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201708223

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UWHC,UWMF,

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

CSC GI Lanreotide(84D:1,29,57) VER 8-15-17 (HL 5452)

CSC GI Lanreotide(84D:1,29,57) VER 8-15-17 (HL 5452) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GI


CSC GI LANREOTIDE(84D:1,29,57) 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: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
Cycle 1 –  8/10/2017 through 11/1/2017 (84 days), Planned
Day 1, Cycle 1 –  Planned for 8/10/2017
Treatment Plan Information
Reference Information (1)
GASTROENTEROPANCREATIC NEUROENDOCRINE TUMORS: Caplin ME, et al. N Engl J Med 2014;371(3):224-33.
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 1 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site
between the right and left sides from one injection to the next. Refrigerate until 30 minutes prior to
injection then remove and allow to come to room temperature. Protect from light.
Follow-Up
DAY 29 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 57 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 85 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; CHEMOTHERAPY ROOM
APPOINTMENT:  lanreotide for 30 minutes.
Day 29, Cycle 1 –  Planned for 9/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
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 9:30:54 AM Page 2 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Day 57, Cycle 1 –  Planned for 10/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 –  11/2/2017 through 1/24/2018 (84 days), Planned
Day 1, Cycle 2 –  Planned for 11/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 3 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
DAY 29 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 57 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 85 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; CHEMOTHERAPY ROOM
APPOINTMENT:  lanreotide for 30 minutes.
Day 29, Cycle 2 –  Planned for 11/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 4 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 57, Cycle 2 –  Planned for 12/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 5 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 –  1/25/2018 through 4/18/2018 (84 days), Planned
Day 1, Cycle 3 –  Planned for 1/25/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
DAY 29 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 57 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 85 FOLLOW-UP
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 6 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; CHEMOTHERAPY ROOM
APPOINTMENT:  lanreotide for 30 minutes.
Day 29, Cycle 3 –  Planned for 2/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 57, Cycle 3 –  Planned for 3/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 7 of 15
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 –  4/19/2018 through 7/11/2018 (84 days), Planned
Day 1, Cycle 4 –  Planned for 4/19/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 8 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
DAY 29 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 57 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 85 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; CHEMOTHERAPY ROOM
APPOINTMENT:  lanreotide for 30 minutes.
Day 29, Cycle 4 –  Planned for 5/17/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 9 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 57, Cycle 4 –  Planned for 6/14/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 5 –  7/12/2018 through 10/3/2018 (84 days), Planned
Day 1, Cycle 5 –  Planned for 7/12/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 10 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
DAY 29 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 57 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 85 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; CHEMOTHERAPY ROOM
APPOINTMENT:  lanreotide for 30 minutes.
Day 29, Cycle 5 –  Planned for 8/9/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 11 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 57, Cycle 5 –  Planned for 9/6/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 12 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site
between the right and left sides from one injection to the next. Refrigerate until 30 minutes prior to
injection then remove and allow to come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 6 –  10/4/2018 through 12/26/2018 (84 days), Planned
Day 1, Cycle 6 –  Planned for 10/4/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
DAY 29 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 13 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

DAY 57 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: lanreotide for 30 minutes.
DAY 85 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; CHEMOTHERAPY ROOM
APPOINTMENT:  lanreotide for 30 minutes.
Day 29, Cycle 6 –  Planned for 11/1/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 57, Cycle 6 –  Planned for 11/29/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastroenteropancreatic Neuroendocrine Tumors (Advanced); THERAPY: lanreotide autogel 120 mg
subcutaneous Day 1, 29, 57; CYCLE LENGTH: 84 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Jeff J [2507481]
8/10/2017 9:30:54 AM Page 14 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

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.
Nursing Procedure, Assessment and Monitoring
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.
Treatment Medications
lanreotide acetate (SOMATULINE DEPOT) 120 MG/0.5ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site between the right
and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection then remove and allow to
come to room temperature. Protect from light.
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 9:30:54 AM Page 15 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org