OHUD HOSPITAL

Continuous Nursing Education Department

Educational Handbook

Prepared By:
Marites M. Torres

Catherine G. Sacdalan
Translated by:
Malak Hussain Halwani
Noted By:

Sahar Marzouk Al Mohammadi

CNED Head
Approved By:
Mr. Mohammad Khaled Aljarrah
Director of Nursing

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Preface

This Handbook is a comprehensive yet concise clinical reference

designed for use by Ohud Hospital Nursing Staff. This Handbook, presents need to know information on daily procedures in
the nursing field.
This handbook is organized for versatility; to allow the Nursing
staff in a rush to go quickly through the guidelines of different
procedures in Ohud Hospital and check the corresponding answers.

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Table of Contents
Topics

Page No

1. Vital Signs..
Temperature.
Pulse.
Respiration..
Blood Pressure.
Glasgow Coma Scale.
Pain Assessment.

4
4
6
7
8
10
11

2. Medication Administration.
Conversion Table..
Dosages based on Body weight
Calculation of tablet..
Calculation of Syrup..
Calculation of IV Medication..

13
13
14
15
16
17

3. Nurse Role in Intravenous Therapy.

Groups of IVF
Types of IVF
Types of IV Infusion..

18
19
20
20

4. Computation of Intravenous Fluid..

Drops/min..
Number of Hours.
mL/Hr.

21
22
23
24

5.Crash Cart Medicine

25

6. Endotracheal Drug Delivery.

32

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Vital Signs
VITAL SIGNS
Temperature, pulse, respiration, blood pressure (B/P) & oxygen
saturation are the most frequent measurements taken by HCP.
Because of the importance of these measurements they are referred to as Vital Signs. They are important indicators of the bodys
response to physical, environmental, and psychological stressors.
VS may reveal sudden changes in a clients condition in addition
to changes that occur progressively over time. A baseline set of VS
are important to identify changes in the patients condition.
VS are part of a routine physical assessment and are not assessed in isolation. Other factors such as physical signs & symptoms are also considered.

Important Consideration:

A clients normal range of vital signs may differ from the standard
range.

TEMPERATURE
difference between the amount of heat produce by the body and
amount of heat lost.

Core temperature temperature of the body tissues, is controlled by

the hypothalamus (control center in the brain) maintained within a narrow range.
Skin temperature rises & falls in response to environmental conditions & depends on blood flow to skin & amount of heat lost to
external environment
Temperature is lowest in the morning, highest during the evening.

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Route
Oral
Posterior sublingual
pocket under
tongue (close to carotid artery)

Consideration
No hot or cold drinks
Leave in place 3 min
or smoking 20 min
prior to temp. Must
be awake & alert.
Not for small children
(bite down)

Axillary
Bulb in center of axilla
Lower arm position
across chest

Non invasive good

for chi dren. Less
accurate (no major
blood vessels nearby)

Leave in place 5-10

min.
Measures 0.5 C lower
than oral temp.

Rectal
Side lying with upper
leg flexed, insert lubricated bulb (1-11/2
inch adult) (1/2 inch
infant)

When unsafe or inaccurate by mouth

(unconscious, disoriented or irrational)
Side lying position
leg flexed

Leave in place 2-3

min.
Measures 0.5 C higher than oral

Ear
Close to hypothalmus
sensitive to core
temp. changes
Adult - Pull pinna up
& back
Child pull pinna
down & back

Rapid measurement
Easy assessibility
Cerumen impaction
distorts reading
Otitis media can distort reading

2-3 seconds

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Degree:
Centigrade

Temperature

Temperature Normal Values

Age
0-1

36.1-37.4

Age
1-6

Age
6-11

Age
11-16

Adult

36.9-37.5

36.3-37.6

36.4-37.6

36.4-37.4

PULSE
Rhythmic expansion and recoil of elastic artery caused by ejection of
blood from the ventricle. Palpated where an artery near the body surface
can be pressed against firm substances.
Felt by palpating artery lightly against underlying bone or muscle.
Carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis
pedis.
Pulse deficit the difference between the radial pulse and the apical
pulse indicates a decrease in peripheral perfusion from some heart
conditions ie. Atrial fibrillation.

