San Francisco General Hospital

IV Infusion Guide
(Adult)

Kathy Pang, Kristin Slown, David Smith -- Pharmacy

Jen Berke, Elisha Perez, Anita Roberts, Ally Villanueva, Piera Wong -- Nursing

What is the IV Infusion Guide?

The list below addresses administration of medications given intravenously, delineating the location and health care personnel
authorized to administer them. These guidelines do NOT address other routes of administration, such as subcutaneous,
intramuscular, intrathecal, or peripheral nerve blocks.
When is this guide updated? Does it always take precedent?
Every effort is made to update and post this document quarterly. If this document is in conflict with a newly approved policy, practice,
or procedure, then defer to the most recently approved or discuss with the nurse manager and/or pharmacy supervisor. For example:
the critical care committee creates new policy on allowing a pressor agent to be used on an alternative unit, this will take precedent
over the IV Infusion guide until the IV infusion guide is updated.
*Note: many antibiotics listed below are listed with an X as a continuous IV infusion. However, in rare cases and in consult with the
Infectious Disease service, they may be administered as a continuous infusion when clinical indicated.

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information

abatacept

Orencia

RN

abciximab

ReoPro

SC*

SC*

*Restricted to high-risk patients undergoing

angioplasty
*Restricted to adult and pediatric patients > 2
years who are (1) NPO before/after surgery for up
to 24 hours, or (2) cannot tolerate oral agents
secondary to abdominal surgery, ileus or
persistent nausea/vomiting for up to 72 hours.
Longer duration requires Formulary manager
approval or ordered by the Pain Service.

acetaminophen

Ofirmev

RN*

acetaZOLAMIDE

Diamox

RN

RN

acetylcysteine

Acetadote

RN

RN

Complex Concentrate
(aPCC or 4-factor PCC)

FEIBA

SC

acyclovir

Zovirax

RN

Activated Prothrombin

adenosine

Adenocard

SC, BS^

Cath Lab*

ado-trastuzumab

Kadcyla

CH

albumin, Human

Albuminar

RN

RN

alteplase (t-PA)

Activase

SC

SC*

SC- EKOS
catheter

amifostine

Ethyol

RN

RN

RN

amikacin

Amikin

RN

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Order Form required

Telemetry monitoring required.

*Restricted to use in the cardiac cath lab for
Fractional Flow Reserve
^ - must give as rapid IV push with NS flush

Order Form required for PE, stroke, EKOS

For PE: drug prepared in pharmacy
For stroke: Bolus or infusion can be initiated on
any unit as part of stroke protocol by SC
*if used to maintain vascular access (e.g. chest
tube) then may be given by provider for chest
tubes or VAS/provider for lines

Requires ID approval

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 1

Updated April 2016

Approved,
P&T

Generic Name
aminocaproic acid

Amicar

aminophylline

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

RN

RN

SC

SC

Additional Information

amiodarone

Cordarone

SC, Ra3

SC, BS

SC, Ra3

Order Form required for initial infusion

amphotericin B
(liposomal)

Ambisome

RN

Requires ID approval

amphotericin B
(conventional)

Fungizone

RN

RN

ampicillin
ampicillin/sulbactam

Unasyn

RN

antihemophilic VIII

HumateP,
MonoclateP

RN

Non-formulary- hematology approval required

RN

*Requires hematology approval.

Paper Order Form required for all units

argatroban
arginine

R-Gene

RN

RN

ascorbic acid

Ascor L

RN

RN (in TPN)

asparaginase

Erwinase

CH

SC, BS

atropine

Telemetry monitoring required

azacitidine

Vidaza

CH

azithromycin

Zithromax

RN

aztreonam

Azactam

RN

bendamustine

Treanda

CH

benztropine

Cogentin

RN

belimumab

Benlysta

RN

bevacizumab

Avastin

CH

Non-cytotoxic; ordered on chemo order form

bivalirudin

Angiomax

SC*

SC*

*Cardiac Cath Lab only-- may continue postprocedure in SC if needed

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Requires ID approval

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 2

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

bleomycin

Blenoxane

CH

bortezomib

Velcade

brentuximab

Adcetris

CH

bumetanide

Bumex

RN

RN

RN

bupivacaine

Marcaine,
Sensorcaine

caffeine citrate

Cafcit

6H

6H

cabazitaxel

Jevtana

CH

calcitriol

Calcijex

RN

calcium chloride

SC, BS

SC, RN (in
TPN)

calcium gluconate

RN

SC, BS

SC, RN (in
TPN)

Additional Information

May be given as epidural or peripheral nerve

block in any area (Ra3 only). See epidural policy
for additional details.

