiratory depression

Heparin2
HIGH ALERT
MEDICATION
(flushes < 500 units
exempt)

Level 1

See Heparin Guideline
1000 units/mL;
5000 units/mL
Dilute in D5W or NS

UWHC standard
concentration: 25,000
units/500 mL


Bolus dose: 5000 units (1
mL)/min

Gradual infusion rate: 12
units/kg/hr

Rapid infusion rate: 18
units/kg/hr

Central, midline, or
peripheral


anti-Xa, signs and symptoms of
bleeding, platelets (at baseline, 24
hours after initiation and then every
48 hours for 14 days or until
discontinued)
Hepatitis B Immune
Globulin2

Level 1
5 mL vial

> 312
Units/mL of
anti-hepatitis B
Dilute in 250 mL NS

2 mL/min. Slow infusion rate to
1 mL/min or less for infusion
reactions
Central, midline, or
peripheral
Hypersensitivity reactions, infusion
reactions
Hetastarch2

Level 1
6%, in 500 mL
NS
No further dilution
required

Up to 20 mL/kg/hr; may adjust
per patient response
Central, midline, or
peripheral
Hypersensitivity reactions (including
anaphylaxis), vomiting, chills, blood
pressure, urine output
HydrALAZINE2

Level 1
20 mg/mL Not recommended


5 mg/minute Central, midline, or
peripheral
Blood pressure every 5 minutes until
stabilized to goal parameters
Hydrocortisone
Sodium Succinate2

Level 1
50 mg/mL after
reconstitution
Dilute in D5W or NS to
a maximum
concentration: 1
mg/mL

500 mg or fraction thereof over
30 seconds

Give at convenient rate for
continuous infusion
Central, midline, or
peripheral

Blood pressure
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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48

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
HYDROmorphone2
HIGH ALERT
MEDICATION

Level 1

Adult Pain, Agitation
and Delirium ICU
Guideline
1 or 2 mg/mL Dilute in D5W or NS,
usual concentration:
1mg/mL


Intermittent dose: over at least
2 minutes

Continuous infusion: titrate to
response
Central, midline, or
peripheral
Respiratory rate/ depth, sedation
level, vital signs
Hydroxocobalamin2

Level 4
5 g vial; 25
mg/mL after
reconstitution
Dilute with provided
200 mL of NS diluent
provided

Do not shake when
diluting; invert or rock
vial for at least 30
minutes.
Over 15 minutes. If second
dose necessary infuse over 15
minutes to 2 hours.
Central, midline, or
peripheral

Blood pressure, signs and
symptoms of hypersensitivity
reactions, seizures

Ibandronate2

Level 1
3 mg/3 mL
syringe
Not recommended


Over 15 seconds Central, midline, or
peripheral

Use supplied needle
Confirm patency of vein
Serum calcium, magnesium,
phosphate and creatinine; may
cause influenza-like side effects
(chills, fever, fatigue, muscle pain)
Ibutilide2

Level 4


0.1 mg/mL May dilute in 50 mL
D5W or NS
Over 10 minutes Central, midline, or
peripheral

Blood pressure, heart rate,
continuous ECG, watch for QT
prolongation
Idarubicin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
1 mg/mL Not recommended


Over 10 - 30 minutes in a
freely running IV line of NS or
D5W
Central, midline, or
peripheral

CBC; risk of extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline

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49

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Idarucizumab2

Level 1

See Procoagulant
guideline


2.5 g/50 mL No further dilution
required
Over 5-10 minutes for each
2.5g dose

Max of 15 minutes between
each 2.5g dose
Central, midline or
peripheral

Flush pre-existing IV line
with NS prior to
administration

Requires dedicated IV
line
Signs of bleeding or thromboembolic
events
Ifosfamide2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg/mL after
reconstitution
Dilute to concentration
of 0.6 - 20 mg/mL

Dose < 5 mg dilute in
250 mL NS

Dose 5 - 10 g dilute in
500 mL NS

Dose > 10 g dilute in
1000 mL NS
Over at least 30 minutes Central, midline, or
peripheral

Administer with mesna

Urinalysis, CBC, irritant at
concentrations > 50 mg/mL, risk of
extravasation.
Signs of neurotoxicity

Irritant: See Chemotherapy
Extravasation Guideline

Immune Globulin
(IVIG)2

Level 1

See IV Immune
Globulin Guideline
20 g/200 mL
(Gammagard
Liquid)

5 g or 10 g
vials
(Gammagard
S/D); 50 - 100
mg/mL after
reconstitution
No further dilution
required


See IV Immune Globulin
Guideline for infusion
recommendations
Central, midline, or
peripheral

Gammagard Liquid
requires no filter

Gammagard S/D
requires 15 micron filter


Anaphylaxis, blood pressure,
temperature, fever, chills, infusion
site discomfort, vital signs,
Premedication may be necessary to
prevent infusion-related reactions.

Risk of thrombophlebitis – use large
vein when giving peripherally. See
Non-Chemotherapeutic
Extravasation Guideline

Indigotindisulfonate
Sodium (Indigo
Carmine)2,4

Level 1
8 mg/mL No information


Rapid injection; rate not
available
Central, midline, or
peripheral
Heart rate – may cause bradycardia
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50

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Infliximab OR
Infliximab dyyb2
HIGH ALERT
MEDICATION

Level 1



100 mg vial; 10
mg/mL after
reconstitution


Dilute to final volume
of 250 mL with NS to a
concentration of 0.4 - 4
mg/ mL


Over at least 2 hours
See Appendix B for
recommended infusion rate
titration schedule7

Central, midline, or
peripheral

Administer with 0.22
micron filter

Premedication with
diphenhydramine,
acetaminophen and/or
corticosteroids may be
considered to prevent
infusion reactions

Blood pressure, pulse, and
respiratory rate prior to infusion and
every 30 minutes during infusion.

If infusion reaction occurs, stop
infusion, notify MD medicate with
diphenhydramine and/or
dexamethasone. If able to resume
infusion, restart at 10 mL/hr.

Insulin, Regular2
HIGH ALERT
MEDICATION

Level 1


100 units/mL
500 units/mL
UWHC standard
concentration is 100
units/100 mL NS

Continuous infusion:
Standard dose algorithm
HIGH dose algorithm

IV push: over seconds for
hyperkalemia
Central, midline, or
peripheral

If giving IV push for
hyperkalemia,
recommend co-
administration of
dextrose
Frequent blood glucose
concentrations, electrolytes
Interferon Alpha – 2B,
Recombinant2

(CHEMO)


50 million
units/mL
Dilute in 100 mL NS;
final concentration
should be ≥ 10 million
units/100 mL


Over 20 minutes Central, midline, or
peripheral

May pre-medicate with
acetaminophen
Frequent blood pressure; will cause
influenza-like symptoms (fever,
headache), CBC
Iodipamide2

Level 1
520 mg/mL, 20
mL vials
No further dilution
required
Over 10 minutes. Slow
infusion if nausea or flushing
occurs.
Central, midline, or
peripheral

Anaphylaxis, nausea, flushing
Ipilimumab2

(CHEMO)

Level 1


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, midline, or
peripheral

Administer with 0.22
micron filter
Electrolytes, LFTs, TSH prior to
each dose
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51

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Irinotecan2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
100 mg vial; 20
mg/mL after
reconstitution
Dilute to a
concentration of 0.12 -
2.8 mg/mL

Dose < 750 mg dilute
in 250 mL D5W

Dose > 750 mg dilute
in 500 mL D5W

Over 90 minutes Central, midline, or
peripheral
Vital signs, risk of thrombophlebitis
extravasation; CBC, diarrhea.

Irritant: See Chemotherapy
Extravasation Guideline


Irinotecan Liposomal2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
43 mg/10 mL Dilute in 500 mL NS Over 90 minutes Central, midline, or
peripheral
Hypersensitivity reactions
Iron Dextran2

Level 1


50 mg/mL Dilute in 250 - 1000 mL
NS


Test dose: 25 mg over 1
minute – if tolerated increase
to 50 mg/min. May give over
1-8 hours.
Central, midline, or
peripheral large vein
Vital signs, anaphylaxis.

Risk of thrombophlebitis – use a
large vein for peripheral
administration. See Non-
Chemotherapeutic Extravasation
Guideline


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52

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Iron Sucrose2,4,8

Level 1


20 mg/mL Dilute in 100 - 250 mL
NS


Undiltued dose of ≤ 200 mg
over 2-5 minutes

Diluted doses:
Dose
(mg)
Volume
(mL)
Infusion
Duration
100-200 100 At least
15
minutes
300 250 1.5
hours
400 250 2.5
hours
500 250 3 hours


Central, midline, or
peripheral
Vital signs prior to infusion and
when experiencing adverse events

Isavuconazole2,4

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
Infuse through a
dedicated line with a 0.2
micron inline filter

Central, midline, or
peripheral line.
Hypersensitivity reactions with initial
doses

Infusion-related reactions
(hypotension, dyspnea, dizziness,
paresthesias, hypoesthesia)
Isoproterenol2
HIGH ALERT
MEDICATION

Level 4
200 mcg/mL UWHC standard
concentration: 1
mg/250 mL


Continuous infusion: 2 - 20
mcg/min - titrate for response

Central, midline, or
peripheral
Continuous blood pressure and
continuous ECG monitoring, central
venous pressure readings
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53

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Ixabepilone2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
15 mg, 45 mg
vial; 2 mg/mL
after
reconstitution
Dilute to a
concentration of 0.2 -
0.6 mg/mL

Dose 20 - 39 mg: dilute
in 100 mL LR

Dose 40 - 119 mg:
dilute in 200 mL LR

Dose ≥ 120 mg: dilute
in 500 mL LR
Over 3 hours


Central, midline, or
peripheral

Must use non-PVC bag
and administer through
non-pyrogenic, low-
protein binding 0.2 - 1.2
micron filter

Premedicate 1 hour
before each infusion with
H1 and H2 antagonist.
For patients with
previous hypersensitivity
reactions premedicate
with a corticosteroid.

