Southampton PICU Intravenous Drug Infusion Guide 2018 (SORT)

Please read the following points before using the guide:

Renew infusions every 24 hours unless otherwise stated.

To avoid unnecessary waste, aim to prescribe/prepare infusion quantities to last for a 24-hour period.

Remember – not all infusions are prescribed in 50ml.

Infusion concentrations may need to be adapted according to the patients’ fluid requirements, particularly in neonates.

Dose ranges are included as a guide only and may not apply in all situations. Neonatal dose ranges may be lower for some drugs.

Many of the drugs are either completely unlicensed in children, or by the method described. Responsibility for “off-label” prescribing lies with the prescriber.

This guide is intended for use on the Paediatric Intensive Care Unit, Southampton Children’s Hospital or in conjunction with the Southampton Oxford Retrieval team.
It is the responsibility of the individual using the guide to ensure the information applies to their clinical situation.

CAUTION: Certain drugs or dose ranges are unsuitable for use outside an Intensive Care Unit, or without adequate monitoring, resuscitation and ventilation facilities.
Only use following discussion with SORT consultant.

Calculation examples

A. Weight based mg/kg dilution B. “Fixed” concentration

e.g. Dopamine for a 10kg child e.g. Dopamine for a 30kg child
Use 15mg/kg in 50ml Use 200mg in 50ml
i.e. 15 x 10 = 150mg in 50ml 1ml/hr = (66.7 ÷ wt) micrograms/kg/min
1ml/hr = 5 micrograms/kg/min 1ml/hr = 2.2micrograms/kg/min
0.4 - 2ml/hr = 2 - 10 micrograms/kg/min 0.03-0.15ml/kg/hr = 2-10 micrograms/kg/min
0.9 - 4.5 ml/hr = 2 - 10 micrograms/kg/min

With this method you are adjusting the With this method the infusion concentration remains the same,
concentration of the infusion for the childs weight. and you are adjusting the volume administered according to weight.

PICU Infusion guidelines SORT August 2018

 Drug and route Prescription and administration guideline (NS=sodium chloride 0.9%; G=glucose 5% or 10%)
Adrenaline (peripheral) Under 13kg: mg/kg dilution Over 13kg: Fixed concentration (8micrograms/ml)
Short-term use only
Central access required for continuing infusions
0.03mg/kg in 50ml (NS or G) 0.4mg in 50ml (NS or G) (or 4mg in 500ml)
1ml/hr = 0.01micrograms/kg/min 1ml/hr = (0.13 ÷ wt) micrograms/kg/min
Usual dose range: 5-50ml/hr = 0.05 -0.5micrograms/kg/min Usual dose range: 0.375-3.75ml/kg/hr = 0.05 -0.5micrograms/kg/min

Adrenaline (central) Under 13kg: mg/kg dilution Over 13kg: Fixed concentration (80micrograms/ml)
Ampoules available:
0.3mg/kg in 50ml (NS or G) 4mg in 50ml (NS or G)
1mg in 1ml (1:1000) 1ml/hr = 0.1micrograms/kg/min 1ml/hr = (1.3 ÷ wt) micrograms/kg/min
1mg in 10ml (1:10,000) Usual dose range: 0.5-5ml/hr = 0.05-0.5micrograms/kg/min Usual dose range: 0.0375-0.375ml/kg/hr = 0.05-0.5micrograms/kg/min

Aminophylline Under 20kg: Fixed concentration (1mg/ml) Over 20kg: Fixed concentration (1mg/ml)
(central or peripheral)
250mg in 250ml (NS or G) 500mg in 500ml (NS or G)
Ampoules available: 1ml/hr = (1 ÷ wt) mg/kg/hr 1ml/hr = (1 ÷ wt) mg/kg/hr
250mg in 10ml Usual dose range 0.5-1ml/kg/hr = 0.5-1mg/kg/hr Usual dose range 0.5-1ml/kg/hr = 0.5-1mg/kg/hr
Following loading dose, maintenance dose depends on age (see BNF-C). Following loading dose, initial maintenance dose depends on age (see BNF-C).
Not usually used in neonates

Amiodarone (peripheral) All ages: Fixed concentration (1.5mg/ml)

Short-term use only
Central access required for continuing infusions
75mg in 50ml glucose 5% (or 750mg in 500ml glucose 5%)
1ml/hr = (25 ÷ wt) micrograms/kg/min
Usual dose range: 0.2-0.8ml/kg/hr = 5-20micrograms/kg/min. Loading dose may be required.

