/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/gi/,

/clinical/cckm-tools/content/beacon-protocols/gi/name-96649-en.cckm

201708223

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UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,GI

CSC GI Concurrent XRT Fluorouracil(42D:1,8,15,22,29,36) VER 8-15-17 (HL 527)

CSC GI Concurrent XRT Fluorouracil(42D:1,8,15,22,29,36) VER 8-15-17 (HL 527) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GI


CSC GI CONCURRENT XRT FLUOROURACIL(42D:1,8,15,22,29,36) VER: 8-15-17 –  Properties
Pre-Cycle –  8/3/2017 through 8/9/2017 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 8/3/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastric, Pancreatic, Esophageal, Rectal and Anal, Gall Bladder Cancer, Cholangiocarcinoma (all
Adjuvant/Advanced); THERAPY: fluorouracil 225 mg/m2/day administered as a continuous infusion IV Day 1 through 7
concurrent with radiation (total dose = 1575 mg/m2 over 7 days per home infusion). CYCLE LENGTH: 42 days; COURSE:
duration of radiation treatments.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S Approximate, Expires: S+365, Routine
BUN
Expected: S Approximate, Expires: S+365, Routine
CREATININE
Expected: S Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Page Or Call ___________
Notify Home infusion provider.
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8 HOURS PRN
starting S, Local Printer
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 1 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Cycle 1 –  8/10/2017 through 9/21/2017 (43 days), Planned
Day 1, Cycle 1 –  Planned for 8/10/2017
Treatment Plan Information
Reference Information (1)
GASTRIC/PANCREATIC/ESOPHAGEAL/
RECTAL AND ANAL/CHOLANGIOCARCINOMA/GALL BLADDER CANCER: Herskovic A. et al. NEJM 1992;326:1593-98.
Treatment Plan Summary
DISEASE: Gastric, Pancreatic, Esophageal, Rectal and Anal, Gall Bladder Cancer, Cholangiocarcinoma (all
Adjuvant/Advanced); THERAPY: fluorouracil 225 mg/m2/day administered as a continuous infusion IV Day 1 through 7
concurrent with radiation (total dose = 1575 mg/m2 over 7 days per home infusion). CYCLE LENGTH: 42 days; COURSE:
duration of radiation treatments.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Condition A
Check for mucositis, irritation of hands or feet, or diarrhea.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil
infusion and to call with concerns.
Page Or Call ___________
Notify Home infusion provider.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Pre-Medications
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 2 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
fluorouracil (ADRUCIL) home infusion bag 3,087 mg
3,087 mg (1,575 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting
when released
Seven Day Infusion: Fluorouracil Dose = 225 mg/m2/DAY administered as a single continuous infusion IV over 7 days
concurrent with radiation. (Total dose = 1575 mg/m2 IV over 7 days).
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: fluorouracil cassette change - 15
minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: fluorouracil cassette change - 15
minutes.
DAY 22 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: fluorouracil cassette change - 15
minutes.
DAY 29 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: fluorouracil cassette change - 15
minutes.
DAY 36 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: fluorouracil cassette change - 15
minutes.
DAY 43 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, BUN, Creatinine, Total
Bilirubin, AST, ALT, Alkaline Phosphatase, Magnesium; PROCEDURE: Pump disconnect for 15 minutes
Day 8, Cycle 1 –  Planned for 8/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastric, Pancreatic, Esophageal, Rectal and Anal, Gall Bladder Cancer, Cholangiocarcinoma (all
Adjuvant/Advanced); THERAPY: fluorouracil 225 mg/m2/day administered as a continuous infusion IV Day 1 through 7
concurrent with radiation (total dose = 1575 mg/m2 over 7 days per home infusion). CYCLE LENGTH: 42 days; COURSE:
duration of radiation treatments.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 3 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Condition A
Check for mucositis, irritation of hands or feet, or diarrhea.
Verify Medication(s) Taken at Home (1)
Verify that patient has fluorouracil pump infusing without difficulty and document in a progress note.  Notify
authorizing prescriber if patient has experienced any difficulties with the fluorouracil infusion.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil
infusion and to call with concerns.
Page Or Call ___________
Notify Home infusion provider.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
fluorouracil (ADRUCIL) home infusion bag 3,087 mg
3,087 mg (1,575 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting
when released
Seven Day Infusion: Fluorouracil Dose = 225 mg/m2/DAY administered as a single continuous infusion IV over 7 days
concurrent with radiation. (Total dose = 1575 mg/m2 IV over 7 days).
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 1 –  Planned for 8/24/2017
Treatment Plan Information
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 4 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Gastric, Pancreatic, Esophageal, Rectal and Anal, Gall Bladder Cancer, Cholangiocarcinoma (all
Adjuvant/Advanced); THERAPY: fluorouracil 225 mg/m2/day administered as a continuous infusion IV
Day 1 through 7 concurrent with radiation (total dose = 1575 mg/m2 over 7 days per home infusion).
