Procedural medication dosing for diagnostic cath and PCI · works offline
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CrCl: not setHEMODIALYSISSession: 0:00
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Workflow figure
Heparin (UFH)
Total this case0 units
Last heparin dosenone
Time since last dose--
Last ACTnone
Time since last ACT--
Step 1: Initial bolus
Diagnostic bolus (50 u/kg)For diagnostic cath only. ACT not measured. Capped at 5,000 units (diagnostic max).
Enter weight to begin.
Diagnostic bolus: for diagnostic cath only. ACT not measured.
PCI bolus
Prior diagnostic dose?
Enter weight to begin.
PCI bolus: goal ACT 250 - 300 sec. Check ACT 1-5 min after bolus.
Step 2: Top-up by ACT
Recommended top-up
Enter weight and ACT.
Top-up by ACT: below 250 sec recheck the ACT 1-5 min after the top-up; 250 - 300 sec is therapeutic, maintenance every 15-30 min; above 300 sec hold and recheck in 15-30 min.
Protamine doseSlow IV over 10-15 min. Pre-medicate or use cautiously with prior protamine exposure (NPH insulin, prior cardiac surgery, fish allergy). Max 50 mg single dose.
Enter total units to calculate.
Protamine: slow IV over 10-15 min. Pre-medicate or use cautiously with prior protamine exposure (NPH insulin, prior cardiac surgery, fish allergy).
Bivalirudin (IV)
Goal ACT ≥ 225 sec at 5 min after bolus.
Step 1: Renal functionRenal function sets the infusion rate only; the bolus (0.75 mg/kg) is unchanged across all renal scenarios. No CrCl entered: normal rate. CrCl and HD are shared with the eptifibatide tab.
CrCl ≥ 301.75 mg/kg/hr
CrCl < 301.0 mg/kg/hr
On HD0.25 mg/kg/hr
Preparation - Bivalirudin
Standard concentration 5 mg/mL (250 mg in 50 mL).
Step 2: Bolus and infusion
Bivalirudin dose
Enter weight to calculate.
Step 3: Check ACT
ACT at 5 min
ACT < 225 sec
Additional 0.3 mg/kg bolus, then continue the infusion.
ACT ≥ 225 sec
Therapeutic. Continue the infusion.
If ACT < 225 sec at 5 min, give an additional 0.3 mg/kg bolus, then continue the infusion; no further ACT checks needed. If ≥ 225 sec: therapeutic, continue the infusion through end of PCI.
Eptifibatide (IV)
GP IIb/IIIa inhibitor. Used for high thrombus burden, slow-flow / no-reflow, or bailout during PCI. Contraindicated in active bleeding, recent stroke, severe HTN, severe thrombocytopenia, and dialysis.
Step 1: Renal functionInfusion 2 mcg/kg/min, or 1 mcg/kg/min (50% reduction) when CrCl < 50. Contraindicated in hemodialysis. No CrCl entered: normal rate. CrCl and HD are shared with the bivalirudin tab.
CrCl ≥ 502 mcg/kg/min
CrCl < 501 mcg/kg/min
On HDContraindicated
Preparation - Eptifibatide
Bolus vial: 20 mg / 10 mL = 2 mg/mL. Infusion bag: 75 mg / 100 mL = 0.75 mg/mL (ready to use).
Step 2: Double bolus and infusion
Eptifibatide doseContraindicated in active bleeding, recent stroke, severe HTN, severe thrombocytopenia, and dialysis. Give a second identical bolus 10 min after the first; start the infusion with the first bolus. Continue infusion up to 18-24 hr. Label maximum: 22.6 mg per bolus; infusion 15 mg/hr (7.5 mg/hr at 1 mcg/kg/min).
Enter weight to calculate.
Give a second identical bolus 10 min after the first; start the infusion with the first bolus. Continue the infusion up to 18-24 hr. Label maximum: 22.6 mg per bolus; infusion 15 mg/hr (7.5 mg/hr at 1 mcg/kg/min).
Adenosine (IV/IC)
Maximal coronary hyperemia for FFR; also used in CMD testing (IMR, CFR). Half-life ~10 sec; transient AV block possible.
Preparation - Adenosine - IV infusion
Standard mix: 90 mg adenosine in 90 mL normal saline = 1,000 mcg/mL (1 mg/mL). Run via large-bore peripheral IV.
Step 1: IV infusionPreferred for FFR. Onset 1-2 min, steady hyperemia. Best for FFR pullback, IMR, CFR. Large-bore peripheral or central line.
