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/clinical/cckm-tools/content/beacon-protocols/head-and-neck/name-96802-en.cckm

201711317

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CSC HEAD/NECK Cisplatin(21D:1)/Fluorouracil(21D:1-4) Post XRT VER 11-10-17 (HL 5799)

CSC HEAD/NECK Cisplatin(21D:1)/Fluorouracil(21D:1-4) Post XRT VER 11-10-17 (HL 5799) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Head and Neck


CSC HEAD/NECK CISPLATIN(28D:1)/FLUOROURACIL(28D:1-4) POST XRT VER: 11/10/17 –  Properties
Pre-Cycle –  11/6/2017 through 11/12/2017 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 11/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Nasopharyngeal Cancer (Adjuvant/Advanced); THERAPY (After radiotherapy): CISplatin 80 mg/m2 IV Day 1,
fluorouracil 1000 mg/m2/day administered as a continuous infusion IV over 96 hours on Days 1 through 4 (Total dose =
4000 mg/m2 IV over 96 hours per cycle per home infusion); CYCLE LENGTH: 28 days; COURSE: 3 cycles.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S Approximate, Expires: S+365, Routine
CREATININE
Expected: S Approximate, Expires: S+365, Routine
BUN
Expected: S Approximate, Expires: S+365, Routine
CALCIUM
Expected: S Approximate, Expires: S+365, Routine
ALBUMIN
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
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Page Or Call ___________
Notify Home infusion provider.
Take Home Medications
aprepitant (EMEND) 80 MG cap
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 1 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Take 1 cap by mouth one time daily. Take Day 2 and Day 3 of each cycle following chemotherapy., 80 mg, Disp-2
cap, R-2, 1 X DAILY starting S
dexamethasone (DECADRON) 4 MG tab
Take 2 tabs by mouth one time daily. Take on Days 2, 3, and 4 following chemotherapy., 8 mg, Disp-18 tab, R-0, 1 X
DAILY starting S, Local Printer
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting., 10 mg, Disp-30 tab, R-5, EVERY 6 HOURS PRN
starting S, Local Printer
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
Cycle 1 –  11/13/2017 through 12/10/2017 (28 days), Planned
Day 1, Cycle 1 –  Planned for 11/13/2017
Treatment Plan Information
Reference Information (1)
NASOPHARYNGEAL CANCER: Al-Sarraf M, et al. J Clin Oncol 1998;16(4):1310-17.
Reference Information (2)
NASOPHARYNGEAL CANCER: Chan AT, et al. J Clin Oncol 2002;20(8):2038-44.
Reference Information (3)
NASOPHARYNGEAL CANCER: Jagdis A, et al. Am J Clin Oncol 2014;37(1):63-69.
Treatment Plan Summary
DISEASE: Nasopharyngeal Cancer (Adjuvant/Advanced); THERAPY (After radiotherapy): CISplatin 80 mg/m2 IV Day 1,
fluorouracil 1000 mg/m2/day administered as a continuous infusion IV over 96 hours on Days 1 through 4 (Total dose =
4000 mg/m2 IV over 96 hours per cycle per home infusion); CYCLE LENGTH: 28 days; COURSE: 3 cycles.
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 with DIFF, Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,500/µL or Platelets less than 100K/µL or Creatinine greater
than ULN.
Nursing Procedure, Assessment and Monitoring
Page Or Call ___________
Notify Home infusion provider.
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 2 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Measure Intake And Output
EVERY 4 HOURS Starting when released Until Specified
Monitor urine output and IV intake.
Patient Instructions(1)
Educate patient about hand-foot syndrome and mucositis that occurs with fluorouracil.
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.
Hydration
sodium chloride 0.9 % infusion
at 500-999 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL over 1-2 hours prior to CISplatin.
sodium chloride 0.9 % infusion
at 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
POST-CISPLATIN HYDRATION. Delete if not needed.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Treatment Medications
CISplatin (PLATINOL) 80 mg/m2 in sodium chloride 0.9 % 1,000 mL bag
80 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 60 to 90 minutes.
fluorouracil (ADRUCIL) home infusion bag 4,000 mg/m2 (Treatment Plan)
4,000 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Four Day Infusion: Fluorouracil Dose = 1000 mg/m2/Day administered as a single continuous infusion IV over 96 hours.
(Total dose = 4000 mg/m2 IV over 96 hours).
Conditional Orders
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE PRN, 1 dose Starting when released, edema
IV push rate 10 mg/minute.
Administer if intake is greater than 2000 mL and urine output less than 500 mL.
Follow-Up
DAY 5 FOLLOW-UP
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 3 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