CBC; symptoms of peripheral
neuropathy

Irritant: See Chemotherapy
Extravasation Guideline

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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54

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
KetAMINE2,4
HIGH ALERT
MEDICATION

Level 1 for continuous
infusion analgesia, IV
push, or intermittent
infusion for treatment of
depression

Level 3 for standard
concentration
(100mg/50mL)
continuous infusion
sedation

Level 3 TAC for
standard concentration

Level 4 for concentrated
infusion (1000mg/20mL)
continuous infusion for
status epilepticus or
sedation

Policy 31.1 Ketamine
in the ED
50 mg/mL or
100 mg/mL
vials

Dilute in D5W or NS to
concentration of 1 - 2
mg/mL


Bolus dose over 1-2 minutes

Continuous infusion:
Analgesia: 0.1 – 0.3 mg/kg/hr

Anesthesia, maintenance: 0.01
-0.03 mg/kg/min
Central, midline, or
peripheral


pain rating, sedation level,
respiratory rate

For other uses: continuous ECG,
vital signs, sedation level

KetOROLAC2

Level 1
15 mg/mL, 30
mg/mL
No dilution necessary


Over at least 15 seconds Central, midline, or
peripheral

For short term pain
management only; no
more than 5 days
Vital signs


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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55

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Labetalol2
HIGH ALERT
MEDICATION
(continuous infusion)

Level 1 IV push

Level 4 infusion

Vasoactive
Continuous Infusion
Guideline
5 mg/mL Dilute in D5W or NS,
usual concentration: 5
mg/mL


Intermittent dose: 10 mg/min

Continuous infusion: 2 mg/min
- titrate to blood pressure
Central, midline, or
peripheral
Blood pressure before and 5 and 10
minutes after each injection, or every
5 minutes during infusion,
respiratory rate/ depth; HR;
continuous ECG with infusion
Lacosamide2

Level 1
200 mg/20 mL May be administered
without further dilution
or mixed with 100mL
NS, LR, D5W
Over 15 – 60 minutes Central, midline, or
peripheral
ECG prior to initiating therapy and at
steady state maintenance dose:
bradycardia, AV block
Laronidase2

Level 1
2.9 gm/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: initiate at 2 mL/hour
and double rate every 15
minutes not exceed 32
mL/hour;
> 20 kg: initiate at 5 mL/hour
and double rate every 15
minutes not to exceed 80
mL/hour
Central, midline, or
peripheral

Requires dedicated line
and 0.2 micron filter

Hypersensitivity: monitor vital signs
every 15 minutes
Leucovorin Calcium2

Level 1

10 mg/mL Dilute in 100 - 500 mL
D5W or NS



Over 10-120 minutes, not to
exceed 160 mg/min
Central, midline, or
peripheral
For methotrexate rescue:
Methotrexate concentrations, renal
function
Levetiracetam2

Level 1

100 mg/mL Dilute in 100 mL D5W
or NS


Over 15 minutes Central, midline, or
peripheral
Neurological status (dizziness and
somnolence); vital signs
Levocarnitine2

Level 1

200 mg/mL Dilute in NS or LR to
concentration 0.5 - 8
mg/mL

Over 2 - 3 minutes or infuse at
convenient rate
Central, midline, or
peripheral
Vital signs
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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56

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Levofloxacin2

Level 1
250 mg/50 mL
500 mg/100
mL
750 mg/150
mL
No further dilution ≤ 500 mg over 60 min
>500 mg over 90 min
Central, midline, or
peripheral

Hydration status, blood pressure
(rapid infusion can cause
hypotension)
Levothyroxine2

Level 1
100 mcg/mL
after
reconstitution
UWHC standard
concentration for organ
procurement: 200
mcg/500 mL
Over 1 minute Central, midline, or
peripheral

Observe patient continuously, vital
signs
Lidocaine2
HIGH ALERT
MEDICATION (when
administered as
epinephrine w/ lidocaine
or continuous
subcutaneous and IV
infusion)

Policy 10.18AP –
Parenteral
(Intravenous or
Subcutaneous)
Lidocaine for
Neuropathic Pain
(Adult & Pediatric)

Level 1 for continuous
infusion for pain

Level 3 for cardiac
indications
20 mg/mL or
2 g/500 mL
Dilute in D5W;

UWHC standard
concentration for IV
infusion: 2 g/500 mL;

For subcutaneous
infusion 4 g/100 mL



Bolus dose prior to infusion: 25
- 50 mg/min

Continuous infusion: 1 - 4
mg/min

Intermittent Analgesia Dose:
over 30 min
Central, midline, or
peripheral
Continuous ECG when used for
arrhythmias;; neurological status
(dizziness, blurred vision, confusion,
anxiety, seizures, etc); perioral
numbness, serum lidocaine
concentrations
Linezolid2

Level 1


600 mg/300
mL
No further dilution Over 30 - 120 minutes Central, midline, or
peripheral

CBC weekly in patients longer than
2 weeks
Liothyronine2

Level 1
10 mcg/mL Not recommended Over 1 minute Central, midline, or
peripheral
Arrhythmia, tachycardia
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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57

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Lorazepam2
HIGH ALERT
MEDICATION –
continuous infusion

Level 1-push, palliative
care

Level 3- infusion for
sedation or alcohol
withdrawal

Level 3 TAC
2 mg/mL or 4
mg/mL
Dilute in D5W, or NS




2 mg/min

Continuous infusion: titrate for
sedation; usual 1 - 3 mg/hr
Central, midline, or
peripheral large vein

Use low sorption tubing
set
Respiratory rate/ depth, blood
pressure, sedation level. If used for
conscious sedation, see Hospital
Administrative Policy 8.38 for
monitoring requirements. Risk for
extravasation and thrombophlebitis –
use large vein if given peripherally
and confirm patency of vein. See
Non-Chemotherapeutic
Extravasation Guideline



Magnesium Sulfate2

Level 1

See Concentrated
Electrolyte Guideline


8 mEq/1 g/2
mL
Dilute in D5W or NS to
≤ 20% for infusion

Standard UWHC
concentrations: 1 g/50
mL, 2 g/100 mL,


Supplementation: Max rate:
0.5 - 1 g/hr. May give faster
for severely low cocentrations.

Severely low magnesium
(Mg<1 mg/dL) with symptoms:
may give 1-2 g over 10
minutes

Severe asthma exacerbation: 2
g over 20 minutes

Torsades de pointes: 2 g over
15 minutes
Central, midline, or
peripheral
Blood pressure, cardiac status.


Mannitol2

Level 1


250 mg/mL vial
(25%); 20%
500 mL bag
Do not dilute. Bolus dose for ICP treatment
over 20 - 60 minutes
Central, midline, or
peripheral

Use 0.22 micron filter
with administration;
observe solution for
crystals
renal function urine output,
electrolytes, serum osmolarity

Risk of extravasation and tissue
damage. See Non-
Chemotherapeutic Extravasation
Guideline


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

58

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Mechlorethamine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 mg vial; 1
mg/mL after
reconstitution
No information
available
Over 3 minutes into freely
running IV line
Central, midline, or
peripheral

Recommend
premedication with
antiemetics
CBC; risk of extravasation. \
Vesicant: See Chemotherapy
Extravasation Guideline



Melphalan2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg vial; 5
mg/mL after
reconstitution
with provided
diluent
Dilute in NS

Doses ≤ 112mg dilute
in 250 mL NS

Doses > 112mg dilute
in 500 mL NS


Over 30 to 60 minutes Central line
recommended; midline
infusion acceptable when
diluted

When undiluted must be
administered via central
line.
CBC; serum creatinine;
hypersensitivity reaction. Risk of
extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline

Meperidine2

Level 1

See Meperidine
Guideline
25 - 100
mg/mL
No further dilution
required.



Over 4 minutes Central, midline, or
peripheral
Blood pressure, vital signs,
respiratory rate/ depth, sedation
level.


Meropenem2

Level 1

See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
500 mg and 1
g vials; 50
mg/mL after
reconstitution
Dilute in D5W or NS
concentration 2.5 - 10
mg/mL
Over 15-30 minutes, Max rate:
over 3-5 minutes.

