Implementation

Drotrecogin should be discontinued 2 hr prior to invasive surgical procedures or procedures with a risk of bleeding. Once hemostasis is achieved, drotrecogin may be started 12 hr after the procedure

IV Adminstration:

• Intermittent Infusion:
Calculate dose and number of 5-mg or 20-mg vials needed (vials contain excess to facilitate delivery). Reconstitute 5-mg vials with 2.5 ml and 20-mg vials with 10 ml sterile water for injection for a concentration of 2 mg/ml. Add sterile water slowly to vial; avoid inverting or shaking. Gently swirl until powder is completely dissolved.
Diluent: Reconstituted solution must be diluted further with 0.9% NaCl. Withdraw amount of reconstituted solution needed from vial and add to infusion bag of 0.9% NaCl; direct stream to side of the bag to avoid agitating solution. Gently invert bag to mix. Reconstituted solution must be used within 3 hr and IV administration must be completed within 14 hr of preparation of IV solution. Do not administer if discolored or contains particulate matter. If infusion is interrupted, restart at initial infusion rate and continue to complete recommended infusion.
Concentration: 100–1000 mcg/ml. When using low concentrations (<200 mcg/ml) at low flow rates (<5 ml/hr), prime infusion set for approximately 15 min at a flow rate of 5 ml/hr

• Rate:
Administer at a rate of 24 mcg/kg/hr for 96 hr. Do not use bolus dosing or dose escalation

• Y-Site Incompatibility:
Administer via a dedicated IV line or a dedicated lumen of a multilumen central venous catheter

• Solution Compatibility:
May be administered only with 0.9% NaCl, LR, dextrose or dextrose/ saline combinations

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