/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/hem---leukemia-and-lymphoma/,

/clinical/cckm-tools/content/beacon-protocols/hem---leukemia-and-lymphoma/name-122367-en.cckm

201711310

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100

UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Hem - Leukemia and Lymphoma

CSC Hem Inpt-Outpt Blinatumomab(42D:1-28) VER 8-3-15 (HL 5728)

CSC Hem Inpt-Outpt Blinatumomab(42D:1-28) VER 8-3-15 (HL 5728) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Leukemia and Lymphoma


CSC HEM INPT/OUTPT BLINATUMOMAB(42D:1-28) VER:8-3-15 (HL 5728) –  Properties
Cycle 1 –  11/6/2017 through 12/17/2017 (42 days), Planned
Days 1 through 9 Inpatient, Cycle 1 –  Planned for 11/6/2017
Treatment Plan Information
Reference Information (1)
ACUTE LYMPHOCYTIC LEUKEMIA: Topp MS, et al. Lancet Oncol 2015;16(1):57-66.
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 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
EVERY 24 HOURS Starting when released for 7 days
AST/SGOT
EVERY 24 HOURS Starting when released for 7 days
ALT/SGPT
EVERY 24 HOURS Starting when released for 7 days
GGT
EVERY 24 HOURS Starting when released for 7 days
BILIRUBIN, TOTAL
EVERY 24 HOURS Starting when released for 7 days
ELECTROLYTES
EVERY 24 HOURS Starting when released for 7 days
GLUCOSE
EVERY 24 HOURS Starting when released for 7 days
BUN
EVERY 24 HOURS Starting when released for 7 days
CREATININE
EVERY 24 HOURS Starting when released for 7 days
CALCIUM
EVERY 24 HOURS Starting when released for 7 days
URIC ACID
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 1 of 95

EVERY 24 HOURS Starting when released for 7 days
LD, TOTAL
EVERY 24 HOURS Starting when released for 7 days
PHOSPHATE
EVERY 24 HOURS Starting when released for 7 days
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
ONCE Starting when released
For women of childbearing potential.
Pre-Labs
CBC WITH DIFFERENTIAL
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
AST/SGOT
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
ALT/SGPT
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
GGT
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
BILIRUBIN, TOTAL
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
ELECTROLYTES
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
GLUCOSE
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
BUN
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
CREATININE
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
CALCIUM
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
URIC ACID
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
LD, TOTAL
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
PHOSPHATE
EVERY 24 HOURS Starting S+7 at 0000 for 2 days
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
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11/6/2017 10:06:38 AM Page 2 of 95

Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes for the second 60 minutes and
then every 4 hours until blinatumomab infusion complete or patient discharges to home. If patient experiences fever
accompanied by chills or rigors, shortness of breath, headache, chest pain, or hypotension, stop infusion and contact
MD.
Measure Intake And Output
EVERY 8 HOURS Starting when released Until Specified
NURSING COMMUNICATION
SEE COMMENTS Starting when released Until Specified
Verify patient has received blinatumomab Medication Guide and blinatumomab Pocket Guide prior to the start of each
cycle.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
dexamethasone (DECADRON) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Administer 60 minutes prior to blinatumomab.
For doses > 10 mg administer via syringe pump at 2 mg/min
dexamethasone (DECADRON) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting S+7 at 0000
Day 8: Administer 60 minutes prior to blinatumomab bag change.
For doses > 10 mg administer via syringe pump at 2 mg/min
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
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Zztestonc,Jeff J [2507481]
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famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) 9 mcg in sodium chloride 0.9 % 250 mL 24hr infusion non-PVC bag
9 mcg, Intravenous, EVERY 24 HOURS, 7 doses Starting when released
Days 1 through 7: Administer with non-PVC tubing and 0.2 or 0.22 micron filter. Do NOT administer other medications
through the same line. Do NOT infuse with any other fluids or flushes. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Do NOT rush the
line. Administering 240 mL over 24 hours = 10 mL/hr. Hypersensitivity to blinatumomab can occur. See Emergency
Medications.
blinatumomab (BLINCYTO) 28 mcg in sodium chloride 0.9 % 250 mL 24hr infusion non-PVC bag
28 mcg, Intravenous, EVERY 24 HOURS, 1 dose Starting S+7 at 0000
Days 8: Administer with non-PVC tubing and 0.2 or 0.22 micron filter. Do NOT administer other medications through
the same line. Do NOT infuse with any other fluids or flushes. Do NOT flush the line that blinatumomab is infusing
through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Do NOT rush the line.
Administering 240 mL over 24 hours = 10 mL/hr. Hypersensitivity to blinatumomab can occur. See Emergency
Medications.
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS, 1 dose Starting S+8 at 0000
Days 9 and 10: Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or
0.22 micron filter. Do NOT administer other medications or fluids through the same line. Do NOT flush the line that
blinatumomab is infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only.
Administer as a continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Supportive Care Medications
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting when released
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
allopurinol (ZYLOPRIM) tab 300 mg
300 mg, Oral, 1 X DAILY, 7 doses Starting when released
Days 1 through 7.
Conditional Orders
NOTE:
EVERY 8 HOURS, For 9 days Starting when released
Avoid NSAIDs if possible due to potential cause of endothelial stress which may contribute to adverse effect of cytokine
release syndrome.
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, fever
No more than 4 grams acetaminophen per 24 hours for adults. Use as first choice for fever treatment. If no relief,
contact provider for alternative.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Total of 24 mg ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Total of 24 mg ondansetron per 24 hours (scheduled and PRN)
prochlorperazine (COMPAZINE) tab 10 mg
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10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
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
fluconazole (DIFLUCAN) 200 MG tab
Take 2 tabs by mouth one time daily., 400 mg, Disp-60 tab, R-5, 1 X DAILY starting S, Local Printer
acyclovir (ZOVIRAX) 400 MG tab
Take 1 tab by mouth 2 times daily., 400 mg, Disp-60 tab, R-5, 2 X DAILY starting S, Local Printer
Follow-Up
DAY 11 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 13 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 15 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT, Total Bilirubin, Electrolytes,
Glucose, BUN, Creatinine, Calcium; CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 17 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 19 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 21 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 23 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT, Total Bilirubin, Electrolytes,
Glucose, BUN, Creatinine, Calcium; CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 25 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 27 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 29 FOLLOW-UP
LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT: Discontinue blinatumomab home infusion.
DAY 36 FOLLOW-UP
LABS: CBC with DIFF.
DAY 43 FOLLOW-UP
Schedule preadmission to B6/6 for blinatumomab infusion.
Day 11 (Home Infusion Bag Change) , Cycle 1 –  Planned for 11/16/2017
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 5 of 95

DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY:
blinatumomab 9 mcg continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg
continuous infusion IV over 24 hours Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42
days; COURSE: 1 cycle followed by THERAPY: blinatumomab 28 mcg continuous infusion IV over 24
hours Days 1 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
11/6/2017 10:06:38 AM Page 6 of 95

Day 13 (Home Infusion Bag Change) , Cycle 1 –  Planned for 11/18/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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11/6/2017 10:06:38 AM Page 7 of 95

infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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 11/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+2 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+2 Approximate, Expires: S+365, Routine
GGT
Expected: S+2 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+2 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+2 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+2 Approximate, Expires: S+365, Routine
BUN
Expected: S+2 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+2 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+2 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
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Zztestonc,Jeff J [2507481]
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Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X
ULN or Total Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17 (Home Infusion Bag Change) , Cycle 1 –  Planned for 11/22/2017
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
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DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
11/6/2017 10:06:38 AM Page 10 of 95

Day 19 (Home Infusion Bag Change) , Cycle 1 –  Planned for 11/24/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 11 of 95

infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 21 (Home Infusion Bag Change) , Cycle 1 –  Planned for 11/26/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 12 of 95

2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 23, Cycle 1 –  Planned for 11/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+2 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+2 Approximate, Expires: S+365, Routine
GGT
Expected: S+2 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+2 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+2 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+2 Approximate, Expires: S+365, Routine
BUN
Expected: S+2 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+2 Approximate, Expires: S+365, Routine
CALCIUM
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 13 of 95

Expected: S+2 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
11/6/2017 10:06:38 AM Page 14 of 95

Day 25 (Home Infusion Bag Change) , Cycle 1 –  Planned for 11/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 15 of 95

infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 27 (Home Infusion Bag Change) , Cycle 1 –  Planned for 12/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 16 of 95

2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 29 (Pump Disconnect) , Cycle 1 –  Planned for 12/4/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Treatment Medications
Pump Disconnection Procedures
Disconnect pump upon completion of 48-hour blinatumomab infusion. Do NOT flush line while there is still
blinatumomab in the line, it may result in overdose and complications. To remove the drug from the line, attach empty
10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 17 of 95

Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-Pediatric/Adult
Guideline.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 36, Cycle 1 –  Planned for 12/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 –  12/18/2017 through 1/28/2018 (42 days), Planned
Days 1 through 3 Inpatient, Cycle 2 –  Planned for 12/18/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
EVERY 24 HOURS Starting when released for 2 days
AST/SGOT
EVERY 24 HOURS Starting when released for 2 days
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 18 of 95

ALT/SGPT
EVERY 24 HOURS Starting when released for 2 days
GGT
EVERY 24 HOURS Starting when released for 2 days
BILIRUBIN, TOTAL
EVERY 24 HOURS Starting when released for 2 days
ELECTROLYTES
EVERY 24 HOURS Starting when released for 2 days
GLUCOSE
EVERY 24 HOURS Starting when released for 2 days
BUN
EVERY 24 HOURS Starting when released for 2 days
CREATININE
EVERY 24 HOURS Starting when released for 2 days
CALCIUM
EVERY 24 HOURS Starting when released for 2 days
URIC ACID
EVERY 24 HOURS Starting when released for 2 days
LD, TOTAL
EVERY 24 HOURS Starting when released for 2 days
PHOSPHATE
EVERY 24 HOURS Starting when released for 2 days
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
ONCE Starting when released
For women of childbearing potential.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes for the second 60 minutes and
then every 4 hours until blinatumomab infusion complete or patient discharges to home. If patient experiences fever
accompanied by chills or rigors, shortness of breath, headache, chest pain, or hypotension, stop infusion and contact
MD.
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Zztestonc,Jeff J [2507481]
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Measure Intake And Output
EVERY 8 HOURS Starting when released Until Specified
NURSING COMMUNICATION
SEE COMMENTS Starting when released Until Specified
Verify patient has received blinatumomab Medication Guide and blinatumomab Pocket Guide prior to the start of each
cycle.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
dexamethasone (DECADRON) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Administer 60 minutes prior to blinatumomab.
For doses > 10 mg administer via syringe pump at 2 mg/min
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) 28 mcg in sodium chloride 0.9 % 250 mL 24hr infusion non-PVC bag
28 mcg, Intravenous, EVERY 24 HOURS, 2 doses Starting when released
Days 1 and 2: Administer with non-PVC tubing and 0.2 or 0.22 micron filter. Do NOT administer other medications
through the same line. Do NOT infuse with any other fluids or flushes. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Do NOT rush the
line. Administering 240 mL over 24 hours = 10 mL/hr. Hypersensitivity to blinatumomab can occur. See Emergency
Medications.
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS, 1 dose Starting S+2 at 0000
Days 3 and 4: Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22
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Zztestonc,Jeff J [2507481]
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micron filter. Do NOT administer other medications or fluids through the same line. Do NOT flush the line that
blinatumomab is infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only.
Administer as a continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Supportive Care Medications
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting when released
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
Conditional Orders
NOTE:
EVERY 8 HOURS, For 2 days Starting when released
Avoid NSAIDs if possible due to potential cause of endothelial stress which may contribute to adverse effect of cytokine
release syndrome.
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, fever
No more than 4 grams acetaminophen per 24 hours for adults. Use as first choice for fever treatment. If no relief,
contact provider for alternative.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Total of 24 mg ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Total of 24 mg ondansetron per 24 hours (scheduled and PRN)
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 5 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 7 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 9 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT,Total Bilirubin, Electrolytes,
Glucose, BUN, Creatinine, Calcium; CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 11 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 13 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 15 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT,Total Bilirubin, Electrolytes,
Glucose, BUN, Creatinine, Calcium; CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 17 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
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Zztestonc,Jeff J [2507481]
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DAY 19 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 21 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 23 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT,Total Bilirubin, Electrolytes,
Glucose, BUN, Creatinine, Calcium; CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 25 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 27 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 29 FOLLOW-UP
LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT: Discontinue blinatumomab home infusion.
DAY 36 FOLLOW-UP
LABS: CBC with DIFF.
DAY 43 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT, Total
Bilirubin, Electrolytes, Glucose, BUN, Creatinine, Calcium, LDH, Phosphate; CHEMOTHERAPY ROOM
APPOINTMENT:  blinatumomab home infusion for 60 minutes.
Day 5 (Home Infusion Bag Change) , Cycle 2 –  Planned for 12/22/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 22 of 95

1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and
complications. To remove the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw
back 5mL. Dispose of 10mL syringe per policy 5.27 "Waste Management".  Then you may flush line
according to Flushing/Locking of Venous Access Devices-Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 7 (Home Infusion Bag Change) , Cycle 2 –  Planned for 12/24/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 23 of 95

Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and
complications. To remove the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw
back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste Management".  Then you may flush line
according to Flushing/Locking of Venous Access Devices-Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 2 –  Planned for 12/26/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 24 of 95

AST/SGOT
Expected: S+2 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+2 Approximate, Expires: S+365, Routine
GGT
Expected: S+2 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+2 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+2 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+2 Approximate, Expires: S+365, Routine
BUN
Expected: S+2 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+2 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+2 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
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Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11 (Home Infusion Bag Change) , Cycle 2 –  Planned for 12/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 26 of 95

heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 13 (Home Infusion Bag Change) , Cycle 2 –  Planned for 12/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Flush Venous Access Device per Guidelines
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 27 of 95

Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 2 –  Planned for 1/1/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 28 of 95

CBC WITH DIFFERENTIAL
Expected: S+2 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+2 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+2 Approximate, Expires: S+365, Routine
GGT
Expected: S+2 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+2 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+2 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+2 Approximate, Expires: S+365, Routine
BUN
Expected: S+2 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+2 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+2 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 29 of 95

Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17 (Home Infusion Bag Change) , Cycle 2 –  Planned for 1/3/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 30 of 95

heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19 (Home Infusion Bag Change) , Cycle 2 –  Planned for 1/5/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Flush Venous Access Device per Guidelines
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 31 of 95

Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 21 (Home Infusion Bag Change) , Cycle 2 –  Planned for 1/7/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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]
11/6/2017 10:06:38 AM Page 32 of 95

Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 23, Cycle 2 –  Planned for 1/9/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
IV Access
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 33 of 95

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+2 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+2 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+2 Approximate, Expires: S+365, Routine
GGT
Expected: S+2 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+8 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+2 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+2 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+2 Approximate, Expires: S+365, Routine
BUN
Expected: S+2 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+2 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+2 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 34 of 95

the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 25 (Home Infusion Bag Change) , Cycle 2 –  Planned for 1/11/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 35 of 95

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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 27 (Home Infusion Bag Change) , Cycle 2 –  Planned for 1/13/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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]
11/6/2017 10:06:38 AM Page 36 of 95

Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 29 (Pump Disconnect) , Cycle 2 –  Planned for 1/15/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 37 of 95

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+2 Approximate, Expires: S+365, Routine
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Treatment Medications
Pump Disconnection Procedures
Disconnect pump upon completion of 48-hour blinatumomab infusion. Do NOT flush line while there is still
blinatumomab in the line, it may result in overdose and complications. To remove the drug from the line, attach empty
10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste
Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-Pediatric/Adult
Guideline.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 36, Cycle 2 –  Planned for 1/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 38 of 95

CBC WITH DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 –  1/29/2018 through 3/11/2018 (42 days), Planned
Day 1, Cycle 3 –  Planned for 1/29/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
GGT
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+14 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 39 of 95

Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
Expected: S+14 Approximate, Expires: S+122, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
NURSING COMMUNICATION
SEE COMMENTS Starting when released Until Specified
Verify patient has received blinatumomab Medication Guide and blinatumomab Pocket Guide prior to the start of each
cycle.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Pre-Medications
dexamethasone (DECADRON) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Administer 60 minutes prior to blinatumomab.
For doses > 10 mg administer via syringe pump at 2 mg/min
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 40 of 95

albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
DAY 3 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 5 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 7 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 11 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 13 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 15 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT:
blinatumomab bag change for 60 minutes.
DAY 17 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 19 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 21 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 23 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 25 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 27 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 29 FOLLOW-UP
LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT: Discontinue blinatumomab home infusion.
DAY 36 FOLLOW-UP
LABS: CBC with DIFF.
DAY 43 FOLLOW-UP
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 41 of 95

(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT, Total
Bilirubin, Electrolytes, Glucose, BUN, Creatinine, Calcium, LDH, Phosphate; CHEMOTHERAPY ROOM
APPOINTMENT:  blinatumomab home infusion for 60 minutes.
Day 3 (Home Infusion Bag Change) , Cycle 3 –  Planned for 1/31/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 42 of 95

56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/2/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 43 of 95

albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 7 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/4/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 44 of 95

dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9 (Home Infusion Bag Change), Cycle 3 –  Planned for 2/6/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 45 of 95

policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/8/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 46 of 95

the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 13 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/10/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 47 of 95