Central line only

capreomycin

Capastat Sulfate

RN

CARBOplatin

Paraplatin

CH

carfilzomib

Kyprolis

CH

ceFAZolin

Ancef

RN

cefepime

Maxipime

RN

cefotaxime

Claforan

RN

cefoTEtan

Cefotan

RN

cefOXitin

Mefoxin

RN

ceftaroline

Teflaro

RN

Requires ID approval

cefTAZidime

Fortaz

RN

Requires ID approval

cefTRIAXone

Rocephin

RN

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Requires ID approval

Restricted to pediatric patients only. Adult usage

requires ID approval.

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 3

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information

cefuroxime

Zinacef

RN

cetuximab

Erbitux

CH

chloramphenicol

Chloromycetin

RN

chlorothiazide

Diuril

RN

RN

chlorproMAZINE

Thorazine

RN

cidofovir

Vistide

CH

ciprofloxacin

Cipro

RN

cisatracurium

Nimbex

SC

SC

CISplatin

Platinol

CH

CH

cladribine

Leustatin

CH

CH

clindamycin

Cleocin

RN

colistin

Coly-Mycin M

RN

RN

copper

Copper

RN

RN (in TPN)

cosyntropin

Cortrosyn

RN

RN

cyclophosphamide

Cytoxan

CH

CH

CH

cycloSPORINE

Sandimmune

RN

cytarabine

Cytosar-U

CH

CH

dacarbazine

DTIC

CH

CH

DACTINomycin

Actinomycin D

CH

CH

dantrolene

Dantrium

RN

RN

DAPTOmycin

Cubicin

RN

Requires ID approval

darbepoetin

Aranesp

RN

Luer lock syringe for IV only

deferoxamine

Desferal

RN

RN

desmopressin

DDAVP

RN

RN

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Non-cytotoxic; ordered on chemo order form

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 4

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information
Doses 10mg can be given slow IV push

dexamethasone

Decadron

RN

RN

dexmedetomidine

Precedex

SC

SC

dexrazoxane

Totect; Zinecard

RN

dextran 40

RN

dextran 70

RN

Order Form Required

**Bolus not recommended due to increased
hemodynamic instability

dextrose 10%

Glucose

RN

RN

RN

May be given in peripheral IV

dextrose 20 35%

Glucose

RN

RN

RN

Must be given via central IV line

dextrose 50%

Glucose

RN

diazepam

Valium

RN

digoxin

Lanoxin

SC, Ra3

digoxin Immune FAB

Digibind

BS

BS

dihydroergotamine

DHE 45

RN

diltiazem

Cardizem

SC, Ra3

SC, Ra3

diphenhydrAMINE

Benadryl

RN

RN

RN

RN

Only available from the CDC

* See link for guidelines on use in Ra3 patients.

diphtheria antitoxin
DOBUTamine critical
care
DOBUTamine Ra3

Dobutrex

SC, Ra3*

DOCEtaxel

Taxotere

CH

DOPamine

Intropin

SC

dornase-alfa

Pulmozyme

Provider

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Telemetry monitoring required

Telemetry monitoring required

RN titration only allowed for SC

Restricted to maintain vascular access (e.g.

chest tube) only

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 5

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

doxapram

Dopram

SC

SC

SC

DOXOrubicin

Adriamycin

CH

CH

CH

DOXOrubicin liposomal

Doxil

CH

doxycycline

Vibramycin

RN

edetate Ca disodium

Calcium EDTA

RN

RN

enalaprilat

Vasotec

SC, Ra3

SC, Ra3

SC

EPHEDrine sulfate
EPINEPHrine

Adrenalin

SC, BS

SC

epiRUBicin

Ellence

CH

CH

epoetin alfa

Epogen, Procrit

RN

epoprostenol

Flolan

SC**, RN^

eptifibatide

Integrilin

SC

SC

ERIbulin

Halaven

CH

CH

ertapenem

INVanz

RN

erythromycin

Erythrocin

RN

esmolol

Brevibloc

SC

SC

estrogen conjugated

Premarin

RN

RN

ethacrynic acid

Edecrin

RN

RN

PICC*

SC

ethanol lock
etomidate

LEGEND

Amidate

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Additional Information

For IV push, ensure appropriate BP monitoring

**Use via IV pumps is ONLY allowed in emergent

situation when use of patients ambulatory pump
is not feasible.
^ If clinically stable from hemodynamic standpoint,
pts can continue home infusion as inpts in nonICU unit. See epoprostenol guideline for further
details.