PROCEDURE: Pump disconnect for 15 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Creatinine,
BUN, Calcium, Albumin, Total Bilirubin, AST, Alkaline Phosphatase, Magnesium, Glucose; CHEMOTHERAPY ROOM
APPOINTMENT: CISplatin and fluorouracil for 210 minutes.
Day 5 (Pump Disconnect), Cycle 1 –  Planned for 11/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Nasopharyngeal Cancer (Adjuvant/Advanced); THERAPY (After radiotherapy): CISplatin 80 mg/m2 IV Day 1,
fluorouracil 1000 mg/m2/day administered as a continuous infusion IV over 96 hours on Days 1 through 4 (Total dose =
4000 mg/m2 IV over 96 hours per cycle per home infusion); CYCLE LENGTH: 28 days; COURSE: 3 cycles.
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
Pump Disconnection Procedures
Disconnect pump upon completion of 96-hour home infusion.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 –  12/11/2017 through 1/7/2018 (28 days), Planned
Day 1, Cycle 2 –  Planned for 12/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Nasopharyngeal Cancer (Adjuvant/Advanced); THERAPY (After radiotherapy): CISplatin 80 mg/m2 IV Day 1,
fluorouracil 1000 mg/m2/day administered as a continuous infusion IV over 96 hours on Days 1 through 4 (Total dose =
4000 mg/m2 IV over 96 hours per cycle per home infusion); CYCLE LENGTH: 28 days; COURSE: 3 cycles.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 4 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+365, Routine
BUN
Expected: S+28 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+365, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,500/µL or Platelets less than 100K/µL or Creatinine greater
than ULN.
Nursing Procedure, Assessment and Monitoring
Page Or Call ___________
Notify Home infusion provider.
Measure Intake And Output
EVERY 4 HOURS Starting when released Until Specified
Monitor urine output and IV intake.
Patient Instructions(1)
Educate patient about hand-foot syndrome and mucositis that occurs with fluorouracil.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 5 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@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.
Hydration
sodium chloride 0.9 % infusion
at 500-999 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL over 1-2 hours prior to CISplatin.
sodium chloride 0.9 % infusion
at 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
POST-CISPLATIN HYDRATION. Delete if not needed.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Treatment Medications
CISplatin (PLATINOL) 80 mg/m2 in sodium chloride 0.9 % 1,000 mL bag
80 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 60 to 90 minutes.
fluorouracil (ADRUCIL) home infusion bag 4,000 mg/m2 (Treatment Plan)
4,000 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Four Day Infusion: Fluorouracil Dose = 1000 mg/m2/Day administered as a single continuous infusion IV over 96 hours.
(Total dose = 4000 mg/m2 IV over 96 hours).
Conditional Orders
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE PRN, 1 dose Starting when released, edema
IV push rate 10 mg/minute.
Administer if intake is greater than 2000 mL and urine output less than 500 mL.
Follow-Up
DAY 5 FOLLOW-UP
PROCEDURE: Pump disconnect for 15 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Creatinine,
BUN, Calcium, Albumin, Total Bilirubin, AST, Alkaline Phosphatase, Magnesium, Glucose; CHEMOTHERAPY ROOM
APPOINTMENT: CISplatin and fluorouracil for 210 minutes.
Day 5 (Pump Disconnect), Cycle 2 –  Planned for 12/15/2017
Treatment Plan Information
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 6 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Nasopharyngeal Cancer (Adjuvant/Advanced); THERAPY (After radiotherapy): CISplatin 80
mg/m2 IV Day 1, fluorouracil 1000 mg/m2/day administered as a continuous infusion IV over 96 hours
on Days 1 through 4 (Total dose = 4000 mg/m2 IV over 96 hours per cycle per home infusion); CYCLE
LENGTH: 28 days; COURSE: 3 cycles.
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
Pump Disconnection Procedures
Disconnect pump upon completion of 96-hour home infusion.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 –  1/8/2018 through 2/4/2018 (28 days), Planned
Day 1, Cycle 3 –  Planned for 1/8/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Nasopharyngeal Cancer (Adjuvant/Advanced); THERAPY (After radiotherapy): CISplatin 80 mg/m2 IV Day 1,
fluorouracil 1000 mg/m2/day administered as a continuous infusion IV over 96 hours on Days 1 through 4 (Total dose =
4000 mg/m2 IV over 96 hours per cycle per home infusion); CYCLE LENGTH: 28 days; COURSE: 3 cycles.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 7 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Expected: S+28 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+365, Routine
BUN
Expected: S+28 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+365, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,500/µL or Platelets less than 100K/µL or Creatinine greater
than ULN.
Nursing Procedure, Assessment and Monitoring
Page Or Call ___________
Notify Home infusion provider.
Measure Intake And Output
EVERY 4 HOURS Starting when released Until Specified
Monitor urine output and IV intake.
Patient Instructions(1)
Educate patient about hand-foot syndrome and mucositis that occurs with fluorouracil.
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
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 8 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

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.
Hydration
sodium chloride 0.9 % infusion
at 500-999 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL over 1-2 hours prior to CISplatin.
sodium chloride 0.9 % infusion
at 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
POST-CISPLATIN HYDRATION. Delete if not needed.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Treatment Medications
CISplatin (PLATINOL) 80 mg/m2 in sodium chloride 0.9 % 1,000 mL bag
80 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 60 to 90 minutes.
fluorouracil (ADRUCIL) home infusion bag 4,000 mg/m2 (Treatment Plan)
4,000 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Four Day Infusion: Fluorouracil Dose = 1000 mg/m2/Day administered as a single continuous infusion IV over 96 hours.
(Total dose = 4000 mg/m2 IV over 96 hours).
Conditional Orders
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE PRN, 1 dose Starting when released, edema
IV push rate 10 mg/minute.
Administer if intake is greater than 2000 mL and urine output less than 500 mL.
Follow-Up
DAY 5 FOLLOW-UP
PROCEDURE: Pump disconnect for 15 minutes.
DAY 29 FOLLOW-UP
RETURN TO CLINIC for appointment with provider.
Day 5 (Pump Disconnect), Cycle 3 –  Planned for 1/12/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Nasopharyngeal Cancer (Adjuvant/Advanced); THERAPY (After radiotherapy): CISplatin 80 mg/m2 IV Day 1,
fluorouracil 1000 mg/m2/day administered as a continuous infusion IV over 96 hours on Days 1 through 4 (Total dose =
4000 mg/m2 IV over 96 hours per cycle per home infusion); CYCLE LENGTH: 28 days; COURSE: 3 cycles.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 9 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

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
Pump Disconnection Procedures
Disconnect pump upon completion of 96-hour home infusion.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:51:47 AM Page 10 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org