Extended infusion: Over 3
hours
Central, midline, or
peripheral

Signs and symptoms of CNS
reactions; serum creatinine, infusion
site for inflammation, may cause
thrombophlebitis. See Non-
Chemotherapeutic Extravasation
Guideline


Mesna2

Level 1
100 mg/mL Dilute in D5W or NS to
concentration of 20
mg/mL
Over 30 minutes or 1000 mL
over 24 hours
Central, midline, or
peripheral
Urine output, hydration status,
hypersensitivity reactions
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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59

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Methadone2
HIGH ALERT
MEDICATION –

Level 1
10 mg/mL No further dilution
required


Over at least 5 minutes Central, midline, or
peripheral
Vital signs, respiratory status


Methohexital2
HIGH ALERT
MEDICATION

Level 4
500 mg vial

Dilute in D5W or NS to
maximum
concentration of 10
mg/mL
2 mg/second


Central, midline, or
peripheral
Respiratory rate; BP; EKG, sedation
score


Methotrexate2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
25 mg/mL Doses 100 - 500 mg
dilute with 250 mL
D5W

Dose 500 - 1000 mg
dilute with 500 mL
D5W

Dose > 1000 mg dilute
with 1000 mL D5W

Recommended max
final concentration is 2
mg/mL
Rate determined by protocol
(over 30 minutes - 4 hours) or
continuous over 24 hours
Central, midline, or
peripheral
Close patient observation for toxicity
– CBC, platelets, skin reactions
should be monitored, methotrexate
concentrations in specific
populations, SCr
Methylene Blue2

Level 1
10 mg/mL No further dilution
required
Infuse over 1-2 minutes Central, midline, or
peripheral

Methemoglobin concentrations, CBC
Methylergonovine2

Level 2
200 mcg/mL Dilute in 5 mL NS


Infuse over ≥ 1 minute Central, midline, or
peripheral
Blood pressure, heart rate, CNS
status

Methylprednisolone
Sodium Succinate2

Level 1

Methylprednisolone
acetate should not be
given IV
10 mg/mL May give undiluted or
dilute in D5W



125 mg 3- 15 min
250 -499 mg 15-30 min
500 -999 mg ≥ 30 min
≥ 1000 mg ≥ 60 min

Central, midline, or
peripheral
Blood pressure, electrolytes, blood
glucose
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60

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Metoclopramide2

Level 1
5 mg/mL Dilute doses over 10
mg in 50 mL D5W or
NS

10 mg 1-2 minutes

> 10 mg over ≥ 15 min

Central, midline, or
peripheral
Vital signs, extrapyramidal effects,
agitation, confusion
Metoprolol2

Level 2
1 mg/mL May give undiluted or
dilute in 50 mL NS


Max rate: 5 mg over 1 minute

May give over 30 – 60 minutes
Central, midline, or
peripheral
Continuous ECG, heart rate and
blood pressure
Metronidazole2

Level 1
500 mg/100
mL
No further dilution

Over 30-60 minutes Central, midline, or
peripheral
Risk of thrombophlebitis– rotate IV
sites often if given peripherally. See
Non-Chemotherapeutic
Extravasation Guideline

Micafungin2

Level 1


50 mg, 100 mg
vial; 10-20
mg/mL after
reconstitution
Dilute in 100 mL NS
(preferred) or D5W


Over 60 minutes Central, midline, or
peripheral; central if
concentration >1.5
mg/mL

Flush IV line before and
after infusion with normal
saline
Facial swelling, rash, vasodilation
may result with too rapid infusion


Midazolam2
HIGH ALERT
MEDICATION -
continuous infusion

Level 1- injection,
palliative care patient on
F4/4 or B6/6 -
continuous infusion

Level 4 - continuous
infusion plus F4/4 IMC,
D6/5 IMC

Adult Pain, Agitation
and Delirium ICU
Guideline

1 mg/mL or 5
mg/mL
Dilute in D5W or NS

UWHC standard
concentrations: 100
mg/mL or 250 mg/250
mL


Bolus dose: 1 mg/2 min

Continuous infusion: 1 - 7
mg/hr (up to 15 mg/hr)
Central, midline, or
peripheral

Use large vein if given
peripherally and confirm
patency of vein.
Blood pressure, respiratory rate/
depth. If used for conscious
sedation, see Hospital
Administration Policy 8.38 for
monitoring requirements.

Risk of extravasation and
thrombophlebitis –See Non-
Chemotherapeutic Extravasation
Guideline

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
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61

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Milrinone2
HIGH ALERT
MEDICATION

Level 4 plus B4/5 IMC,
D4/5 IMC, D6/5 IMC,
F4/5 IMC

Level 4 TAC

Vasoactive
Continuous Infusion
Guideline
1 mg/mL UWHC standard
concentrations: 20
mg/100 mL and 40
mg/100 mL


Loading dose of 50 mcg/kg
over 10 minutes

Continuous infusion: 0.375 -
0.75 mcg/kg/min
Central, midline, or
peripheral large vein
Continuous ECG, blood pressure,
urine output, risk of thrombophlebitis
– use large vein if given peripherally.
See Non-Chemotherapeutic
Extravasation Guideline

Minocycline2

Level 1
100 mg vial Dilute in 100 to 1000
mL of NS, D5W,
D5NS, or 250 mL to
1000 mL of LR
Infuse over 60 minutes; avoid
rapid administration
Central, midline, or
peripheral
Prolonged intravenous therapy may
be associated with thrombophlebitis
Mitomycin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
5 mg and 20
mg vials; 500
mcg/mL after
reconstitution
No information Over at least 5 minutes via a
freely-running saline infusion
Central, midline, or
peripheral

CBC, risk of extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline

Mitoxantrone2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
2 mg/mL Diluted to 25 mL in
syringe with NS


Dose over at least 3 minutes
in a freely running IV infusion
Central, midline, or
peripheral
ECG, CBC, risk of extravasation

Irritant: See Chemotherapy
Extravasation Guideline

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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62

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
MORPHine2
HIGH ALERT
MEDICATION

Level 1

Adult Pain, Agitation
and Delirium ICU
Guideline

2 - 10 mg/mL Dilute in D5W or NS

UWHC standard
concentration 1 mg/mL


Intermittent dose over 4-5
minutes

Continuous infusion at desired
rate-titrate to response
Central, midline, or
peripheral large vein
Respiratory rate/ depth, sedation
level, vital signs If used for
conscious sedation, see Hospital
Administrative Policy 8.38 for
monitoring requirements.

Risk of thrombophlebitis – use large
vein if given peripherally. See Non-
Chemotherapeutic Extravasation
Guideline


Moxifloxacin2

Level 1
400 mg/250
mL
No further dilution


Over 60 minutes Central, midline, or
peripheral
Allergic reaction (including
anaphylaxis, rash, and hypotension);
QT prolongation

Risk of thrombophlebitis – use large
vein if given peripherally. See Non-
Chemotherapeutic Extravasation
Guideline

Multivitamin2

Level 1
10 mL Dilute in D5W or NS


Over 30 minutes Central, midline, or
peripheral
Vital signs, anaphylaxis
Mycophenolate
mofetil2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
500 mg vial 500 mg/120 mL D5W

1000 mg/135 mL D5W


Over minimum of 2 hours Central, midline, or
peripheral large vein

Do not administer as
bolus or rapid infusion.

Blood pressure, CBC

Risk of thrombophlebitis – use large
vein if given peripherally. See Non-
Chemotherapeutic Extravasation
Guideline

Nalbuphine2,4

Level 1
10 mg/mL or
20 mg/mL
No further dilution Up to 10 mg over 3 minutes Central, midline, or
peripheral

Vital signs, respiratory rate, pain
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63

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Naloxone2
HIGH ALERT
MEDICATION -
continuous infusion

Level 1 – IV push

Level 3 – continuous
infusion

Level 3 TAC

400 mcg/mL,
or 1 mg/mL
Standard UWHC
concentrations: 2.5
mg/250 mL or 20
mg/250 mL



Opioid side effect:
Intermittent dose: Up to 400
mcg over 30 secondsInfusion:
Titrate rate to patient
response; usual 0.5 - 1 mg/hr

Spinal cord ischemia
prophylaxis (TAA): 1 mcg/kg/hr
x 48 hr
Central, midline, or
peripheral
Respiratory rate/ depth, blood
pressure, opioid withdrawal
symptoms
Natalizumab2
HIGH ALERT
MEDICATION

Level 1


20 mg/mL Dilute 300 mg in 100
mL NS
Over 1 hour Central, midline, or
peripheral

Hypersensitivity reactions during and
for 1 hour following infusion; CBC



Nelarabine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
5 mg/mL No further dilution
necessary
Over 2 hours Central, midline, or
peripheral

CBC, serum creatinine, tumor lysis
syndrome
Neostigmine2

Level 2

See Neostigmine
Guideline for
contraindications and
precautions
1 mg/mL No information 2 mg at rate up to 500 mcg/min Central, midline, or
peripheral
Respiratory rate/ depth and blood
pressure every 15 minutes x 2

Bedside telemetry required to
monitor for bradycardia or asystole

MD and RN presence required at
bedside for at least 30 minutes after
administration
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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64

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Nesiritide2
HIGH ALERT
MEDICATION

Level 4 plus B4/5 IMC,
D4/5 IMC, F4/5 IMC

Not in TAC ICU
1.5 mg vial Standard UWHC
concentration: 1.5
mg/250 mL



Bolus dose over 60 seconds

Continuous infusion: 0.01 -
0.03 mcg/kg/min
Central, midline, or
peripheral

Prime IV tubing with 5
mL of dilute nesiritide
before administering
loading dose
Blood pressure, continuous ECG.


Nicardipine2
HIGH ALERT
MEDICATION

Level 3

Vasoactive
Continuous Infusion
Guideline
2.5 mg/mL Dilute in D5W or NS

UWHC standard
concentrations: 50
mg/250 mL, 50 mg/100
mL
Initiate at 5 mg/ hr, may
increase every 5 minutes;
maximum: 15 mg/hr
Central, midline, or
peripheral; Central line
only if concentration
0.5mg/mL

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

Risk of phlebitis - See Non-
Chemotherapeutic Extravasation
Guideline


Nitroglycerin2
HIGH ALERT
MEDICATION

Level 3

Level 3 TAC

Vasoactive
Continuous Infusion
Guideline
5 mg/mL
50 mg/250 mL
bottle
Dilute in D5W or NS

Standard UWHC
concentrations: 50
mg/250 mL, 200
mg/500 mL and 400
mg/500 mL

Initial: 5 mcg/minute – titrate by
0.2 – 0.5 mcg/kg/min to
response (0.5 - 3 mcg/kg/min).


Central, midline, or
peripheral
Blood pressure, heart rate, central
venous pressure, respiratory rate/
depth, pulmonary wedge pressure
recommended (if swan in place).