*Can only be administered by VAS service

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 6

Updated April 2016

Approved,
P&T

Generic Name

etoposide

VePesid

factor VIIa

NovoSeven

IV Push/
bolus

IVPB

Brand /Synonym

CH

IV Infusion
(continuous)

Additional Information

CH

SC, RN*

For Trauma/Neuro cases: Requires Factor VIIa

Order Form; Trauma,Neuro-Critical Care, or
Neurosurgery attending approval required
*For Hemophilia-related uses, order form is not
required and may be given on the floor by any RN

factor VIII

Humate-P,
Monoclate-P

RN

famotidine

Pepcid

RN

fat emulsion

Intralipid

RN (in TPN),
SC*

*for local anesthetic (i.e. bupivacaine) or other

toxicities

RN*

* IV Infusions should only be initiated on SC unit

or comfort care patients; on floor units, only downtitrations or comfort care is appropriate. Infusions
as epidurals are allowed (per those polices).

fentaNYL

Sublimaze

SC, RN
(Comfort
Care only)

fenoldopam

Corlopam

SC

ferric gluconate

Ferrlecit

RN

Hemodialysis

fluconazole

Diflucan

RN

fludarabine

Fludara

CH

CH

flumazenil

Romazicon

RN*

fluorouracil

5-FU

CH

CH

folic acid

Folvite

RN

RN (in TPN)

fomepizole

Antizol

RN

foscarnet

Foscavir

RN

fosphenytoin

Cerebyx

RN*

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Non-formulary- hematology approval required

*Consider MERT evaluation if administered

Restricted to patients in status epilepticus

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 7

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information
*Consider MERT evaluation if this medication is
being administered

furosemide

Lasix

RN

RN*

RN

ganciclovir

Cytovene

CH

gemcitabine

Gemzar

CH

gentamicin

Garamycin

RN

glucagon

Glucagen

RN*

SC

glycopyrrolate

Robinul

RN

haloperidol lactate

Haldol

SC

RN

RN

heparin
hydrALAZINE

Apresoline

SC, Ra3

hydrocortisone sodium
succinate

Solu-CORTEF

RN

RN

*Doses 100mg can be given as IV push

*Consider MERT evaluation if administered

All other units can give IM haloperidol

Ensure appropriate BP monitoring

Order Form required for infusions.

* IV Infusions should only be initiated on SC unit
or comfort care patients. Infusions as
epidurals/PCA are allowed (per those polices).

HYDROmorphone

Dilaudid

RN

SC, RN*

hydroxocobalamin

Cyanokit

SC

ibutilide

Corvert

SC*

SC*

*SC, Cath Lab. Provider must be present. PreAF/A flutter cardioversion only.

idaruCIZUMAB

Praxbind

SC

SC

Order Form Required.

ifosfamide

Ifex

CH

CH

imipenem/cilastatin

Primaxin

RN

immune globulin (IVIG)

Privigen

RN

RN

indomethacin

Indocin

6H only

inFLIXimab

Remicade

RN

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Requires ID approval

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 8

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information

insulin regular

NovoLIN R,
HumuLIN R

RN*

SC

*Hyperkalemia: IV may be given on any unit by

RN -- always give with D50

interferon alfa-2B

Intron A

RN

ipilimumab

Yervoy

CH

irinotecan

Camptosar

CH

isoproterenol

Isuprel

SC

SC

kanamycin

Kantrex

RN

Kcentra

4F-PCC

RN

Order form and attending approval required

ketamine

Ketalar

SC*

SC

*Anesthesia MD only in ICU. RNs can administer

in the ED per protocol.

Non-cytotoxic; ordered on chemo order form

ketorolac

Toradol

RN

Unrestricted use up to a maximum of 72 hours in

adult and pediatric patients >2 years who are
NPO. Longer duration or use in pediatric patients
<2 years require approval by Formulary Manager
except for orders written by Chronic Pain Service
or Anesthesia.

labetalol

Normodyne

SC, Ra3

SC

Telemetry monitoring required

lacosamide

Vimpat

RN

leucovorin

Folinic acid

RN

levETIRAcetam

Keppra

RN

levOCARNitine

Carnitor

RN

RN

levofloxacin

Levaquin

RN

levothyroxine

Synthroid

RN

SC

lidocaine

Xylocaine

SC

SC

linezolid

Zyvox

RN

Requires ID approval

LORazepam

Ativan

RN

SC, Ra3*, RN^

*Ra3 weaning to off only

^RN palliative/comfort care only

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 9

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

magnesium sulfate

RN

SC, BS

SC, OB

manganese

RN (in TPN)

mannitol

RN

RN

mechlorethamine

Nitrogen mustard

CH

melphalan

Alkeran

CH

meperidine

Demerol

RN

meropenem

Merrem

RN

mesna

Mesnex

RN

RN

RN

methadone

SC

methotrexate

CH

CH

methylene blue

RN

RN

methylergonovine

Methergine

RN

methylPREDNISolone

Solu-MEDROL

RN

RN

RN

metoclopramide

Reglan

RN

RN

Additional Information

Requires ID approval

Exception: administration in ED for ectopic

pregnancy by charge RNs in ED (often performed
by OB/Gyn provider).

