Weil Cornell Medical College - New York Presbyterian Hospital


  Drip Medications
Furosemide (Lasix) Initial IV bolus dose of 0.1 mg/kg followed by continuous IV infusion doses of 0.1 mg/kg/hour doubled every 2 hours to a maximum of 0.4 mg/kg/hour.
(Lexi-Comp Online)
Heparin Initial IV bolus dose of 75 unit/kg followed by a continuous IV infusion of 20 unit/kg/hr (or 28 unit/kg/hr for patients < 1 year of age).
(NYP Heparin Prescribing Guidelines)
Milrinone (Primacor)

Loading dose of 50 mcg/kg administered over 15 minutes followed by a continuous infusion of 0.5 mcg/kg/minute; range: 0.25-0.75 mcg/kg/minute; titrate dose to effect. Adjust for renal impairment.
(Lexi-Comp Online)

Terbutaline (Brethine) Continuous IV infusion has been used successfully in children with asthma; a 2-10 mcg/kg loading dose followed by an 0.08-0.4 mcg/kg/minute continuous infusion; depending upon the clinical response, the dosage may require titration in increments of 0.1-0.2 mcg/kg/minute every 30 minutes; doses as high as 10 mcg/kg/minute have been used. Adjust for renal impairment.
(Lexi-Comp Online)

Loading dose (in patients not currently receiving aminophylline or theophylline): 5 mg/kg given IV over 20-30 minutes; administration rate should not exceed 20 mg/minute. After the loading dose, refer to the following for approximate I.V. theophylline dosages:

  • Infants 6 weeks to 6 months: 0.4 mg/kg/hour
  • Children 6 months to 1 year: 0.5-0.6 mg/kg/hour
  • Children 1-9 years: 0.8-1 mg/kg/hour
  • Children 9-16 years and young adult smokers: 0.7 mg/kg/hour
  • Healthy, nonsmoking adults: 0.55 mg/kg/hour
  • Older patients and patients with cor pulmonale: 0.2 mg/kg/hour
  • Patients with congestive heart failure or liver failure: 0.2 mg/kg/hour

(Lexi-Comp Online)

Vasopressin (DI)

Continuous IV infusion 0.5 milliunit/kg/hour (0.0005 unit/kg/hour); double dosage as needed every 30 minutes to a maximum of 0.01 unit/kg/hour.
(Lexi-Comp Online)

Vasopressin (Shock) The initial continuous infusion dose of vasopressin is: 0.0005 units/kg/minute. If patient responds to a greater degree than expected, this initial continuous infusion rate of 0.0005 units/kg/minute should be weaned downward to the minimal effective dose. If patient does not respond to the initial 0.0005 units/kg/minute continuous infusion rate within the first 10-20 minutes, adjust continuous infusion rate upward to deliver 0.001 units/kg/minute. If patient does not respond to this increase within the next 10 to 20 minutes, adjust the continuous infusion rate upward to deliver a maximum rate of 0.002 units/kg/minute.
(NYP Vasopressin Prescribing Guidelines)
Vasopressin (GI Bleed) Initial: 0.002-0.005 units/kg/minute; titrate dose as needed; maximum dose: 0.01 units/kg/minute. If bleeding stops for 12 hours, then taper off over 24-48 hours.
(Lexi-Comp Online)


  Pharmacy Procedures

Continuous Infusions Prepared by Pharmacy for the PICU

  1. All epidural infusions
  2. All continuous infusions which require additional dextrose or electrolytes (sodium, potassium, calcium, magnesium, etc)
  3. All continuous infusions which require multiple vials / ampules of the same medication (10 or more) to prepare (e.g. terbutaline)
  4. Heparin arterial line and CVP bags (125 units / 500 ml) - stocked in Pyxis
  5. All insulin infusions (encourage adult standard of 100 unit / 100 mL NS)
  6. All Aminophylline infusions
  7. Standardized medicated infusions listed in the table ...

In emergent situations, the first bag will be made on the unit (or pulled from Pyxis). Subsequent bags will come from the pharmacy. To request a new infusion bag, please fax a missing med request to the pharmacy satellite 2 hours prior to the next bag hang time.


  Nursing Procedures

PICU Standardized Medicated Infusions

  • All Premix (made by manufacturer) medicated infusions are good for 72 hours
  • Available in Pyxis
    • Dobutamine
    • Dopamine
    • Heparin
    • Milrinone
    • Theophylline
  • Spike bag with Secondary set
    • Use Stopcock and 60cc syringe / microbore tubing
    • * For double syringe changes: [Click for image]
  • Standardized medicated infusions not available in Pyxis
    • Pharmacy will make these according to standard dose / expire in 24 hours
      • Epinephrine
      • Fentanyl
      • Norepinephrine
      • Vecuronium
    • Emergently needed medication
      • PICU nurse will make FIRST bag/syringe
      • Pharmacy will then make up subsequent bags
    • Notify pharmacy 2 hours before new infusion needed
    • Fax a missing medication request
    • Follow-up with a phone call
  • No other variations are to be made for these 9 medication



Fixed Concentrations v Rule-of-Six (Discussion)

Disclaimer: All calculations must be confirmed. This program is not a substitute for clinical judgement nor an understanding of the use of the drugs. There are no claims, explicit or implied, of the accuracy of any of the data or information provided.

Weill Cornell University Medical Center - New York Presbyterian Hospital
Created: December 14, 2004                                       Revised: December 14, 2004