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RESPIRATION
RESPIRATION- exchange of oxygen and carbon dioxideb etween
cellsof the body and the atmosphere. It consist of inhalation and
expansion and the pause which follows.
INSPIRATION Inhalation ( Breathing In)
EXPIRATION Exhalation ( Breathing Out)
Normal Breathing is active and passive.
Assess after taking pulse, while still holding hands, so patient is
unaware you are counting the respirations.
Assess by observing Rate, Rhythm and Depth
NORMAL RESPIRATION
Rate

Depth

Rhythm
Character

No. of breathing cycles per minute (inhale/exhale

1cycle)
Normal RR: 12-20 breaths/min (adult)
Eupnea normal rate & depth breathing
Tachypnea- Abnormal increase .
Bradypnea- Abnormal decrease .
Apnea- Absence of breathing.
Amount of air inhaled/exhaled
Normal (deep & even movements of chest)
Shallow (rise & fall of chest is minimal)
SOB shortness of breath (shallow & rapid)
Regularity of inhalation/exhalation
Normal- very little variation in length of pauses between Inhalation and exhalation.
Digressions from normal effortless breathing
Dyspnea difficult or labored breathing
Cheyne-Stokes alternating periods of apnea and
hyperventilation, gradual increase & decrease in
rate & depth of resp. with period of apnea at the end
of each cycle.

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NORMAL RESPIRATION
Age

Age 0-1

Age 1-6

Age 6-11

Age 11-16

Adult

Breath/
minute

26-40

20-30

18-24

16-24

12-20

BLOOD PRESSURE
Force exerted by the blood against vessel walls. Pressure of blood
within the arteries of the body Its ventricle contracts blood is forced
out into the aorta to the large arteries, smaller arteries & capillaries
SYSTOLIC- force exerted against the arterial wall as lt. ventricle contracts & pumps blood into the aorta max. pressure exerted on vessel
wall.
DIASTOLIC arterial pressure during ventricular relaxation, when the
heart is filling, minimum pressure in arteries.
Factors affecting BLOOD PRESSURE
Lower during sleep
Lower with blood loss
Position changes B/P
Anything causing vessels to dilate or constrict - medications
Measured in mmHg millimeters of mercury

Normal range

Systolic: 110-140 mmHg

Diastolic: 60-90 mmHg
Hypertensive - >160 (systolic) / >90 (diastolic)
Hypotensive- <90 (systolic)

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Improper cuff size

Cuff to wide will give false low reading
Cuff too narrow will give false high reading

Cuff too loose will give false high reading

Do not take Blood Pressure in:

Arms with cast
Arms with AVF ( Arteriovenous fistula)
Arm on the side of a mastectomy

(i.e. Right Mastectomy; Right Arm)

Blood Pressure in Lower Extremities

Best position:prone or Supine with knee slightly flexed,locate popliteal
artery (back of knee).
Use Large cuff 1 inch above artery, same procedure as arm. Systolic
pressure in legs maybe 10-40 mm hg higher
If unable to palpate a pulse you may use a Doppler stethoscope

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GLASGOW COMA SCALE

A neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent
assessment.
Composed of three test: EYE, VERBAL, and MOTOR responses
Lowest possible GCS is 3 (pt in deep coma), while the highest is 15
(pt is fully awake)

GLASGOW COMA SCALE

EYE

VERBAL

MOTOR

4
Eye opening
spontaneously
3
Eye opening to speech
2
Eye opening to pain

5
Oriented

6
Obeys commands

4
Confused
3
Inappropriate words
(random)
2
Incomprehensible
sounds (moaning)
1
No verbal response

5
Localizes pain
4
Flexion/withdrawal to
pain
3
normal flexion to pain
(decorticate)
2
Extension to pain
(decerebrate)
1
No motor response

1
No eye opening

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PAIN ASSESSMENT
PAIN
is an unpleasant feeling that is conveyed to the brain by sensory neurons
.The discomfort signals actual or potential injury to the body.
The main types of information that are useful:

How and when the pain started. Give details on how long the
pain has persisted, what caused it (following what kind of event)
and how it started (gradually or suddenly).