Amiodarone (central) All ages: Fixed concentration (3mg/ml)

Ampoules available:
150mg in 50ml glucose 5%
150mg in 3ml 1ml/hr = (50 ÷ wt) micrograms/kg/min
Usual dose range: 0.1-0.4ml/kg/hr = 5-20micrograms/kg/min. Loading dose may be required.

Calcium gluconate 10% All ages: Fixed concentration (0.225mmol/ml)

Ampoules available: 4.5mmol in 20ml
1g in 10ml (0.225mmol per ml) 1ml/hr = (0.225 ÷ wt) mmol/kg/hr
Usual dose range: 0.1-0.2ml/kg/hr = 0.5-1mmol/kg/day

PICU Infusion guidelines SORT August 2018

Dinoprostone (central or peripheral) Neonates only: Fixed concentration (1microgram/ml)
Ampoules available: 50micrograms in 50ml glucose 5% or 10%
0.75mg in 0.75ml 1ml/hr = (16.7 ÷ wt ) nanograms/kg/min)

Please note: Usual dose range: 0.3-3ml/kg/hr = 5-50 nanograms/kg/min

1mg = 1000micrograms
1 microgram = CAUTION : 750 micrograms in ampoule – prepare infusion in 2 stages:
1000 nanograms 1) Take 0.5ml (500micrograms) of concentrated solution from the ampoule and dilute to 10ml to make a 50microgram/ml solution;
2) Take 1ml of this 50microgram/ml solution and dilute to 50ml to make a 1microgram/ml solution.

Dopamine (peripheral) Under 13kg: mg/kg dilution Over 13kg: Fixed concentration (0.4mg/ml)
Short-term use only
Central access required for continuing infusions
1.5mg/kg in 50ml (NS or G) 20mg in 50ml (NS or G)
1ml/hr = 0.5micrograms/kg/min 1ml/hr = (6.7 ÷ wt) micrograms/kg/min
Usual dose range: 4-20ml/hr = 2-10 micrograms/kg/min Usual dose range: 0.3-1.5ml/kg/hr = 2-10 micrograms/kg/min

Dopamine (central) Under 13kg: mg/kg dilution Over 13kg: Fixed concentration (4mg/ml)
Ampoules available:
200mg in 5ml
15mg/kg in 50ml (NS or G) 200mg in 50ml (NS or G)
1ml/hr = 5micrograms/kg/min 1ml/hr = (66.7 ÷ wt) micrograms/kg/min
Usual dose range: 0.4-2ml/hr = 2-10 micrograms/kg/min Usual dose range: 0.03-0.15ml/kg/hr = 2-10 micrograms/kg/min

Fentanyl (peripheral or central) Under 10kg: Fixed concentration (20 microgram/ml) Over 10kg: Fixed concentration (50 microgram/ml)
Ampoules available: 1000micrograms in 50ml 1000micrograms in 20ml
100micrograms in 2ml 1ml/hr= (20 ÷ wt) micrograms/kg/hr (or 2500micrograms in 50ml depending on rate of infusion)
500micrograms in 10ml
Usual dose range: 1-6micrograms/kg/hr 1ml/hr= (50 ÷ wt) micrograms/kg/hr
Usual dose range: 1-6micrograms/kg/hr

PICU Infusion guidelines SORT August 2018

Isoprenaline Under 6kg: mg/kg dilution Over 6kg: Fixed conc (40micrograms/ml)
(central or peripheral)
0.3mg/kg in 50ml (NS or G) 2mg in 50ml (NS or G)
1ml/hr = 0.1microgram/kg/min 1ml/hr= (0.67÷ wt) micrograms/kg/min
Ampoules available:
Usual dose range: 0.2-5ml/hr = 0.02-0.5micrograms/kg/min (bradycardia); Usual dose range: 0.03-0.75ml/kg/hr = 0.02-0.5micrograms/kg/min (bradycardia);
1-10ml/hr = 0.1-1mcg/kg/min (CHB) 0.15-1.5ml/kg/hr = 0.1-1mcg/kg/min (CHB)