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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 3 –  Planned for 2/12/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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]
11/6/2017 10:06:38 AM Page 48 of 95

Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+2 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/14/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 49 of 95

DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY:
blinatumomab 9 mcg continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg
continuous infusion IV over 24 hours Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42
days; COURSE: 1 cycle followed by THERAPY: blinatumomab 28 mcg continuous infusion IV over 24
hours Days 1 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
11/6/2017 10:06:38 AM Page 50 of 95

Day 19 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/16/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 51 of 95

infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 21 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/18/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 52 of 95

2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 23 (Home Infusion Bag Change), Cycle 3 –  Planned for 2/20/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 53 of 95

10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 25 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 54 of 95

Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 27 (Home Infusion Bag Change) , Cycle 3 –  Planned for 2/24/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 55 of 95

heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 29 (Pump Disconnect) , Cycle 3 –  Planned for 2/26/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 56 of 95

sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and
complications. To remove the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw
back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste Management".  Then you may flush line
according to Flushing/Locking of Venous Access Devices-Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Treatment Medications
Pump Disconnection Procedures
Disconnect pump upon completion of 48-hour blinatumomab infusion. Do NOT flush line while there is still
blinatumomab in the line, it may result in overdose and complications. To remove the drug from the line, attach empty
10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste
Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-Pediatric/Adult
Guideline.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 36, Cycle 3 –  Planned for 3/5/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 –  3/12/2018 through 4/22/2018 (42 days), Planned
Day 1, Cycle 4 –  Planned for 3/12/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 57 of 95

DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
GGT
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+14 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
Expected: S+14 Approximate, Expires: S+122, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 58 of 95

Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
NURSING COMMUNICATION
SEE COMMENTS Starting when released Until Specified
Verify patient has received blinatumomab Medication Guide and blinatumomab Pocket Guide prior to the start of each
cycle.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Pre-Medications
dexamethasone (DECADRON) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Administer 60 minutes prior to blinatumomab.
For doses > 10 mg administer via syringe pump at 2 mg/min
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
DAY 3 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 5 FOLLOW-UP
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 59 of 95

CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 7 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 11 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 13 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 15 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT:
blinatumomab bag change for 60 minutes.
DAY 17 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 19 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 21 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 23 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 25 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 27 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 29 FOLLOW-UP
LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT: Discontinue blinatumomab home infusion.
DAY 36 FOLLOW-UP
LABS: CBC with DIFF.
DAY 43 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, AST, ALT, GGT, Total
Bilirubin, Electrolytes, Glucose, BUN, Creatinine, Calcium, LDH, Phosphate; CHEMOTHERAPY ROOM
APPOINTMENT:  blinatumomab home infusion for 60 minutes.
Day 3 (Home Infusion Bag Change) , Cycle 4 –  Planned for 3/14/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 60 of 95

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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5 (Home Infusion Bag Change) , Cycle 4 –  Planned for 3/16/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 61 of 95

DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
11/6/2017 10:06:38 AM Page 62 of 95

Day 7 (Home Infusion Bag Change) , Cycle 4 –  Planned for 3/18/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 63 of 95

infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9 (Home Infusion Bag Change), Cycle 4 –  Planned for 3/20/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 64 of 95

2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11 (Home Infusion Bag Change) , Cycle 4 –  Planned for 3/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 65 of 95

10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 13 (Home Infusion Bag Change) , Cycle 4 –  Planned for 3/24/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 66 of 95

Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 4 –  Planned for 3/26/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 67 of 95

sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and
complications. To remove the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw
back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste Management".  Then you may flush line
according to Flushing/Locking of Venous Access Devices-Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17 (Home Infusion Bag Change) , Cycle 4 –  Planned for 3/28/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 68 of 95

Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19 (Home Infusion Bag Change) , Cycle 4 –  Planned for 3/30/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 69 of 95

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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 21 (Home Infusion Bag Change) , Cycle 4 –  Planned for 4/1/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 70 of 95

DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
11/6/2017 10:06:38 AM Page 71 of 95