The location of the pain. Show the point where it hurts or areas
where the pain travels.

Pain characteristics. Describe the duration, frequency, intensity

(mild, moderate, intense, severe, etc.) and quality of the pain
(continuous, intermittent, throbbing, etc.). Describing pain is not
easy. This is why a pain rating scale is a useful evaluation technique.

Associated symptoms. Tell your doctor whether other symptoms

(sluggishness, fatigue, fever, etc.) are present.

Pain response to Activities Describe activities that increase the

pain and also those that relieve it.

What improves or worsens the pain. Describe situations that

make your pain better or worse. These can include changes in
weather conditions, living or working environment, lifestyle, etc.).

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PAIN ASSESSMENT TOOL

Different Pain Assessment Tools

1.
2.
3.

Numeric Rating Scale

Verbal Descriptor Scale
Faces Pain Scale

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MEDICATION
ADMINISTRATION
CONVERSION
NAME

ABBREVIATION

EQUIVALENT

1 Kilogram

KG

1000g

1 gram

1000mg

1 milligram

mg

1000mcg

1liter

1000ml

1mg = 1000mcg

4mg = 4000mcg

1000ml= 1 Liter

175ml to liter=0.175liter

500g=0.5kg

8.5mcg to mg=0.0085mg

5mcg=0.005mg

3000g to kg=3kg
450g to mg=450,000mg

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DOSAGES BASED ON BODY WEIGHT

(MG/KG OR MCG/KG):
FIRST:

Multiply the ordered mg/kg dose by weight of the patient in kg

to get dose desired for that patient.
SECOND: Determine the supply of the drug you have on hand.
THIRD:
Calculate the dose to give, using the method of your choice
and administer.

Examples:
A baby is ordered to receive a Furosemide oral solution 2mg/kg. Available is Furosemide 10mg/ml. The baby weighs 6.7kg, how many ml you
will give?
Answer:
First: 6.7kg X 2mg/kg= ?
6.7kg X 2mg/kg= 13.4mg
Second: Stock on hand is 10mg/ml
D
Third: S X Q

13.4mg 10mg/ml X 1ml= ?

13.4 mg 10 mg/ml X 1ml= 1.34 ml

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Medication Calculations
Calculation for Tablets or Capsules
Formula : D
X Q
S
Q = 1 tablet/capsule
To get the number of tablet/ capsule:
= Dose ordered by the doctor
Stock medication

X Quantity

Example:
Doctor ordered to give Tablet Voltaren 50mg twice daily. The stock available is 100mg per tablet. How many tablet will you give per dose?
= Dose ordered by the doctor
Stock medication

= 50 mg
100 mg

X Quantity

X 1 Tablet

= 0.5 Tablet or 1/2 Tablet

= 0.5 tablet or 1/2 tablet will be given per dose.

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Calculation for Syrup or Suspension

Formula: = Dose ordered by the doctor
Stock medication

X Quantity

Q = ml of Suspension

Example:
Keflex Suspension 125mg/ 5ml. Doctor ordered to give 250mg. How
many ml will you give?
= Dose ordered by the doctor
Stock medication
= 250mg

125mg

X Quantity

X 5ml

= 10 ml
=10 ml will be given to the patient.

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Calculation for Intravenous (IV) medications

Formula: = Dose ordered by the doctor
Stock medication

X Quantity

Q= Amount of Dilution

Example:
Patient receiving Ceftriaxone 750mg three times daily. Stock on
hand is 1Gram. It is diluted with 5ml. How many ml should be given per
dose?
= 750mg X 5ml
1 Gram
Stock on hand is on GRAMS,
= Dose ordered by the doctor
Stock medication

X Amount of dilution

Convert first, Grams to milligrams!

1 Gram= 1000mg
Stock on hand 1 Gram x 1000 mg = 1000 mg

NOW, WE CAN COMPUTE!!!!

= 750 mg X 5ml
1000 mg
= 3.75 ml
=3.75 ml will be aspirated and administered to the patient.