CYCLE LENGTH: 42 days; COURSE: duration of radiation treatments.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Condition A
Check for mucositis, irritation of hands or feet, or diarrhea.
Verify Medication(s) Taken at Home (1)
Verify that patient has fluorouracil pump infusing without difficulty and document in a progress note.  Notify
authorizing prescriber if patient has experienced any difficulties with the fluorouracil infusion.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil
infusion and to call with concerns.
Page Or Call ___________
Notify Home infusion provider.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 5 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
fluorouracil (ADRUCIL) home infusion bag 3,087 mg
3,087 mg (1,575 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting
when released
Seven Day Infusion: Fluorouracil Dose = 225 mg/m2/DAY administered as a single continuous infusion IV over 7 days
concurrent with radiation. (Total dose = 1575 mg/m2 IV over 7 days).
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 22, Cycle 1 –  Planned for 8/31/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastric, Pancreatic, Esophageal, Rectal and Anal, Gall Bladder Cancer, Cholangiocarcinoma (all
Adjuvant/Advanced); THERAPY: fluorouracil 225 mg/m2/day administered as a continuous infusion IV Day 1 through 7
concurrent with radiation (total dose = 1575 mg/m2 over 7 days per home infusion). CYCLE LENGTH: 42 days; COURSE:
duration of radiation treatments.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Condition A
Check for mucositis, irritation of hands or feet, or diarrhea.
Verify Medication(s) Taken at Home (1)
Verify that patient has fluorouracil pump infusing without difficulty and document in a progress note.  Notify
authorizing prescriber if patient has experienced any difficulties with the fluorouracil infusion.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil
infusion and to call with concerns.
Page Or Call ___________
Notify Home infusion provider.
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 6 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
fluorouracil (ADRUCIL) home infusion bag 3,087 mg
3,087 mg (1,575 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting
when released
Seven Day Infusion: Fluorouracil Dose = 225 mg/m2/DAY administered as a single continuous infusion IV over 7 days
concurrent with radiation. (Total dose = 1575 mg/m2 IV over 7 days).
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 29, Cycle 1 –  Planned for 9/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastric, Pancreatic, Esophageal, Rectal and Anal, Gall Bladder Cancer, Cholangiocarcinoma (all
Adjuvant/Advanced); THERAPY: fluorouracil 225 mg/m2/day administered as a continuous infusion IV Day 1 through 7
concurrent with radiation (total dose = 1575 mg/m2 over 7 days per home infusion). CYCLE LENGTH: 42 days; COURSE:
duration of radiation treatments.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 7 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Condition A
Check for mucositis, irritation of hands or feet, or diarrhea.
Verify Medication(s) Taken at Home (1)
Verify that patient has fluorouracil pump infusing without difficulty and document in a progress note.  Notify
authorizing prescriber if patient has experienced any difficulties with the fluorouracil infusion.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil
infusion and to call with concerns.
Page Or Call ___________
Notify Home infusion provider.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
fluorouracil (ADRUCIL) home infusion bag 3,087 mg
3,087 mg (1,575 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting
when released
Seven Day Infusion: Fluorouracil Dose = 225 mg/m2/DAY administered as a single continuous infusion IV over 7 days
concurrent with radiation. (Total dose = 1575 mg/m2 IV over 7 days).
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 36, Cycle 1 –  Planned for 9/14/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastric, Pancreatic, Esophageal, Rectal and Anal, Gall Bladder Cancer, Cholangiocarcinoma (all
Adjuvant/Advanced); THERAPY: fluorouracil 225 mg/m2/day administered as a continuous infusion IV Day 1 through 7
concurrent with radiation (total dose = 1575 mg/m2 over 7 days per home infusion). CYCLE LENGTH: 42 days; COURSE:
duration of radiation treatments.
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 8 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Condition A
Check for mucositis, irritation of hands or feet, or diarrhea.
Verify Medication(s) Taken at Home (1)
Verify that patient has fluorouracil pump infusing without difficulty and document in a progress note.  Notify
authorizing prescriber if patient has experienced any difficulties with the fluorouracil infusion.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil
infusion and to call with concerns.
Page Or Call ___________
Notify Home infusion provider.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
fluorouracil (ADRUCIL) home infusion bag 3,087 mg
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 9 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

3,087 mg (1,575 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting
when released
Seven Day Infusion: Fluorouracil Dose = 225 mg/m2/DAY administered as a single continuous infusion IV over 7 days
concurrent with radiation. (Total dose = 1575 mg/m2 IV over 7 days).
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
8/10/2017 8:42:15 AM Page 10 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org