IV infusion dose
IV infusion: 140 mcg/kg/min is the standard rate; 180 mcg/kg/min is the escalation if hyperemia is inadequate.
Enter weight to calculate.
Preparation - Adenosine - IC bolus
Dilute 1 mg adenosine in 100 mL saline = 10 mcg/mL. Practical mL volumes for IC push:
15 mcg = 1.5 mL · 20 mcg = 2 mL · 30 mcg = 3 mL · 40 mcg = 4 mL
Alternative two-step dilution: take 1 mL of the IV prep (1,000 mcg/mL) + 99 mL saline = 10 mcg/mL.
Step 2: IC bolus (quick check)Alternative to the IV infusion for a single FFR check, no pullback. Onset <10 sec; duration 5-10 sec. May cause transient AV block; requires rapid pressure recording.
Dose by vessel
RCA
15-20 mcg rapid IC bolus, then saline flush
LCA / left main
20-40 mcg rapid IC bolus, then saline flush
Onset <10 sec; duration 5-10 sec. May cause transient AV block; requires rapid pressure recording.
Enter vessel and dose to log.
Dobutamine (IV)
Inotropic stress for myocardial bridging assessment or CMD provocation. Incremental IV infusion.
Preparation - Dobutamine
250 mg in 250 mL D5W = 1,000 mcg/mL · 500 mg in 250 mL = 2,000 mcg/mL · 1,000 mg in 250 mL = 4,000 mcg/mL.
Use central or large-bore peripheral line; do not mix with bicarbonate.
Step 1: Concentration
Step 2: TitrateStart at 10 mcg/kg/min and escalate every 3-5 min up to 40 mcg/kg/min based on hemodynamic response. Stop for: arrhythmia, ischemia, symptomatic hypotension, target heart rate reached.
10Start here
20Common target
30If response inadequate
40Maximal dose
Infusion rate
Enter weight to calculate.
Start at 10 mcg/kg/min and titrate every 3-5 min up to 40 mcg/kg/min based on hemodynamic response. Monitor for arrhythmia, hypotension, ischemia.
Acetylcholine (IC)
Provocative testing for coronary vasospasm. Incremental IC boluses; positive test = >90% narrowing, ischemic ECG changes, or typical chest pain. Reverse with IC nitroglycerin 100-200 mcg.
Preparation - Acetylcholine
Use Miochol-E ophthalmic solution (10 mg/mL). Draw 1 mL and dilute in 1,000 mL (1 L) normal saline. This yields a working concentration of 10 mcg/mL.
Discard if not used within prep window; protect from light.
Step 1: Incremental IC bolusesHave IC NTG 100-200 mcg, atropine, and pacing available. Avoid in severe LV dysfunction, severe AS, or recent ACS.
Incremental IC bolus dosing
Step
Dose
Volume of 10 mcg/mL prep
1
20 mcg
2 mL
2
50 mcg
5 mL
3
100 mcg
10 mL
4 (LCA only)
200 mcg
20 mL
Administration: step 1 slow IC bolus over ~20 sec, observe 2-3 min for response. Step 2: if no spasm and no ischemia, escalate. Step 3: repeat angiography and ECG. Step 4: maximal LCA dose; RCA usually stops at 80 mcg.
Stop at any positive test. Have IC NTG 100-200 mcg, atropine, and pacing available. Avoid in severe LV dysfunction, severe AS, or recent ACS.
Anti-bradycardia / anti-AV block adjunct for rotational atherectomy. Given at the start of the case so the effect is on board before slow-flow / no-reflow develops.
Preparation - Aminophylline
Aminophylline 25 mg/mL (250 mg / 10 mL or 500 mg / 20 mL). For 250 mg: draw 10 mL (one full 250 mg vial). Dilute in 50-100 mL NS or D5W and infuse over 5-10 min, or give as slow IV push.
Step 1: Dose at case startGive at the start of the case, before rota burr activation. Peak effect ~30 min, sustained activity for several hours, covers the procedure. Watch for tachyarrhythmia.
Standard dose for rotational atherectomy
250 mg IV slow push (over 5-10 min)
Given at the start of the case, before rota burr activation. Peak effect ~30 min, sustained activity for several hours - covers the procedure. Single dose typically sufficient; consider a second dose for unusually long cases or recurrent symptomatic bradycardia. Watch for tachyarrhythmia.
Step 2: Second dose?
No
Single dose typically sufficient.
Yes
Consider a second dose.
Dosing timeline (this encounter)
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Patient context
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