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Nurse Role in Intravenous

Therapy
IV Therapy requires Doctors order and Documentation.
It is performed under aseptic technique.
Limb or site insertion should be secured with plaster and splint to
avoid dislodgement.
Site must be assessed for complications and change after 72 hours.

Indications of IV Therapy.
Restore and maintain fluid and electrolyte balance.
for medication and chemotherapeutic agents.
Blood and Blood products administration

Parental nutrition if patient is unable to eat orally.

Commonly Accessed Veins for IV therapy.

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Basilic Vein largest arm vein of the upper extremity. Begins at the
dorsum of the hand, crosses the elbow, and drains
into the brachial vein
Cephalic Vein - runs along the radial aspect of the arm from the
wrist to should and empties in to the axillary vein
Median Vein forms a Y below the elbow and drains into both
basilica and cephalic veins
Median Antecubital Vein oblique coursing vein at the elbow that
joins the basilica and cephalic veins
Brachial Vein deep vein of the upper arm, travels in the upper arm
parallel to the brachial artery and joins with the
basilic vein

Two Main Groups of Fluids

Crystalloid isotonic and remain isotonic and are effective volume
expanders. Ideal for patients who need fluid replacement

Example: LR, NS
Colloid contains molecules that are too large to pass out of the
capillary membranes and therefore remains in the vascular
compartment. Works well in reducing edema while expanding
the vascular compartment
Example: albumin, steroids

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3 Main Types of Fluids/ Solution

Isotonic Isotonic crystalloidA crystalloid solution that has the same
concentration of electrolytes as the body plasma
Example: LR, NS/0.9% saline in water
Hypotonic Hypotonic crystalloidA crystalloid solution that has a
lower concentration of electrolytes than the body plasma.=
Example: NS
Hypertonic - Hypertonic crystalloidA crystalloid solution that has a
higher concentration of electrolytes than the body plasma.
Example: D5 NS, D10Water, D5NS

TYPES OF IV INFUSION
IV Push/Bolus direct administration of a medication into an ongoing IV
infusion
Continuous Infusion uses infusion control devices or traditionally hung
bags of solutions and tubings with flow rate regulation
Intermittent Infusion given through an intermittent access device,
piggybacked to continuous IV infusion {eg. Medication
administered)

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COMPUTATION OF
INTRAVENOUS FLUIDS.
An IV infusion set is used to administer fluids and medications directly
into the blood stream. Infusion or flow rates are adjusted to the desired
drops per minute (gtts/min) by a clamp on the tubing. The flow rate is
calculated by the nurse in drops per minute (gtts/min).
To calculate this, one must know the administration set drop factor,
which is constant.

MACRODRIP TUBING administers a larger drop and may be used for

10gtts/ml, 15gtts/ml,20 gtts/ml.

MICRODRIP TUBING administers 60gtts/mL.

These are called drop factors. The drop factor is the number of drops
contained in 1 milliliter.

drops/min =

Volume of solution in ml
Number of Hours

# Hours =

Volume of solution in mL
mL/Hr

mL / Hr

Volume of solution in mL
Number of Hours

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Drop Factor
60 minutes

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Sample Computation
DROPS/MINUTE ( gtts/min)
drops/min =

Volume of solution in ml
Number of Hours

Drop Factor
60 minutes

Doctor ordered to infuse NS 500 mL to run for 6 hours. Using a tubing

set of 20.How many drops/min you will regulate your fluids?

FORMULA:

drops/min =

drops/min =

drops/min =

Volume of solution in ml
Number of Hours

500 ml
6 Hours

Drop Factor
60 minutes

20
60 minutes

10,000
360

=27.78 or 27-28 drops/min (gtts/min)

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NUMBER OF HOURS
# Hours =

Volume of solution in mL
mL/Hr

Doctor ordered to infuse NS 500 x 100 mL/ Hour. How many Hours the
fluid will be given?