Doses 125mg can be given slow IV push

Telemetry monitoring required except for

replacement doses in strict NPO patients with no
cardiac disease or other indications for cardiac
monitoring. (see P&T memo 2006 on pharmacy
website).
metoprolol

Lopressor

RN*

RN

In NPO patients using metoprolol as IV push, the

maximum dose is 10mg every 4 hrs.
*IVPB: appropriate only for NPO & non-1st dose
patients; no dosing limits apply for IVPB. Doses
may be increased to IV equivalent of the
maximum oral dose.

metroNIDAZOLE
LEGEND

Flagyl

RN

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

x
CARE TEAM MEMBER
RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 10

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

micafungin

Mycamine

RN

midazolam

Versed

SC

SC

milrinone lactate

Primacor

SC

SC

CH

CH

CH

mitoMYcin
mitoXANtrone

Novantrone

morphine sulfate

RN

RN*

moxifloxacin

Avelox

RN

MVI-12

MVI

RN (in TPN)

RN

nafcillin
naloxone

Narcan

RN*

SC

natalizumab

Tysabri

RN

neostigmine

Prostigmin

SC

niCARdipine

Cardene

SC

Cath lab

SC

nitroglycerin
nitroprusside

Nipride

SC

nitroprusside +
thiosulfate

Nipride + thiosulfate

SC

nivolumab

Opdivo

CH

norepinephrine

Levophed

SC

octreotide

Sandostatin

RN

RN

RN

ondansetron

Zofran

RN

RN*

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

Additional Information
Requires ID approval

Order Form required for infusions.

* IV Infusions should only be initiated on SC unit
or comfort care patients. Infusions as
epidurals/PCA are allowed (per those polices).

*Consider MERT evaluation if administered

Non-cytotoxic; ordered on chemo order form

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

*Doses 8mg can be given as IV push. Maximum

dose is 16mg/dose

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 11

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information

oxaliplatin

Eloxatin

CH

oxytocin

Pitocin

OB, SC

PACLitaxel

Taxol

CH

CH

PACLitaxel (protein
bound)

Abraxane

CH

pancuronium

Pavulon

SC

SC

panitumumab

Vectibix

CH

Non-cytotoxic; ordered on chemo order form

pantoprazole

Protonix

RN

RN

RN

80mg bolus can be given as slow IV push over 2

min

papaverine

Papaverine

Provider

paricalcitol

Zemplar

RN

pegaspargase

Oncaspar

CH

Non-cytotoxic; ordered on chemo order form

pembrolizumab

Keytruda

CH

Non-cytotoxic; ordered on chemo order form

PEMEtrexed

Alimta

CH

RN

RN

penicillin G
pentamidine

Pentam

RN

PENTobarbital

Nembutal

SC*

SC*

pentostatin

Nipent

CH

pertuzumab

Perjeta

CH

SC
(seizure)

SC

PHENobarbital
phentolamine

Regitine

SC

SC

phenylephrine

Neosynephrine

SC

SC

phenytoin

Dilantin

RN

SC

physostigmine

Antilirium

SC

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

OR and ICU use only

Non-cytotoxic; ordered on chemo order form

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 12

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

phytonadione

Vitamin K

RN

piperacillin/tazobactam

Zosyn

RN

polymyxin B sulfate

Aerosporin Injection

RN

RN

potassium acetate

RN (in TPN)

potassium chloride

RN

RN (in TPN)

potassium phosphate

RN

RN (in TPN)

Additional Information

Requires ID approval

Maximum infusion rate:

10 mEq/hr PERIPHERAL; 20 mEq/hr CENTRAL
line only

pralidoxime

Protopam

RN

RN

RN

procainamide

Pronestyl

SC

SC

SC

prochlorperazine

Compazine

RN

RN

propofol

Diprivan

Provider

SC

propranolol

Inderal

SC, Ra3

Telemetry monitoring required

RN

Must be pushed over 10 minutes to decrease the

risk of hypotension

RN

Order form and attending approval required

RN

SC

pyridoxine

RN

quiNIDine

SC

SC

protamine sulfate
Prothrombin Complex
Concentrate, 4 factor
Prothrombin Complex
Concentrate activated 4
factor
pyridostigmine

