BNF for Children 2011-2012

792 Appendix 4: Intravenous infusions for neonatal intensive care BNFC 2011–2012Appendix 4: Intravenous infusions for neonatal intensive careOther infusions Infusions that frequently give rise toincompatibility include amino acids, mannitol, and sodiumbicarbonate.MethodReady-prepared infusions should be used wheneveravailable. When dilution of drugs is required to bemade extemporaneously, any product reconstitutioninstructions such as those relating to concentration,vehicle, mixing, and handling precautions should bestrictly followed using an aseptic technique throughout.Once the product has been reconstituted, further dilutionwith the infusion fluid should be made immediatelyin order to minimise microbial contamination and, withcertain products, to prevent degradation or other formulationchange which may occur; e.g. reconstitutedampicillin injection degrades rapidly on standing, andalso may form polymers which could cause sensitivityreactions.It is also important in certain instances that an infusionfluid of specific pH be used (e.g. furosemide injectionrequires dilution in infusions of pH greater than 5.5).When drug dilutions are made it is important to mixthoroughly; additions should not be made to an infusioncontainer that has been connected to a giving set, asmixing is hampered. If the solutions are not thoroughlymixed, a concentrated layer of the drug may form owingto differences in density. Potassium chloride is particularlyprone to this ‘layering’ effect when added withoutadequate mixing to infusions; if such a mixture isadministered it may have a serious effect on the heart.A time limit between dilution and completion of administrationmust be imposed for certain admixtures toguarantee satisfactory drug potency and compatibility.For admixtures in which degradation occurs without theformation of toxic substances, an acceptable limit is thetime taken for 10% decomposition of the drug. Whentoxic substances are produced stricter limits may beimposed. Because of the risk of microbial contaminationa maximum time limit of 24 hours may be appropriatefor additions made elsewhere than in hospital pharmaciesoffering central additive service.Certain injections must be protected from light duringcontinuous infusion to minimise oxidation, e.g. amphotericinand sodium nitroprusside.Table of drugs given by continuousintravenous infusion to neonatesThe table lists key drugs given by continuous intravenousinfusion to neonates.Covers dilution with Glucose intravenous infusion5% and 10% and Sodium chloride intravenous infusion0.9%. Compatibility with glucose 5% and withsodium chloride 0.9% indicates compatibility withSodium chloride and glucose intravenous infusion.Infusion of a large volume of hypotonic solutionshould be avoided, therefore care should be takenif water for injections is used.Adrenaline/Epinephrine (p. 113)Dilute 3 mg/kg body-weight to a final volume of50 mL with Glucose 5% or Sodium Chloride 0.9%; anintravenous infusion rate of 0.1 mL/hour provides adose of 100 nanograms/kg/minute; infuse through acentral venous catheter. Incompatible with bicarbonateand alkaline solutions.Note Usually made up with adrenaline 1 in 1000 (1 mg/mL)solution; this concentration of adrenaline is not licensed forintravenous administrationAlprostadil (Prostin VR c ) (p. 131)Dilute 150 micrograms/kg body-weight to a finalvolume of 50 mL with Glucose 5% or Sodium Chloride0.9%; an intravenous infusion rate of 0.1 mL/hourprovides a dose of 5 nanograms/kg/minute. Undilutedsolution must not come into contact with thebarrel of the plastic syringe; add the required volumeof alprostadil to a volume of infusion fluid in thesyringe, and then make up to final volumeAtracurium besilate (p. 643)Dilute 60 mg/kg body-weight to a final volume of50 mL with Glucose 5% or Sodium Chloride 0.9%; anintravenous infusion rate of 0.1 mL/hour provides adose of 120 micrograms/kg/hour; minimum concentrationof 500 micrograms/mL, max. concentration of5 mg/mLIntravenous infusion information for neonatal intensivecare only; for information in other children, seeindividual drug monographs.Dobutamine (as hydrochloride) (p. 111)Dilute 30 mg/kg body-weight to a final volume of50 mL with Glucose 5% or Sodium Chloride 0.9%; anintravenous infusion rate of 0.5 mL/hour provides adose of 5 micrograms/kg/minute; max. concentrationof 5 mg/mL; infuse higher concentration solutionsthrough central venous catheter only. Incompatiblewith bicarbonate and other strong alkaline solutionsDopamine hydrochloride (p. 111)Dilute 30 mg/kg body-weight to a final volume of50 mL with Glucose 5% or Sodium Chloride 0.9%; anintravenous infusion rate of 0.3 mL/hour provides adose of 3 micrograms/kg/minute; max. concentrationof 3.2 mg/mL; infuse higher concentration solutionsthrough central venous catheter. Incompatible withbicarbonate and other alkaline solutionsEpoprostenol (Flolan c ) (p. 96)Reconstitute the 500-microgram vial using the glycinebuffer diluent provided to make a 10 micrograms/mLconcentrate (pH 10.5); filter the concentrate using thefilter provided; the concentrate can be administeredvia a central venous catheter, or it may be dilutedfurther.Neonate body-weight under 2 kg, using the concentrate,dilute 150 micrograms/kg body-weight to a finalvolume of 50 mL with Sodium Chloride 0.9%; anintravenous infusion rate of 0.1 mL/hour provides adose of 5 nanograms/kg/minute.Neonate body-weight over 2 kg, using the concentrate,dilute 60 micrograms/kg body-weight to a finalvolume of 50 mL with Sodium Chloride 0.9%; anintravenous infusion rate of 0.1 mL/hour provides adose of 2 nanograms/kg/minute.Note Diluted solution stable for 12 hours at room temperature,although some units use for 24 hours and allow for lossof potency. Minimum concentration of 1.43 micrograms/mL