Risk of thrombophlebitis – change
infusion site every 12 hours if given
peripherally

Nitroprusside2 -
thiosulfate
HIGH ALERT
MEDICATION

Level 4

Vasoactive
Continuous Infusion
Guideline
25 mg/mL Standard UWHC
concentrations: 50
mg/250 mL, 100
mg/250 mL; 200
mg/250 mL
Initial 0.25-0.3 mcg/kg/min,
titrate by 0.25 – 0.5
mcg/kg/min to patient
response (usual range: 0.3 -
10 mcg/kg/min)
Central, midline, or
peripheral

Confirm patency of vein if
given peripherally

Protect from light
Continuous blood pressure, cyanide
concentrations (for long-term
therapy)

Risk for extravasation. See Non-
Chemotherapeutic Extravasation
Guideline


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
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65

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Nivolumab2

(CHEMO)


40mg/ 4mL &
100mg/ 10mL
solution in
single dose vial
Dilute in D5W or NS

Final concentration of
1 -10 mg/mL
Infuse over 60 minutes Central, midline, or
peripheral

Low protein binding 0.2 –
1.2 micron in-line filter.

Rash, fatigue, dyspnea
Norepinephrine2
HIGH ALERT
MEDICATION

Level 4

Vasoactive
Continuous Infusion
Guideline

1 mg/mL Dilute in D5W

Standard UWHC
concentrations: 4
mg/250 mL; 8 mg/250
mL; 16 mg/250 mL

Initial: 0.01 mcg/kg/min;

Titrate by 0.01 – 0.05
mcg/kg/min every 5 minutes to
target blood pressure
Central line preferred,
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks
Blood pressure every 2 minutes until
stabilized, then every 5 minutes,
continuous ECG

Risk of ischemic necrosis with
extravasation. See Non-
Chemotherapeutic Extravasation
Guideline

Obinutuzumab2

(CHEMO)


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-consult
protocol for initial rate)

Subsequent: may increase to
400 mg/hr if no infusion
reactions noted (disease state
dependent-consult protocol for
titration instructions)

Do not administer IV push or
bolus
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
Signs of infection

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66

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Ocrelizumab
HIGH ALERT
MEDICATION

Level 1
300 mg/10 mL
vial
Dilute 300mg dose in
250mL NS

Dilute 600mg dose in
500mL NS
First 2 infusions (300mg dose):
Begin infusion at 30 mL/hour;
increase by 30 mL/hour every
30 minutes to a maximum rate
of 180 mL/hour. Infusion
duration is 2.5 hours or longer.

Subsequent infusions (600 mg
dose): Begin infusion at 40
mL/hour; increase by 40
mL/hour every 30 minutes to a
maximum rate of 200 mL/hour.
Infusion duration is 3.5 hours
or longer.

For infusion reactions: contact
pharmacist for dosing
instructions on how or if
infusion should be retitrated
Central, midline, or
peripheral

Administer though a
dedicated IV line using a
0.2 or 0.22 micron in-line
filter

Premedicate with
methylprednisolone (100
mg IV) 30 minutes prior
to each infusion, and an
antihistamine 30 to 60
minutes prior each
infusion; may also
consider acetaminophen
Monitor for hypersensitivity reactions
during and for at least 1 hour after
infusion is completed
Octreotide2

Level 1

100 mcg/mL,
1000 mcg/mL
Dilute in D5W or NS

Standard UWHC
concentration: 500
mcg/250 mL
Intermittent dose: max rate
over 3 minutes

Continuous infusion: 25 - 50
mcg/hr
Central, midline, or
peripheral
Hypotension
Ondansetron2

Level 1

See Postoperative
Nausea and Vomiting
in Adult

See Chemotherapy-
Induced Nausea and
Vomiting in Adults
2 mg/mL Dilute in 50 mL D5W or
NS for intermittent
infusion; may be
diluted in larger
amounts for
continuous infusion
May give undiluted over 2 – 5
minutes

Diluted over 15 - 30 minutes

Central, midline, or
peripheral

May cause orthostatic hypotension;
transient EKG changes
Oxacillin2

Level 1
1 g, 2, 10 g
vials
Dilute in NS to 10 to
100 mg/mL


Over 30 minutes

Continuous infusion over 24
hours
Central, midline, or
peripheral
Anaphylaxis, rapid infusion may
result in seizures
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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67

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Oxaliplatin2,9

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
50 mg or 100
mg vial; 5
mg/mL or 2
mg/mL after
reconstitution,
respectively
Dilute in 250mL D5W

DO NOT DILUTE
WITH NS or any
chloride containing
diluent

Infuse at a rate of 1 mg/m2/min Central, midline or
peripheral
Hypersensitivity reactions (including
anaphylaxis, rash, bronchospasm),
risk of extravasation. –
Irritant: See Chemotherapy
Extravasation Guideline
DO NOT APPLY COLD

Oxytocin2

Level 2

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 units/mL Dilution required: 500
- 1000 mL D5W, NS or
LR

Standard UWHC
Concentration: 30
units/ 500 mL
Adjust as necessary; usual
0.001 - 0.002 units/minute
Central, midline, or
peripheral
Blood pressure at least every 15
minutes, continuous observation of
patient
PACLItaxel2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
6 mg/mL Dilute in D5W, final
concentration: 0.3 -1.2
mg/mL

Dose 30 - 79 mg dilute
in 100 mL D5W

Dose 80 - 174 mg
dilute in 250 mL D5W

Doe 175 - 600 mg
dilute in 500 mL D5W
Over 1 - 24 hours Central, midline, or
peripheral

Use non-PVC equipment
and 0.22 micron filter

Premedicate with
dexamethasone,
diphenhydramine, and
ranitidine to prevent
hypersensitivity reactions
Cardiac status, anaphylaxis, risk of
extravasation.\
Irritant: See Chemotherapy
Extravasation Guideline

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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68

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
PACLItaxel protein-
bound2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
100 mg vial; 5
mg/mL NS
after
reconstitution
Not recommended
after reconstitution
Over 30 minutes Central, midline, or
peripheral
Infusion reactions, vein irritation

Irritant: See Chemotherapy
Extravasation Guideline

Pamidronate2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
30 mg vial; 3
mg/mL after
reconstitution
Dilute in 250 - 1000 mL
D5W or NS


Over a minimum of 2 hours Central, midline, or
peripheral

Pre-hydration required.

Slow infusion reduces
the risk of adverse
effects

Vein irritation, thrombophlebitis.


Pancuronium2
HIGH ALERT
MEDICATION

Level 4

See Neuromuscular
Blocker Guideline
1 mg/mL May dilute in D5W or
NS
Intermittent dose over 1 minute Central, midline, or
peripheral

Patient must be
intubated. Ensure patient
is adequately sedated
prior to administration of
a neuromuscular blocker.
Blood pressure, cardiac status,
respiratory rate/ depth, use
neuromuscular blockade monitor
Panitumumab2

(CHEMO)


100 mg/5 mL,
400 mg/20 mL
Doses ≤ 1000 mg:
dilute in 100 mL NS

Doses > 1000 mg:
dilute in 150 mL NS
Doses ≤ 1000 mg: over 1 hour

Doses > 1000 mg: over 90
minutes
Central, midline, or
peripheral

Administer through a low
protein-binding 0.2 or
0.22 micron in-line filter
Infusion reactions, vital signs and
temperature before, during, and after
infusion, GI upset, severe skin
reactions, peripheral edema,
electrolytes (including Mg and Ca)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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69

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Pantoprazole2

Level 1



40 mg vial; 4
mg/mL after
reconstitution
Intermittent: Dilute
doses of ≤ 40 mg in 50
mL D5W or NS; dilute
does of >40 mg in 100
mL D5W or NS

Continuous
Standard UWHC
concentration: 80
mg/250 mL
Max rate: over 2 minutes

Intermittent: over 15 minutes

Continuous infusion: 8 mg/hr
Central, midline, or
peripheral large vein

Vital signs, anaphylaxis

Risk for thrombophlebitis – evaluate
for pain at injection site, rotate
peripheral IV sites often and use
large vein. See Non-
Chemotherapeutic Extravasation
Guideline



Papaverine2

Level 1
30 mg/mL No dilution necessary Administer over at least 2
minutes

Rapid IV injection can cause
death
Central, midline, or
peripheral

Allergic reaction (pruritus, rash),
blood pressure, heart rate


Paricalcitol2

Level 1
2 mcg/mL No dilution necessary 5 mcg over 15 seconds; give
as bolus during dialysis
Central, midline, or
peripheral

Serum calcium and phosphate
Pegaspargase2

(CHEMO)
750 IU/mL Dilute in 100 mL NS or
D5W


Over at least 1 hour Central, midline, or
peripheral


Anaphylaxis, vital signs, CBC, blood
glucose, signs and symptoms of
bleeding, hepatotoxicity,
Pegloticase2

Level 1
8 mg/mL Dilute in 250 mL NS or
0.45% NaCl
Over 2 hours Central, midline, or
peripheral

Premedicate with
antihistamines and
corticosteroids
Anaphylaxis, uric acid
concentrations, exacerbation of
heart failure

If infusion reactions occur, stop or
slow rate of infusion.