FORMULA:
# Hours =

Volume of solution in mL
mL/Hr

# Hours =

500 mL
100 mL/hr

= 5 HOURS

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mL/Hour
mL / Hr =

Volume of solution in mL
Number of Hours

Doctor ordered NS 500 to run for 5 hours. How many mL /Hr the fluid will
be running?
FORMULA:

mL / Hr =

mL / Hr =

Volume of solution in mL
Number of Hours
500 mL
5 hours

= 100 mL/Hr

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CRASH CART MEDICATIONS

1. ATROPINE 0.5mg/mL

Classification: Anticholinergic/ Vagolytic

(Suppresses sweating, lacrimation, salivation and secretion)

Action: Organophosphate poisoning; antidote. Used for pupil dilation. Potent bronchodilator, bronchial secretions.GI spasms, block vagal
impulses to the heart.

Route: Intravenuous (1mg), Endotracheal ( 1-2mg) maximum dose of

3 mg.

Nursing Implication: Follow measures to relieve dry mouth, adequate hydration, avoid driving and other hazardous activities.

2. Epinephrine 1 mg/ ml

Classification: Alpha and Beta adrenergic agonist, cardiac stimulant,

vasopressor, anti-anaphylactic.

Action: Restore cardiac rhythm, relief of bronchospasm, ophthalmic

decongestant.

Route: Intravenous (1mg), Endotracheal (2-2.5 mg)

Nursing Implication: Take medication as prescribed, discard discolored or precipitated solutions.

3. Calcium Gluconate 10% 1gram

Classification: Fluid and Electrolyte Replacement

Action: Hyperkalemia, Hypocalcemia

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Route: Intravenous
Nursing Implication: Remain on bed for 15-20 min, Instruct patient
to avoid foods high in calcium.

4. Furosemide 20mg/ 2mL

Classification: Loop diuretics/ Antihypertensive

Action: To produce more urine, reduce the fluid overload in patients
with CHF or hypertension. Pulmonary Edema

Route: Intravenous / per orem

Nursing Implication: Consult physician regarding allowed Salt and
water intake. Learn signs and symptoms of hypokalemia. Avoid direct
exposure to sun.

5. Digoxin 0.5mg / 2mL

Classification: Cardiac glycoside/ Antiarrythmic

Action: Increase contractility to heart muscle, AF atrial flutter
Route: Intravenous / per orem
Nursing Implication: Report to physician pulse less than 60.
Weigh daily. Do not skip or double dose

6. Lidocaine 50mg/ 5mL

Classification: Anti-Arrythmics
Action: Ventriculatar Tachycardia/ Ventricular Fibrillation, Treat cardiac arrythmias . To have normal sinus rhythm. Local anesthetic.

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Route: Intravenous
Nursing Implication: Do not ingest food within 60 min after drug
application for oral anesthetics.

7. Verapamil 5mg/ 2mL

Classification: Calcium channel blocker/ Antihypertensive/ Antiarrythmic

Action: Atrial flutter, Atrial Fibrillation, Paroxysmal SVT. Decreases

angina attacks.

Route: Intravenous / per orem

Nursing Implication: Monitor radial puse before each dose. Decrease caffeine. Change position slowly.

8. Propanolol 1 mg/ mL

Classification: Antagonist, Anti hypertensive, Anti-arrhythmic, Beta

adrenergic blocker

Action: Prophylaxis & treatment of life threathening of life threathening ventricular Arrythmias particular Af with stable VT, Cardiac Arrest,
Pulseless VT/VF.

Route: Intravenous
Nursing Implication: Take radial pulse before the dose, it will suppress signs of hypoglycemia.

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9. Amiodarone 150mg/ 3mL

Classification: Antiarrythmic
Action: Prophylaxis & treatment of life threatening Ventricular arrythmias particular with AF, stable VT, Cardiac arrest; Pulseless VT/VF.

Route: Intravenous
Nursing Implication: Check pulse daily, report pulse less than 60.
Take oral drug consistently, use dark glasses with photophobias, wear
protective clothing and sunscreen.

10. Adenosine 6mg/ 2mL

Classification: Antiarrythmias
Action: Restore normal sinus rhythm with paroxysmal supraventricular tachycardia

Route: Intravenous ( macimum single dose 12 mg) rapid IV push

Nursing Implication: Flushing may occur during injection. Patient
should be connected to cardiac monitor. CPR trolley ready.

