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of Vancouver General Hospital. Prepared by the Pharmaceutical Sciences Clinical Services Unit by authority of the Drugs & Therapeutics Committee and the Medical & Academic Advisory Committee. |
The standardization of reconstitution and delivery of selected critical care drugs has been reviewed in an effort to provide uniformity and consistency for all staff using these drugs throughout the critical care areas. Three separate issues were addressed:
Standard concentrations
Bottles vs. viaflex plastic bags
Solution withdrawal
The following recommendations have been accepted and are to be followed unless stated otherwise by a physician's order.
1. Standard Drug Concentrations
| Standard Drug Concentrations | Amount of Drug added to 250 mL of appropriate IV solution | |
| Dobutamine | 1000 mcg/mL | 250 mg (1 vial) |
| 2000 mcg/mL* | 500 mg (2 vials) | |
| 4000 mcg/mL** | 1000 mg (4 vials) | |
| Dopamine | 1600 mcg/mL | 400 mg (premixed bag) |
| 3200 mcg/mL | 800 mg (premixed bag) | |
| Epinephrine | 8 mcg/mL | 2 mg (2 mL-1:1000) |
| 16 mcg/mL | 4 mg (4 mL - 1:1000) | |
| 32 mcg/mL | 8 mg (8 mL - 1:1000) | |
| 60 mcg/mL | 15 mg (15 mL-1:1000) | |
| Isoproterenol | 4 mcg/mL | 1 mg (5 mL-1:5000) |
| Labetolol | 1.6 mg/mL | 400mg (80 mL) |
| 3.2 mg/mL | 800mg (160 mL) | |
| Lidocaine | 4 mg/mL | premixed bag |
| Nitroglycerin | 200 mcg/mL | 50 mg (10 mL-5 mg/mL) |
| 400 mcg/mL* | 100 mg (20 mL-5 mg/mL) | |
| Nitroprusside | 200 mcg/mL | 50 mg (1 vial) |
| Norepinephrine | 16 mcg/mL 32 mcg/mL* 64 mcg/mL** |
4 mg (4 mL-1 mg/mL) 8mg (8 mL - 1 mg/mL) 16 mg (16 mL- 1 mg/mL) |
| Phenylephrine | 400 mcg/mL | 40 mg (4 mL-10 mg/mL) in 100 mL IV fluid |
| Procainamide | 4 mg/mL | 1000 mg (10 mL-100 mg/mL) |
* Double Strength ** Quadruple Strength
2. All of the aforementioned drugs must be mixed in plastic viaflex bags.
3. Overfill of the primary solution should not be withdrawn.
For the addition of drugs to primary solutions, it is recommended that the addition of drug volumes greater than 10% of the primary solution volume be preceded by the withdrawal of an equal volume of the primary solution.
Note: The final concentration obtained when overfill is not withdrawn is insignificantly different from that obtained following withdrawal, especially when titrating dose to patient response.
Rev July 2007