Monitory for 1 hour after the end of
the infusion
Pembrolizumab2

(CHEMO)


25 mg/mL Dilute in NS or D5W to
a final concentration of
1 – 10 mg/mL
Over 30 minutes Central, midline, or
peripheral

Use 0.22 micron filter
Hypersensitivity or infusion reactions
LFTs, SCr and thyroid function
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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70

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Pemetrexed2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital 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 Central, midline, or
peripheral

Pre-treat with folic acid
and vitamin B12 and
adequate hydration and a
corticosteroid

CBC, serum creatinine
Penicillin G Potassium
Penicillin G Sodium2

Level 1
500,000 units/
mL after
reconstitution
Dilute in 100 mL D5W
or NS


Over a minimum of 20 minutes Central, midline, or
peripheral large vein
Hypersensitivity reactions, vein
irritation, risk for thrombophlebitis –
evaluate for pain at injection site,
rotate peripheral IV sites often and
use large vein. See Non-
Chemotherapeutic Extravasation
Guideline


Pentamidine2

Level 1


300 mg vial Dilute in 50 - 250 mL
D5W


Over 60 -120 minutes Central, midline, or
peripheral large vein

Administer in the supine
position
Continuous blood pressure, risk for
thrombophlebitis – use large vein if
given peripherally. See Non-
Chemotherapeutic Extravasation
Guideline



Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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71

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Pentobarbital2
HIGH ALERT
MEDICATION

Level 4
50 mg/mL Not recommended Maximum: 50 mg/min

Continuous infusion 0.5 – 4
mg/kg/hr
Central, midline, or
peripheral large vein


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

Risk of extravasation and
thrombophlebitis –See Non-
Chemotherapeutic Extravasation
Guideline

If used for conscious sedation, see
Hospital Administrative Policy
8.38 for monitoring requirements.


Pentostatin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 mg vial
reconstituted to
final
concentration
of 2 mg/mL
Dilute in 25-50 mL NS
or D5W
Over 20-30 minutes or as a
bolus infusion
Central, midline, or
peripheral

Hydrate with 500 to 1000
mL fluid prior to infusion
and 500 mL fluid after
infusion
Signs/symptoms of pulmonary and
CNS toxicity, SCr, CBC, LFTs
Peramivir2

Level 1
200 mg/20 mL Dilute in max of 100
mL NS or D5W
Over 15-30 minutes Central, midline, or
peripheral
Hypersensitivity reaction,
dermatologic reactions and
behavioral changes
Pertuzumab2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
420 mg/14 mL Dilute in 250 mL NS Initial dose over 60 minutes

Maintenance dose over 30-60
minutes
Central, midline, or
peripheral
Hypersensitivity, infusion reaction

Observe for 30-minutes after first
dose
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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72

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Phenobarbital2

Level 1 – Maintenance
dose

Level 2 - Loading dose
130 mg/mL Not recommended Maximum: 60 mg/min; loading
dose over 10 minutes

Central, midline, or
peripheral large vein
Vital signs every hour, respiratory
rate/ depth, irritant, sedation score
Risk of extravasation and
thrombophlebitis –See Non-
Chemotherapeutic Extravasation
Guideline


Phentolamine2

Level 4
5 mg vial; 5
mg/mL after
reconstitution
No dilution necessary Up to 5 mg over 1 minute Central, midline, or
peripheral
Vital signs every 2 minutes initially,
then every 7 minutes for 30 minutes
PhenylEPHRINE2
HIGH ALERT
MEDICATION

Level 1 for IV push –
with physician
administration

Level 4 + D4/5 IMC and
F4/4 IMC for spinal
trauma

Vasoactive
Continuous Infusion
Guideline
10 mg/mL Dilute in D5W or NS

Standard UWHC
concentrations:
10 mg/250 mL,
20 mg/250 mL,
50 mg/250 mL,
100 mg/250 mL


Continous infusion: Initial: 0.5
mcg/kg/min.
Titrate by 0.25 mcg/kg/min
every 1 - 15 minutes
Central line preferred,
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks
Blood pressure every 2 minutes until
stabilized, continuous ECG, potent
vasoconstrictor

If used for treatment of transient
hypotension secondary to epidural,
pt must be monitored by Anesthesia
staff after administration

Risk of extravasation and associated
tissue necrosis. See Non-
Chemotherapeutic Extravasation
Guideline


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

73

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Phenytoin2

Level 1 for Maintenance
dose
Level 2 for Loading dose

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
See Fosphenytoin and
Phenytoin Guideline

50 mg/mL May dilute in NS to
concentration of ≥5
mg/mL
Max rate: 50 mg/min Central, midline, or
peripheral

Use in -line filter if giving
as IV piggy-back due to
precipitation risk
Extravasation, hypotension,
bradycardia

Risk of extravasation and associated
tissue damage – See Non-
Chemotherapeutic Extravasation
Guideline
Phosphate
(Potassium)2

Level 1

See Concentrated
Electrolyte Guideline
3 mMol
phosphorous/
mL
(4 mEq
potassium/mL)
Dilute in D5W or NS

UWHC standard
concentrations:
Peripheral: 7.5
mMoL/100 mL, 15
mMol/100 mL


Total dose over ver 2 - 3 hours
for mild-moderate
hypophosphatemia;

For severe hypophosphatemia
administer give 7.5 mmole
over 60 minutes and remaining
dose over 4- 6 hours
Central, midline, or
peripheral

Central recommended:
15 mMoL/ 100 mL

Give via central line if
potassium rate > 10
mEq/hr
Cardiac status – HR and regularity,
vein irritation, thrombophlebitis,
avoid extravasation.
Phosphate (Sodium)2

Level 1

See Concentrated
Electrolyte Guideline
3 mMol
phosphorous/
mL
(4 mEq
sodium/mL)
Dilute in D5W or NS

UWHC standard
concentrations:
7.5 or 15 mMoL in 100
mL


Over 2 - 3 hours for mild-
moderate hypophosphatemia;

For severe hypophosphatemia
administer give 7.5 mmole
over 60 minutes and remaining
dose over 4- 6 hours
Central, midline, or
peripheral

Do not infuse with
calcium-containing IV
fluids

Physostigmine
Salicylate2

Level 2
1 mg/mL Not recommended Up to 1 mg over 1 minute Central, midline, or
peripheral
Vital signs, respiratory status,
telemetry for at least 1 hour after
dose; MD should be present at
bedside.

Atropine should be available to treat
bradycardia or respiratory distress
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74

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Phytonadione2

Level 1

See Procoagulant
Guideline

10 mg/mL Dilute in 50 mL D5W or
NS


Over 60 minutes; max rate
over 20 minutes
Central, midline, or
peripheral
Fever/ chills, anaphylaxis, blood
pressure.
Piperacillin/
Tazobactam2

Level 1
See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
2.25, 3.375 or
4.5 g vials
Dilute in 50 - 100 mL
D5W or NS



Over 30 minutes

Extended infusion: Over 4
hours
Central, midline, or
peripheral
Anaphylaxis, irritant. Risk of
thrombophlebitis – rotate peripheral
IV infusion sites often. See Non-
Chemotherapeutic Extravasation
Guideline

New formulation does not cross-
react with beta- 1,3 glucan or
galactomannan test
Polymyxin B2

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

Over 60 - 90 minutes Central, midline, or
peripheral
Vein irritation, thrombophlebitis
Posaconazole2

Level 1
300 mg/16.7
mL
Dilute to 150 mL D5W
or NS
Central over 90 minutes

Peripheral over 30 minutes
Central; if unavailable,
may administer 1 dose
through a peripheral
catheter (over 30 min)

Use 0.22 micron PES or
PVD in-line filter during
administration

May be colorless to
yellow in color
Electrolytes disturbances, hepatic
function, renal function, QT
prolongation, arrhythmias
Potassium Acetate2

Level 1

See Concentrated
Electrolyte Guideline

2 mEq/mL; 4
mEq/mL
Available at UWHC as
premixed bag

UWHC standard
concentrations:
10 mEq/100 mL,
20 mEq/100 mL
Over 60 minutes

Infusion rates ≥ 20 mEq/hr
requires cardiac monitoring
Peripheral or midline if
concentration 10 mEq/
100 mL

Central line if
concentration 20
mEq/100 mL

Cardiac monitoring – HR and
regularity, vein irritation,
thrombophlebitis.

Risk of extravasation and phlebitis.
See Non-Chemotherapeutic
Extravasation Guideline
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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75

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Potassium Chloride2

Level 1

See Concentrated
Electrolyte Guideline

Sliding Scale potassium
only ICUs, IMCs, and
cardiology units (B4/5,
D4/5, F4/5)

2 mEq/mL Available at UWHC as
premixed bag

UWHC standard
concentrations:
10 mEq/ 100 mL,
20 mEq/100 mL

Over 60 minutes

Infusion rates ≥ 20 mEq/hr
requires cardiac monitoring
Peripheral or midline if
concentration 10 mEq/
100 mL

Central if concentration
20 mEq/100 mL

Cardiac monitoring – HR and
regularity, vein irritation,
thrombophlebitis.
Risk of extravasation and phlebitis.
See Non-Chemotherapeutic
Extravasation Guideline



Pralatrexate2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
20 mg/1 mL;
40 mg/2mL
Do not dilute Over 3-5 minutes into free-
flowing line of NS
Central, midline, or
peripheral
Dyspnea, CBC, electrolytes, renal
and liver function tests, mucositis,
tumor lysis syndrome
Pralidoxime2

Level 4
1 g vial; 50
mg/mL after
reconstitution
Dilute in 100 mL NS


Over 15-30 minutes; may give
up to 1 g over no less than 5
minutes only if pulmonary
edema is present or infusion
not practical
Central, midline, or
peripheral
Continuous vital signs and blood
pressure
Procainamide2
HIGH ALERT
MEDICATION

Level 4


100 mg/mL Dilute loading dose in
D5W to maximum
concentration of 20
mg/mL

UWHC standard
concentration:
1 g/250 mL
Intermittent dose: Up to 50 mg
over 1 minute

Continuous infusion: 1 - 6
mg/min
Central, midline, or
peripheral
Continuous BP and ECG monitoring
of blood pressure; serum
concentrations for therapy over 24
hours. 3 mg/min for more than 24
hours
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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76

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Prochlorperazine2

Level 1


5 mg/mL May dilute in 50 - 1000
mL D5W or NS



Max rate: 5 min into a running
IV
Central, midline, or
peripheral

Avoid hypotension by
maintaining in supine
position for at least 30
minutes
Blood pressure and pulse before
administration and between doses
Promethazine2
HIGH ALERT
MEDICATION

Level 1


25 mg/mL Dilute in 50 mL NS;
max concentration: 25
mg/mL for central line
infusion.