11. Procainamide

Classification: Antiarrythmics
Action: Atrial arrythmias, produces peripheral vasodilation and hypotension

Route: Intravenous . Slow infusion

Nursing Implication: Keep record of weekly weight, keep record of
pulse rate. Do not double dose or change an interval because a previous
dose was missed.

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12. Dexamethasone 8 mg/ 2mL

Classification: Adrenal corticosteroid, glucocorticoid

Action: Anti-Inflammatory, reduce inflammations in the airways
Route: Intravenous / per orem
Nursing Implication: Take exactly as prescribed. Reposrt lack of
response to medication or malaise, hypotension, muscular weakness and
pain, nausea and vomiting, anorexia, hypoglycemic reactions. Report
changes in appearance and easy bruising.

13. Methylprednisolone 500mg/ vial

Classification: Adrenal corticosteroid, cardiac arrest

Action: Prevent recurrence of anaphylaxis after epinephrine worn off
and for patients with asthma.

Route: Intravenous
Nursing Implication: Do not alter established dosage regimen.
Report onset of hypocorticism, adrenal insufficiency.

14. Magnesium Sulfate 1gram/ 10mL

Classification: Electrolyte, Anticonvulsant

Action: Seizure, Pre-eclampsia, Hypomagnesia
Route: Intravenous
Nursing Implication: Drink sufficient amount of water during the
day. Recommended dietary allowance of magnesium sulfate is obtained
in normal diet.

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15. Diphenhydramine 50mg/mL

Classification: Antihistamine, H1 receptor antagonist

Action: Acute allergic reaction, Extrapyramidal reaction to Phenothiazine.

Route: Intravenous
Nursing Implication: Do not use alcohol or other CNS depressant.
Do not engage in any hazardous activities.

16. Naloxone 0.4mg/ mL

Classification: Narcotic antagonist

Action: Antidote to opiods such as heroin or morphine/ narcotic
respiratory depression

Route: Intravenous
Nursing Implication: Reports post operative pain that emerges
after administration of this drug.

17. Dextrose 50% water 25mg/ 50mL

Classification: 6 carbon sugar that is principal carbohydrate used by

the body.

Action: Hypoglycemia
Route: Intravenous
Nursing Implication: Monitoring of RBS. Hydrate the patient.

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18. Sodium Bicarbonate 50 mmol

Classification: Electrolyte/ cardiac arrest

Action: Hyperkalemia, Metabolic acidosis with bicarbonate loss, hypoxic lactic acidosis. Used as a buffer in respiratoty acidosis-induced cardiac arrest.

Route: Intravenous
Nursing Implication: Do not used as antacid. Do not use antacids
longer than two weeks. Be aware that Over the counter medicines includes sodium bicarbonate.

19. Dopamine 200mg/ mL

Classification: cardiac stimulant/ adrenergic anatagonist

Action: Increased heart rate and blood pressure/ bradycardia, hypotension. Vasoconstriction and raise BP.

Route: Intravenous
Nursing Implication: Monitor BP, pulse and urinary output, Monitor
therapeutic effectiveness.

20. Dobutamine 250mg/ vial

Classification: Beta adrenergic agonist/ cardiac stimulant

Action: Used in treatment of heart failure and cardiogenic shock.
Route: Intravenous
Nursing Implication: Report anginal pain to physician

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21. Norepinephrine/ noradrenaline 4mg/ mL

Classification: Symphatomimetic
Action: Cardiogenic/ Neurogenic/ Inotropic shock. Hemodynamically
significant hypotension refractory to other symptoms.

Route: Intravenous
Nursing Implication: Observe carefullt mental status, monitor Intake and Output. Be aware of patient complaints of headache, vomiting
palpitation.

22. Vasopressin 20 units/ vial.

Classification: Hormone pituitary, Antidiuretic, ADH replacement

Action: Alternative vasopressor in cardiac arrest. Effective in reversing dieresis caused by diabetes insipidus. Used as diuretic.

Route: Intravenous
Nursing Implication: Prepared for anginal attack and have coronary artery vasodilator available. Avoid Concentrated fluids like syrups.
Measure and record data related to polydypsia.