Kcentra, 4F-PCC
FEIBA

Mestinon

rasburicase

Elitek

RN

remifentanil

Ultiva

OB

OB

RHO(D) IntravenousHuman)Globulin

WinRho SDF

RN

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 13

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information

rifampin

Rifadin

RN

Requires ID approval for non-TB use

riTUXimab

Rituxan

CH

Non-cytotoxic; ordered on chemo order form

rocuronium

Zemuron

SC

SC

romiPLOStim

Nplate

For SQ administration only

May be given as epidural or peripheral nerve
block in any med-surg area.

ropivacaine

Naropin

selenium

Trace Element
(Selenium)

RN (in TPN)

sodium acetate

RN (in TPN)

sodium bicarbonate

6H, SC, BS

RN

Restricted to Anesthesiology Department for use

in the OR or epidural anesthesia (all epidural
orders must be co-signed by an attending)

sodium chloride 2%

Hypertonic NaCl

RN

For Peripheral IV. Refer to SFGH Hypertonic

Saline Guidelines for more specific information.

sodium chloride 3%

Hypertonic NaCl

RN

For Central Line. Refer to SFGH Hypertonic

Saline Guidelines for more specific information.

SC - Provider
only*

Vial MUST be returned to pharmacy- used or

unused.
*Restricted to providers from neurology,
neurosurgery

sodium phosphate

RN

RN (in TPN)

sodium thiosulfate

RN

RN

streptomycin

RN

sodium chloride 23.4%

Hypertonic NaCl

streptozocin

Zanosar

CH

succinylcholine

Anectine

SC

SUFentanil

Sufenta

SC

SC

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 14

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

sulfamethoxazole/
trimethoprim (SMX/TMP)

Septra, Bactrim

RN

temsirolimus

Torisel

CH

tenecteplase

TNKase

SC

SC

SC

SC

RN

RN (in TPN)

THAM (tromethamine)
treprostinil

Remodulin

thiamine
tigecycline

Tygacil

RN

tirofiban

Aggrastat

SC

SC

tobramycin

Nebcin

RN

tocilizumab

Actemra

RN

topotecan

Hycamtin

CH

TPA (alteplase)

Activase

SC

SC*

SC (EKOS
catheter)

trace elements

Multi-Trace

RN (in TPN)

Additional Information

Requires ID approval

Requires ID approval

Order Form required for PE, stroke, EKOS

For PE: drug prepared in pharmacy
For stroke: Bolus or infusion can be initiated on
any unit as part of stroke protocol by SC
*if used to maintain vascular access (e.g. chest
tube) then may be given by provider for chest
tubes or VAS/provider for lines

tranexamic acid (TXA)

Cyklocapron

SC, OB

SC, OB

Restricted to Anesthesia, ED and Trauma services

for use in trauma patients. Refer to SFGH
Tranexamic Acid Protocol for more information
(Administration Policy # 2.06 Appendix F to
Massive Transfusion Protocol) related to trauma
use.
Also approved for OR patients undergoing total
joint replacements or obstetric patients with postpartum hemorrhage (PPH).

trastuzumab

Herceptin

CH

Non-cytotoxic; ordered on chemo order form

LEGEND

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 15

Updated April 2016

Approved,
P&T

Generic Name

IV Push/
bolus

IVPB

Brand /Synonym

IV Infusion
(continuous)

Additional Information

trimethoprim/
sulfamethoxazole

Septra, Bactrim

RN

tromethamine

THAM

SC

SC

valproic acid

Depacon

RN

vancomycin

Vancocin

RN

vasopressin

Pitressin

SC, BS

SC

vecuronium

Norcuron

SC

SC

vedolizumab

Entyvio

RN

verapamil

Isoptin

SC, BS

vinBLAStine

Velban

CH

CH

vinCRIStine

Oncovin

CH

CH

CH

vinorelbine

Navelbine

CH

CH

voriconazole

VFEND

RN

Requires ID approval

zidovudine

Retrovir

RN

OB*

*Continuous IV infusion can be given during labor

RN (in TPN)

RN

zinc
zoledronic acid

LEGEND

Zometa, Reclast

LEVEL OF CARE
Ra3 - Ratio 3 RN only
SC - Special Care RN** (CC, ED, OR, PACU, Cath Lab)
X - Do not administer using this method

CARE TEAM MEMBER

RN all RNs
Provider - Provider only
CH - Chemotherapy trained RN

Restricted to oncology-related indications. Use

for osteoporosis requires non-formulary approval

BS all RNs with provider at bedside

**Code/MERT = a mobile SC unit

Page 16