Guidelines

Critical Care

• Adult ICUs
• Pediatric ICUs

General Care

• IV Push List
• Adult
• Pediatric
• Obstetrics

Respiratory Care

Radiology

• Follow MGH procedure "IV Admixtures" when preparing IV medications

• Follow all policies and procedures in the Clinical Policy and Procedure Manual , Section II, "Intravenous Therapy".

• ACLS guidelines have been incorporated where applicable.

•  IV bolus medications that require administration by a physician will be specified. If not specified, IV bolus medications may be administered by a Registered Nurse.

• Administration times will be specified only for IV bolus medications that require slow administration.

• The standard solution for all admixtures is Dextrose 5% in Water. Most admixtures are stable in Dextrose 5% in Water or 0.9% Sodium Chloride. The solution will be specified only if the medication requires mixing in a particular solution for stability reasons.

• Central and peripheral concentrations are differentiated where applicable. If there is no delineation present, all concentrations may be administered through peripheral or central access.

• Check the Compatibility Chart prior to infusing two or more medications simultaneously via the same intravenous line. If the medication or compatibility is not listed, consult with a pharmacist.

• Utilize a 5 micron filter straw for withdrawal of medication from glass ampules. Discard filter; attach new needle or needless system device for administration

• Refer to statement defining "Usual Dosage Range and Route".

• Follow the extravasation protocol in the MGH Nursing Procedure manual for peripheral infiltration of medications.

• Patients receiving vasoactive drugs require frequent monitoring of blood pressure with parameters clearly defined in the physician's order.

Usual Dosage Range and Route Guidelines

•  The usual dosage range and route of all drugs was established after review of individual drug administration practices as deemed appropriate by Pharmacy, Nursing, and Medicine.

•  When a clinical situation arises which may necessitate exceeding the usual dosage range and route, a reevaluation of drug therapy must take place. Pharmacy, the primary or nurse caring for the patient at that time, the house officer, the medical director, and/or attending when indicated must be involved.

•  Documentation of newly established dose and parameters must be present in the medical orders and the rationale for the increase in the progress notes.