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ENDOTRACHEAL DRUG
DELIVERY
The endotracheal (ET) route for delivery may be use when a life
threathening or srious condition requires immediate drug intervention, but
intravenous or intraosseous access is not readily available.

Endotracheal Drugs
If vascular access is unavailable, the ET route may be used for
the administration of certain drugs, including Lidocaine, Epinephrine, Atropine, Naloxone and vasopressin.

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Factors that determine the

Effectiveness of
Endotracheal Drugs
1. Method of Drug Delivery
In Intubated patients, the ETdelivered drug may be given either by direct
injection of the solution down the ET tube or through a 5 French feeding
catheter passed 0.5cm. Beyond the distal tip of the ET tube.

2. Diluents Used with the Drugs.

Various diluents used with ET-delivered drug can affect the rate of absorption of a drug, the peak serum level attained by the drug, and the
duration of therapeutic levels of the drug. Tracheal absorption is greater
with distilled water as the diluents than with saline.

3. Volume
Placing an excess volume of solution into the ET tree may cause hypoxia
or respiratory acidosis.

4. Drug Dosage
For adults, the recommendation is to give all ET drugs at 2 to 2.5 times
the recommended IV dose. 1 PEDS: the recommended ET dose of epinephrine for pediatric patients is approximately 10 times the dose given
via an intravenous route.

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Specific Drug Observation

and Recommendations
Lidocaine:
Current adult AHA Guidelines recommend that an ET delivered dose of
lidocaine of 2 to 4 mg/kg. For this ET dose to reach therapeutic levels
takes 5 minutes and to reach peak levels takes 20 minutes. The level
remains therapeutic for 30 to 60 minutes.

Epinephrine:
Current AHA guidelines for ET use of epinephrine in an adult recommend
using 2 to 2.5 times the standard IV dose of 1 mg (ET dose= 2 to 2.5
mg), while suggesting that the (PEDS) Pediatric ET dose of epinephrine
be increased by approximately 10 times the standard IV dose of 0.1 mL/
kg of a 1:10,000 solution (0.01 mg/kg) (ET dose= 1mL/kg of 1: 10,000
solution or 0.1 mg/kg). For neonatal resuscitation, ET doses of epinephrine up to 0.1 mg/kg of a 1 to 10,000 (0.1 mg/ mL) are suggested.

Atropine:
Current AHA Guidelines suggest that the recommended ET delivered
dose of atropine be 2 o 2.5 the standard IV dose of 1 mg (ET dose =2 to
2.5 mg). PEDS AHA Guidelines that the pediatric ET dose should be 0.04
to 0.6 mg/kg with a minimal dose of 0.1 mg.

Naloxone:
Human data on the use of naloxone ET is sparse to nonexistent. Current
AHA Guidelines do not specifically give an adult dose for naloxone ET,
but logic would suggest that the dose should be 2 to 2.5 times the standard IV/IO dose of 0.4 to 2 mg. PEDS AHA guidelines do not recommend

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ET use of naloxone in neonates; for pediatric patients, the AHA states

that other routes are preferred. If used, a reasonable dose, base on 2 to
10 times the IV/IO dose of 0.1 mg/kg, would be 0.2 to 1mg/kg. For single
dose, a maximum of 2 mg is consistent with standard dosing recommendation.

Vasopressin :
The administration of vasopressin appears to be equally effective by ET
and IV routes.

CONCLUSION
The administration of drugs via the ET route is an option in special situations in which IV/IO access cannot be obtained and critical medications
must be given immediately. Continue to seek intravenous or intraosseous
access and use in place of the ET route as soon as possible.

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Mneumonics Diuretics

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References:
1.

Nursing Services Policy and Procedures

Vital Signs

Medication Administration

Nurse Role in IV Therapy

2. Cardiovascular 4: Endotracheal Drug Delivery.

(2011,October 13 ). https:/calsprogram.org/manual/volume3/
section12/CV/05-CV4EndotrachDrugDelive13.html

CONTINUOUS NURSING EDUCATION DEPARTMENT

TELEPHONE NUMBER;
830-0016 Local 2809

Email Address:
cned_ohudhospital@yahoo.com

Website:
www.ohudhospital.com
cnedohud.weebly.com

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