Max rate: 25 mg/min into
running IV


Peripheral or midline if
giving intermittent bolus
dose by syringe push
rather than slow infusion

Central if infusing by
secondary IV line
Continuous vital signs, respiratory
rate/depth, and irritant.

Risk of extravasation. – use large
vein when given peripherally and
confirm patency. Avoid hand and
wrist veins. Administer in IV tubing
port that is farthest from vein;
observe patient continuously if giving
in peripheral vein. See Non-
Chemotherapeutic Extravasation
Guideline

Propofol2
HIGH ALERT
MEDICATION

Level 4

Adult Pain, Agitation
and Delirium ICU
Guideline

10 mg/mL Do not dilute


Intermittent dose: 0.5 mg/kg
over 3 minutes.

Continuous infusion: titrate by
10 – 20 mcg/kg/min to
response; usual 25 - 70
mcg/kg/min
Central, midline, or
peripheral large vein
Continuous blood pressure and
ECG, respiratory rate/ depth. See
Sedation Policy. Risk of
extravasation and Phlebitis. See
Non-Chemotherapeutic
Extravasation Guideline



Propranolol2

Level 4
1 mg/mL Dilution of 1 mg in 10
mL D5W or NS is
recommended to
facilitate titration of
exact dose
Up to 1 mg/min


Central, midline, or
peripheral
Continuous blood pressure and
ECG, respiratory rate/ depth
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77

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Protamine Sulfate2

Level 1

See Procoagulant
Guideline

10 mg/mL No dilution necessary.
May dilute in D5W or
NS

10 mg ove 1-3 minute. Max 50
mg over 10 minutes


Central, midline, or
peripheral
Observe patient continuously,
flushing, blood pressure, coagulation
studies
Prothrombin complex
concentrate (PCC) 2

Level 1

See Procoagulant
Guideline

Factor Products
Operating Procedure
500 units Not recommended 100 units/min
(maximum 200 units/min)
Central, midline, or
peripheral
Monitor for hypersensitivity reactions
and thrombosis
Pyridostigmine
Bromide2

Level 4
5 mg/mL No information Over 2 minutes Central, midline, or
peripheral

Respiratory rate/ depth, blood
pressure, bradycardia , arrhythmias
Pyridoxine2,4

Level 1
100 mg/mL Dilute in D5W or NS


Up to 50 mg over 1 minutes Central, midline, or
peripheral
Flushing possible


QuinIDINE gluconate2,4

Level 1
80 mg/mL Dilute in D5W or NS to
maximum
concentration of 16
mg/mL
Loading dose and mainteance
doses over 4 hoursl
Central, midline, or
peripheral

Non-PVC tubing
CBC
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78

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Ramucirumab2

(CHEMO)

100 mg/10mL Dilute in 250ml NS Over 60 minutes

Do NOT give IV push or bolus
Central, midline, or
peripheral

Use of 0.22 micron filter
recommended

Flush line with NS after
infusion complete

Premedicate with H1
antagonist; If previous
infusion reaction noted,
give steroids and
acetaminophen
Infusion related reactions, blood
pressure
Rasburicase2

Level 1

See Rasburicase
Guideline
1.5 mg vial; 1.5
mg/mL after
reconstitution
Dilute in 50mLNS


Over 30 minutes Central, midline, or
peripheral

Pre-hydration is
recommended.

Uric acid concentrations,
hypersensitivity

In order to avoid false low uric acid
assay readings, prescribers should
order uric acid concentrations for
patients on rasburicase as "Uric Acid
for Patient’s on Rasburicase" or
"Rasburicase Uric Acid"
Remifentanil2
continuous infusion -
HIGH ALERT
MEDICATION

Level 4
1 mg and 2 mg
vial; 1 mg/mL
after
reconstitution
Dilute in D5W or NS to
a concentration of 20,
25, 50 or 250 mcg/mL


Intermittent dose: over 30
seconds

Continuous infusion: usual -
0.1 - 0.2 mcg/kg/min
Central, midline, or
peripheral
Continuous vital signs, respiration
depth/rate
Reslizumab2
HIGH ALERT
MEDICATION

Level 1

100 mg/10 mL
vial

Dilute in 50 mL NS

Infuse over 20-50 minutes

Central, midline, or
peripheral
Use an infusion set with
an in-line, low protein-
binding filter (pore size:
0.2 micron)
Hypersensitivity (anaphylaxis);
Monitor patients for an appropriate
period of time after infusion is
complete for anaphylaxis symptoms.
Anaphylaxis symptoms have been
reported during infusion and within
20 minutes after infusion completed


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79

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Rh0 (D) Immune
Globulin2,4

Level 1
1500 units/1.3
mL
Not recommended Over 3 - 5 minutes Central, midline, or
peripheral

Observe patient for at least 20 - 30
minutes after injection

Rifampin2,4

Level 1
600 mg vial; 60
mg/mL after
reconstitution
Dilute in 100 or 500 mL
D5W or NS
100 mL: over 30 minutes

500 mL: over 3 hours
Central, midline, or
peripheral
Vein irritation and risk of
extravasation. See Non-
Chemotherapeutic Extravasation
Guideline

Rituximab2,4
HIGH ALERT
MEDICATION

(CHEMO)


10 mg/mL Dilute in D5W or NS to
final concentration of 1
- 4 mg/mL

UWHC standard
dilution is in 500 mL
NS

Initial: 50 mg/hr; increase by
50 mg/hr every 30 minutes;
maximum: 400 mg/hr

For select patients, a 60 or 90
minute rapid infusion may be
used. See Rituximab dose
rounding and rapid infusion
rates: delegation protocol



Central, midline, or
peripheral

Pre-medicate with
acetaminophen and
diphenhydramine
Blood pressure and heart rate
frequently; CBC; hypersensitivity
reactions are common
Rocuronium2
HIGH ALERT
MEDICATION

Level 4

See Continuous
Infusion
Neuromuscular
Blocker Guideline
10 mg/mL UWHC standard
dilution 200 mg/100
mL
Bolus dose over 1 minute

Continuous infusion has been
employed at rate of 5 - 8
mcg/kg/min when isoflurane
anesthesia is used and 10 -
12.5 mcg/kg/min with balanced
anesthesia;ICU continuous
infusion 4 - 16 mcg/kg/min
Central, midline, or
peripheral

Patient must be
intubated. And
adequately sedated prior
to initiation
Respiratory rate/ depth, use
peripheral nerve stimulator

See Policy 8.36 Peripheral Nerve
Stimulation (Adult & Pediatric)

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80

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
RomiDEPsin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 mg vial; 5
mg/mL after
reconstitution
Dilute in 500 mL NS Infuse over 4 hours Central, midline, or
peripheral


ECG and electrolytes at baseline
and periodically in patients with long
QT syndrome, significant
cardiovascular disease, or on
antiarrhythmic or QT prolonging
medications. CBC.
Sargramostim2

Level 1


250 mcg/mL or
500 mcg/mL
Dilute in NS; if
concentration < 10
mg/mL - add 1 mL
albumin 5% to each 50
mL NS



Over 2 - 24 hours Central, midline, or
peripheral


Flushing, blood pressure, syncope
(especially with first dose)

Scopolamine2

Level 1

0.4 mg/mL No information 0.4 mg over 3 minutes Central, midline, or
peripheral
Blood pressure, heart rate, urinary
output, intraocular pressure
Secretin2

Level 1

16 mcg vial, 2
mcg/mL after
reconstitution
with NS
No information Dose over 1 minute Central, midline, or
peripheral

Administer test dose prior
to full dose

Allergic reactions (including
anaphylaxis)

Sincalide2

Level 1



5 mcg vial, 1
mcg/mL after
reconstitution
Dilute in 50 mL NS Over 30 minutes (increases GI
tolerance); may be given over
30 seconds


Central, midline, or
peripheral
Abdominal pain/ discomfort, blood
pressure during administration
Sodium Acetate2

Level 1

2 mEq/mL Dilute in D5W or NS


Give at any convenient rate;
generally given as continuous
infusion
Central, midline, or
peripheral
Cardiac status
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81

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Sodium Bicarbonate2

Level 1

1 mEq/mL Dilute in D5W, 0.45%
NaCl or sterile water

Standard UWHC
concentrations:

250 mEq/250 mL for
UNdiluted drug;

150mEq/1000mL for
diluted drug
Bolus 10 mEq/min

Continuous infusion: 5-
50mEq/hr
Bolus: Central, midline,
or peripheral

Continuous infusion of
diluted drug: Central,
midline or peripheral

Continuous infusion of
UNdiluted drug: Central
line preferred
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks

Do NOT administer with
calcium containing IV
products unless line has
been adequately flushed
between administration

Do NOT administer with
catecholamine infusions
as sodium bicarbonate
will inactivate the
catecholamine
Cardiac status – HR and regularity,
extreme irritant

Risk of extravasation. See Non-
Chemotherapeutic Extravasation
Guideline

Sodium Chloride 1.8%2
HIGH ALERT
MEDICATION

Level 1

See IV Hypertonic
Sodium Chloride
Guideline

308 mEq/L No further dilution For elevated intracranial
pressure: 1 - 2 mL/kg/hr (or 75
to 150 mL/hr. A bolus of 250
mL over 30 min can be
administered for aggressive
treatment.