Midazolam Under 3kg: mg/kg dilution Over 3kg: mg/kg dilution

(central or peripheral)
2mg/kg in 50ml (NS or G) 1mg/kg in 50ml (NS or G)
Ampoules available: 1ml/hr = 40micrograms/kg/hr 1ml/hr = 20micrograms/kg/hr
10mg in 2ml and 10mg in 5ml Usual dose range: 0.2-1.5ml/hr =10-60micrograms/kg/hr Usual dose range: 0.5-5ml/hr =10-100micrograms/kg/hr

Milrinone All ages: Fixed concentration (200mcg/ml)

(central or peripheral)
10mg in 50ml (NS or G)
Ampoules available: 1ml/hr= (3.3 ÷ wt) micrograms/kg/min
10mg in 10ml Usual dose range: 0.11-0.23ml/kg/hr = 0.375-0.75micrograms/kg/min

Morphine Under 3kg: mg/kg dilution Over 3kg: mg/kg dilution

(central or peripheral)
2mg/kg in 50ml (NS or G) 1mg/kg in 50ml (NS or G)
Ampoules available: 1ml/hr = 40micrograms/kg/hr 1ml/hr = 20micrograms/kg/hr
10mg in 1ml and 30mg in 1ml Usual dose range: 0.2-1ml/hr =10-40micrograms/kg/hr Usual dose range: 0.5-4ml/hr =10-80micrograms/kg/hr

Noradrenaline Under 13kg: mg/kg dilution Over 13kg: Fixed concentration (80micrograms/ml)
(central) 0.3mg/kg in 50ml (NS or G) 4mg in 50ml (NS or G)
1ml/hr = 0.1micrograms/kg/min 1ml/hr= (1.3 ÷ wt) micrograms/kg/min
Ampoules available:4mg in 4ml
Usual dose range: 0.5-5ml/hr = 0.05 -0.5micrograms/kg/min Usual dose range: 0.0375-0.375ml/kg/hr = 0.05 -0.5micrograms/kg/min

Phenylephrine Fixed concentration (100mcg/ml)

(central or peripheral) 10mg in 100ml (NS or G)
Short-term use only
1ml/hr= (1.67 ÷ wt) micrograms/kg/min
Central access required for continuing infusions
Usual dose range: 0.06-0.3ml/kg/hr = 0.1-0.5mcg/kg/min
Ampoules:10mg in 1ml and 1mg in 10ml

Propofol Fixed concentration (10mg/ml)

(central or peripheral) 500mg in 50ml (NS or G)
Amp/vial available: 1ml/hr= (10 ÷ wt) mg/kg/hr
200mg in 20ml and 500mg in 50ml
Usual dose range: 0.1-0.4ml/kg/hr = 1-4mg/kg/hr

Salbutamol Fixed concentration (0.2mg/ml)

(central or peripheral) 10mg in 50ml (NS or G)
Ampoules available: 1ml/hr= (3.3 ÷ wt) micrograms/kg/min
0.5mg in 1ml
5mg in 5ml Usual dose range: 0.15-0.6ml/kg/hr = 0.5-2micrograms/kg/min . Loading dose may be required

Vasopressin Under 20kg: units/kg dilution Over 20kg: Fixed concentration (1unit/ml)
(argipressin)
1unit/kg in 50ml (NS or G) 20units in 20ml (NS or G)
(central) 1ml/hr = 0.02units/kg/hr 1ml/hr= (1 ÷ wt) units/kg/hr
Ampoules available: 20units in 1ml
Usual dose range: 0.5-6ml/hr = 0.01-0.12units/kg/hr Usual dose range: 0.01-0.12ml/kg/hr = 0.01-0.12units/kg/hr

PICU Infusion guidelines SORT August 2018

PICU Infusion guidelines SORT August 2018