Central, midline, or
peripheral
Vital signs, sodium concentration,
ICP

Risk of extravasation. See Non-
Chemotherapeutic Extravasation
Guideline


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82

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Sodium Chloride 3%2
HIGH ALERT
MEDICATION

Level 1 for intermittent
doses

Level 3 for infusions

Level 3 TAC

See IV Hypertonic
Sodium Chloride
Guideline

513 mEq/L No further dilution


For elevated intracranial
pressure: 1 - 2 mL/kg/hr (or 75
to 150 mL/hr. A bolus of 250
mL over 30 min can be
administered for aggressive
treatment.

For sodium correction: 15 - 80
mL/hr for 2 - 3 hours
Central line preferred
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks
Vital signs, sodium concentration,
ICP

Risk of extravasation. See Non-
Chemotherapeutic Extravasation
Guideline



Sodium Thiosulfate2

Level 1 when
administered for
calciphylaxis (slow IV
infusion)

Level 1 when
administered for
prophylaxis of cisplatin
induced nephrotoxicity
during HIPEC

Level 4 when
administered for cyanide
toxicity (IV push)
250 mg/mL
(25%) 50 mL
vials= 12.5 g
per vial
May dilute in 100 mL

HIPEC: Dilute infusion
in 1000 mL D5W



Cyanide toxicity: 12.5 g IV over
at least 10 minutes

Calciphylaxis: Administer 12.5-
25 g IV over 60 minutes

HIPEC: Administer bolus as
slow IV push over 10 minutes;
Then administer HIPEC
infusion bag over 12 hours
Central, midline, or
peripheral
Best administered
through a dedicated line.


Vital signs, respiratory rate, signs of
extravasation.

Hypotension, nausea, vomiting and
diarrhea are more common with
rapid IV administration. Rapid
administration may cause severe
hypotension

HIPEC: renal function

Streptomycin2

Level 1
1 g vial;
reconstitution
needed before
dilution
May dilute in D5W or
NS to concentration of
5 to 10 mg/mL
Infuse over 60 minutes Central, midline, or
peripheral
Serum drug concentrations;
Renal function/serum creatinine
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83

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Streptozocin2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
1 g vial; 100
mg/mL after
reconstitution
May dilute in D5W or
NS

Over 5 minutes Central, midline, or
peripheral
Serum creatinine, risk of
extravasation.

Irritant: See Chemotherapy
Extravasation Guideline

Succinylcholine2
HIGH ALERT
MEDICATION

Level 4

See Continuous
Infusion
Neuromuscular
Blocker Guideline
20 mg/mL No dilution required,
may dilute in D5W or
NS; concentration: 1 -
2 mg/mL


Dose over 30 seconds Central, midline, or
peripheral

Patient must be
adequately sedated with
administration

Respiratory rate/ depth, continuous
ECG, vital signs
SUFENTanil2
HIGH ALERT
MEDICATION

Level 4

50 mcg/mL No dilution required Over 30 seconds Central, midline, or
peripheral
Vital signs, respiratory rate/ depth,
pain relief
Sugammadex2

Level 1
500 mg/5 mL No dilution required Over 10 seconds Central, midline, or
peripheral

Flush lV line with NS
before and after
administration of
sugammadex
Hypersensitivity & anaphylaxis,
bradycardia, recurrence of
neuromuscular blockade, respiratory
function, skeletal muscle tone

Drug interaction with hormonal
contraceptive agents
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84

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Tacrolimus2,10,11

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
5 mg/mL Dilute in D5W or NS;
concentration: 4 - 20
mcg/mL


Continuous infusion over 24
hours

Intermittent dose over 3-4
hours
Central, midline, or
peripheral

Do not use PVC-
containing containers
and tubing

Reserve for patients
unable to take oral

Blood pressure, anaphylaxis, CBC,
tacrolimus trough concentrations


Telavancin2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
250, 750 mg
vials,
reconstituted to
15 mg/mL
Dilute in 100-250 mL of
NS, D5W


Over 60 minutes Central, midline, or
peripheral
Pregnancy test prior to initiation,
renal function, histamine release
syndrome (hypotension, rash) if
rapid infusion
Temsirolimus2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
25 mg/mL;
diluted with
provided
diluent to
concentration
of 10 mg/mL
Dilute in 250 mL NS Over 30-60 minutes Central, midline, or
peripheral

Administer with non-PVC
tubing and 0.22 micron
in-line filter

Premedicate with
diphenhydramine

Hypersensitivity reactions, CBC
Thiamine2

Level 1

100 mg/mL Dilute in D5W, NS, or
LR

Doses >100mg should
be diluted in 50mL NS



Undiluted doses up to 100 mg
over 3-5 minutes

Diluted doses ≥100 mg over 30
minutes
Central, midline, or
peripheral

Administer prior to
glucose in patients with
thiamine deficiency.
Anaphylaxis/hypersensitivity
reactions

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85

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Thiotepa2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
15 mg vial
diluted to 10
mg/mL after
reconstitution
Dose 30 - 150 mg
dilute in 50 mL NS

Dose 150 - 300 mg
dilute in 100 mL NS

Dose 300 - 750 mg
dilute in 250 mL NS

Dose 750 - 1500 mg
dilute in 500 mL NS

Dose > 1500 mg dilute
in 1000 mL NS

Final conc 0.5 - 3
mg/mL
Over 15 minutes or as directed
by treatment protocol; Max
rate: up to 60 mg over 1
minute
Central Vein irritation, thrombophlebitis
Ticarcillin / clavulanic
acid2
(Timentin®)

Level 1
3.1 g or 31 g
vial; 200
mg/mL of
ticarcillin after
reconstitution
Dilute in 50 - 100 mL
D5W or NS


Over 30 minutes Central, midline, or
peripheral
Hypersensitivity (rash, anaphylaxis),
thrombophlebitis, hypokalemia
Tigecycline2

Level 1
50 mg vial; 10
mg/mL after
reconstitution
Dilute in 100 mL D5W
or NS; max
concentration 1 mg/mL
Over 30 minutes Central, midline, or
peripheral

Consider antiemetic
premedication
Signs and symptoms of infection;
signs of hypersensitivity; injection
site reactions; nausea and vomiting.
Tobramycin2

Level 1

See PK/PD dose
optimization of
antibiotics for
treatment of gram-
negative infections
40 mg/mL

Dilute in 50 - 100 mL
D5W or NS


Doses < 250 mg over 30
minutes

Doses ≥ 250 mg over 60
minutes
Central, midline, or
peripheral
Respiratory rate/ depth; serum
concentrations; renal function
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86

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Tocilizumab2
HIGH ALERT
MEDICATION
Level 1



80mg/4mL,
200 mg/10 mL,
400mg/20mL
vials
Dilute in 100 mL with
NS
Over 60 minutes Central, midline, or
peripheral
Infusion-related reactions, including
hypersensitivity/ anaphylaxis;
hypertension
Topotecan2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
4 mg vial; 1
mg/mL after
reconstitution
Non 24 hour infusion:
100 mL NS

24 hr infusion: 500 mL
NS


Over 30 minutes or over 24
hours
Central, midline, or
peripheral
Vital signs, CBC, avoid
extravasation

Irritant: See Chemotherapy
Extravasation Guideline

Trace elements2

Level 1
3 mL Dilute in D5W or NS


Give at convenient rate -
usually included in Parenteral
Nutrition
Central, midline, or
peripheral

Tranexamic acid2

Level 1

See Procoagulant
Guideline

100 mg/mL Dilute single dose in at
least 50 mL D5W or
NS
Maximum 100 mg over 1
minute

Usual bolus administration
over 15 – 30 min

Continuous infusion based on
indication
Central, midline, or
peripheral
Risk of thromboembolic events;
seizures
Too rapid administration may cause
hypotension

Trastuzumab2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
21 mg/mL after
reconstitution
Dilute in 250 mL NS


Loading dose: over 90 minutes

Maintenance dose: over 30
minutes if tolerated
Central, midline, or
peripheral
Vital signs before and during
treatment, chills, fever; serious
infusion-related reactions may occur
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87

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Treprostinil2
HIGH ALERT
MEDICATION


Level 4 (TLC) and D6/5
IMC , B4/5 pre-surgical
transplant on home
pump only

Not in TAC ICU
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;
titrate to response weekly.
Central line

Can be administered by
a continuous IV infusion
in medically emergent
situations using a central
indwelling catheter.
Peripheral administration
on a temporary basis has
been documented.

Do NOT administer other
medications through the
same lumen
Do NOT infuse with any
other fluids or flushes
Do NOT flush the lumen
that treprostinil is infusing
through
Do NOT pause the
infusion except to change
bags


BP, heart rate, headache, fainting

Abrupt withdrawal can cause
immediate deterioration of patient’s
condition
Trimethoprim/
sulfamethoxazole2

Level 1
80 mg TMP/
400 mg Sulfa/
5 mL
Dilute each 5 mL in 75
- 125 mL D5W or NS

NS preferred
Over 60-90 minutes Central, midline, or
peripheral

Use large vein when
administering
peripherally and check
patency.
Allergic reaction, nausea, vomiting,
rash, risk of thrombophlebitis and
extravasation – See Non-
Chemotherapeutic Extravasation
Guideline
Ustekinumab2
HIGH ALERT
MEDICATION

Level 1

130 mg/ 26 mL
vial
Dilute in 250ml NS Administer over at least 60
minutes.
Central, midline, or
peripheral

Use an in-line, low-
protein binding filter (0.2
micrometer)
Requires dedicated line
Hypersensitivity reactions
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88

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Valproate Sodium2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
100 mg/mL Dilute in 50 mL D5W or
NS

Intermittent dosing: Over 60
minutes at a rate ≤ 20mg/min;

Loading dose: maximum: 3-
6mg/kg/min
Central, midline, or
peripheral
Abdominal pain, nausea, vomiting
Vancomycin2

Level 1

See Vancomycin
Serum Concentration
Monitoring Guideline;


500 mg, 1g, 5
g vials, 1 g/200
mL premixed
bag;
50 mg/mL after
reconstitution
Peripheral: Maximum
concentration 5 mg/mL

Central: Maximum
concentration 10
mg/mL
Maximum: 500 mg/30 minutes
, 1000 mg/60 minutes, etc.
Central, midline, or
peripheral

Rotate peripheral IV sites
often and use large
veins. PICC
recommended for
prolonged therapy.
Extreme vein irritation, blood
pressure, histamine-like reaction
(hypotension/flushing). Risk of
thrombophlebitis and extravasation –
See Non-Chemotherapeutic
Extravasation Guideline

Vasopressin2
HIGH ALERT
MEDICATION

Level 4
Vasoactive
Continuous Infusion
Guideline
20 units/mL Dilute in D5W or NS

Standard UWHC
concentrations:
Shock: 20 units/100
mL,

DI: 10 units/250 mL


Continuous infusion:

Shock: Initial 0.3 units/minute
with range of 0.01 - 0.06
units/minute
Central line preferred,
however,
midline/peripheral/intraos
seous access may be
used when benefit
outweighs risks
Continuous ECG and vital signs,
fluid and electrolyte status, risk of
extravasation. See Non-
Chemotherapeutic Extravasation
Guideline

Vecuronium2
HIGH ALERT
MEDICATION

Level 4

See Continuous
Infusion
Neuromuscular
Blocker Guideline
10 mg vial; 2
mg/mL after
reconstitution
Dilute in D5W or NS
Standard UWHC
concentration: 100
mg/100 mL


Bolus dose: 0.05 - 0.1 mg/kg
over 15 seconds

Continuous infusion: usual -
0.01 - 2 mcg/kg/min
Central, midline, or
peripheral

Intubate and sedate
patients prior to
administration
Respiratory rate/ depth, peripheral
nerve stimulation, vital signs
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89

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Vedolizumab2
HIGH ALERT
MEDICATION

Level 1


300 mg vial; 60
mg/mL after
reconstitution
Dilute in 250 mL of NS Over 30 minutes Central, midline, or
peripheral

Flush line with 30 mL of
NS after infusion
complete
hypersensitivity/infusion reactions



Verapamil2
HIGH ALERT
MEDICATION
- infusion

Level 2 - Push
Level 4 - Infusion
2.5 mg/mL Dilute in D5W or NS;
concentration: 1
mg/mL


Bolus dose over 3 minutes

Continuous infusion: usual - 5 -
10 mg/hr
Central, midline, or
peripheral
Continuous 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
Verteporfin2

Level 1

15 mg vial; 2
mg/mL after
reconstitution
Dilute in D5W to a total
volume of 30 mL


Over 10 minutes in a freely
running IV line
Central, midline, or
peripheral

Establish patency of
large vein if given
peripherally.

Use of an in--line 0.22 to
1.2 micron filter is
required.

Light therapy to begin 15
minutes following start of
10 minute infusion
Risk of extravasation –See Non-
Chemotherapeutic Extravasation
Guideline


VinBLAStine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 mg vial; 1
mg/mL after
reconstitution
Dilute in 25 mL NS Give over 5 minutes into freely
running IV line
Central, midline, or
peripheral
CBC, risk of extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline

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90

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
VinCRIStine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
1 mg/mL Dose diluted with 25
mL of NS, prepared in
a bag

Over 3- 5 minutes Central, midline, or
peripheral
CBC, neurological status, risk of
extravasation.
Vesicant: See Chemotherapy
Extravasation Guideline

VinCRISTine2
Liposomal

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
5 mg/31mL Dilute in 100 mL of NS Over 1 hour

Do NOT give IV push
Central, midline or
peripheral
CBC, neurological status, risk of
extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline

Vinorelbine2

(CHEMO)

Hazardous Drug –
HIGH RISK

See Hospital UW
Health Clinical Policy
6.1.11
10 mg/mL Diluted with 50 mL NS Administer over 10 minutes
into side port of free flowing IV
line

Administer 75-125 mL NS or
D5W after injection to reduce
phlebitis and inflammation
Central, midline, or
peripheral
CBC, phlebitis, risk of extravasation.

Vesicant: See Chemotherapy
Extravasation Guideline

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91

Drug How Supplied Dilution Administration Rate
Considerations For IV
Administration and
Comments Monitoring
Voriconazole2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11


200 mg vial;
10mg/mL after
reconstitution
Dilute in D5W or NS to
concentration < 5
mg/mL


Over 1 hour;
Max: 3 mg/kg/hr
Central, midline, or
peripheral
Hypersensitivity reactions (including
anaphylaxis); electrolytes, serum
creatinine
Warfarin Sodium2
HIGH ALERT
MEDICATION

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
5 mg vial; 2
mg/mL after
reconstitution
Not recommended Over 1 minute Central, midline, or
peripheral
INR
Zoledronic Acid2

Level 1

Hazardous Drug –
LOW RISK

See Hospital UW
Health Clinical Policy
6.1.11
Zometa®: 4
mg/5 mL

Reclast®: 5
mg/100 mL
Zometa®: Dilute in 100
mL NS or D5W

Reclast®: no further
dilution necessary


Over at least 15 minutes

Flush line with 10 mL NS
following infusion
Central, midline, or
peripheral large vein

Use a vented line
separate from other
drugs


Serum calcium, electrolytes.

Risk of thrombophlebitis –See Non-
Chemotherapeutic Extravasation
Guideline






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92
UW Health Implementation
Potential Benefits:
ξ Standardized of intravenous medication administration to promote safety and efficacy

Potential Harms:
ξ Extravasation of intravenous medication
ξ If not administered properly, intravenous medications can result in serious complications

Qualifying Statements:
Recommendations 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 the administration rate and route.

Pertinent UWHC Policies & Procedures
1. UW Health Clinical Policy 6.1.8 – Administration of Intravenous Medications
2. Policy 8.33 High Alert Medication Administration
3. Policy 10.18AP – Parenteral (Intravenous or Subcutaneous) Lidocaine for Neuropathic Pain
(Adult & Pediatric)
4. Policy 31.1 Ketamine: Low Dose IV Ketamine with Pain Management for Adult Patients in
the ED
5. Policy 6.1.11 Preventing Non-therapeutic Exposure to Hazardous Drugs
6. Policy 8.38 Adult Sedation Policy
7. Policy 5.1.5 Acute Stroke Response for Adults

Guideline Metrics
Patient Safety Net reports can be monitored for errors or adverse events associated IV
medication administration.

Implementation Plan/Clinical Tools
The guideline will be available on UConnect and uwhealth.org and cross referenced in related
guidelines and protocols. Health Link medication records include medication administration
times from this guideline.

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.
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93
Appendix A. Evidence Grading Scheme(s)
Figure 1. GRADE Methodology adapted by UW Health


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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Appendix B. Infliximab Infusion Algorithm






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Appendix C. Medications Requiring a Central Line

1. Acyclovir – Central line for concentrations ≥ 10mg/mL
2. Adenosine – Central line preferred (or site as proximal to trunk as possible)
3. Amiodarone – Central line preferred. Central line required for 600mg/250mL or any
infusion concentrations ≥ 2mg/mL
4. Anti-thymocyte globulin RABBIT – Central line required for doses diluted in <
500mL
5. Busulfan
6. Calcium chloride – Central line preferred
7. Carmustine – Central line if undiluted or doses ≥300 mg/m2
8. Copper-selenium-zinc
9. Continuous renal replacement therapy (CRRT) – Hemodialysis line required for all
bags
10. Dobutamine – Central line preferred, however, midline/peripheral/intraosseous
access may be used when benefit outweighs risks
11. Dopamine – Central preferred, however, midline/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, midline/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 ≥ 20mg/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 midline or peripheral infusion is acceptable
19. Micafungin – Central line required for concentrations >1.5mg/ml
20. Nicardipine – Central line required for concentrations >0.5mg/mL
21. Norepinephrine – Central line preferred, however, midline/peripheral/intraosseous
access may be used when benefit outweighs risks
22. Parenteral Nutrition
23. Phenylephrine – Central line preferred, however, midline/peripheral/intraosseous
access may be used when benefit outweighs risks
24. Posaconazole – Central line preferred, however, if unavailable, may administer 1
dose through a peripheral catheter (over 30 min)
25. Potassium acetate – Central line for concentrations ≥ 20meq/100mL
26. Potassium chloride – Central line for concentrations ≥ 20meq/100mL
27. Potassium phosphate – Central line recommended for concentration >
15mMol/100mL. Central line required for rate > 10mEq/hr
28. Promethazine – Central line required if infusing by secondary IV line
29. Sodium Bicarbonate – Central line preferred if undiluted, however,
midline/peripheral/intraosseous access may be used when benefit outweighs risks
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30. Sodium Chloride 3% – Central line preferred, however,
midline/peripheral/intraosseous access may be used when benefit outweighs risks
31. Thiotepa
32. Treprostinil – Central line preferred, however, peripheral administration on a
temporary basis has been documented
33. Vancomycin – Central line for concentrations ≥10mg/mL
34. Vasopressin – Central line preferred, however, midline/peripheral/intraosseous
access may be used when benefit outweighs risks



































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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
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