Day 23 (Home Infusion Bag Change), Cycle 4 –  Planned for 4/3/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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Zztestonc,Jeff J [2507481]
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infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 25 (Home Infusion Bag Change) , Cycle 4 –  Planned for 4/5/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
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Zztestonc,Jeff J [2507481]
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2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 27 (Home Infusion Bag Change) , Cycle 4 –  Planned for 4/7/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
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Zztestonc,Jeff J [2507481]
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10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 29 (Pump Disconnect) , Cycle 4 –  Planned for 4/9/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
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Zztestonc,Jeff J [2507481]
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Treatment Medications
Pump Disconnection Procedures
Disconnect pump upon completion of 48-hour blinatumomab infusion. Do NOT flush line while there is still
blinatumomab in the line, it may result in overdose and complications. To remove the drug from the line, attach empty
10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste
Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-Pediatric/Adult
Guideline.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 36, Cycle 4 –  Planned for 4/16/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 5 –  4/23/2018 through 6/3/2018 (42 days), Planned
Day 1, Cycle 5 –  Planned for 4/23/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
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Zztestonc,Jeff J [2507481]
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CBC WITH DIFFERENTIAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
GGT
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
CALCIUM
Expected: S+14 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
Expected: S+14 Approximate, Expires: S+122, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Total Bilirubin, AST, ALT.
Treatment Parameters
Hold treatment and notify authorizing prescriber for AST greater than 5 X ULN or ALT greater than 5 X ULN or Total
Bilirubin greater than 3 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
NURSING COMMUNICATION
SEE COMMENTS Starting when released Until Specified
Verify patient has received blinatumomab Medication Guide and blinatumomab Pocket Guide prior to the start of each
cycle.
Flush Venous Access Device per Guidelines
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 77 of 95

Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Pre-Medications
dexamethasone (DECADRON) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Administer 60 minutes prior to blinatumomab.
For doses > 10 mg administer via syringe pump at 2 mg/min
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
DAY 2 FOLLOW-UP
RETURN TO CLINIC for appointment with provider.
DAY 3 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 5 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 7 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes.
DAY 11 FOLLOW-UP
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 78 of 95

CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 13 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 15 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT:
blinatumomab bag change for 60 minutes.
DAY 17 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 19 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 21 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 23 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: blinatumomab bag change for 60 minutes..
DAY 25 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 27 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: Home infusion blinatumomab bag change for 60 minutes.
DAY 29 FOLLOW-UP
LABS: CBC with DIFF; CHEMOTHERAPY ROOM APPOINTMENT: Discontinue blinatumomab home infusion.
DAY 36 FOLLOW-UP
LABS: CBC with DIFF.
DAY 43 FOLLOW-UP
RETURN TO CLINIC for appointment with provider.
Day 3 (Home Infusion Bag Change) , Cycle 5 –  Planned for 4/25/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Flush Venous Access Device per Guidelines
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 79 of 95

Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5 (Home Infusion Bag Change) , Cycle 5 –  Planned for 4/27/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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]
11/6/2017 10:06:38 AM Page 80 of 95

Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 7 (Home Infusion Bag Change) , Cycle 5 –  Planned for 4/29/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
IV Access
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Zztestonc,Jeff J [2507481]
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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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9 (Home Infusion Bag Change), Cycle 5 –  Planned for 5/1/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 82 of 95

DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
11/6/2017 10:06:38 AM Page 83 of 95

Day 11 (Home Infusion Bag Change) , Cycle 5 –  Planned for 5/3/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 84 of 95

infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 13 (Home Infusion Bag Change) , Cycle 5 –  Planned for 5/5/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 85 of 95

2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 5 –  Planned for 5/7/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 86 of 95

diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17 (Home Infusion Bag Change) , Cycle 5 –  Planned for 5/9/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 87 of 95

1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and
complications. To remove the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw
back 5mL. Dispose of 10mL syringe per policy 5.27 "Waste Management".  Then you may flush line
according to Flushing/Locking of Venous Access Devices-Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19 (Home Infusion Bag Change) , Cycle 5 –  Planned for 5/11/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 88 of 95

Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and
complications. To remove the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw
back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste Management".  Then you may flush line
according to Flushing/Locking of Venous Access Devices-Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 21 (Home Infusion Bag Change) , Cycle 5 –  Planned for 5/13/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 89 of 95

Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 23 (Home Infusion Bag Change), Cycle 5 –  Planned for 5/15/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Jeff J [2507481]
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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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 25 (Home Infusion Bag Change) , Cycle 5 –  Planned for 5/17/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
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DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
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]
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Day 27 (Home Infusion Bag Change) , Cycle 5 –  Planned for 5/19/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to blinatumomab can occur. See Emergency Medications.
Monitoring Parameters (1)
Patient to perform a writing test to be evaluated by medical staff prior to each bag change.
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
For doses > 10 mg administer via syringe pump at 2 mg/min
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
blinatumomab (BLINCYTO) home infusion bag 56 mcg
56 mcg, Intravenous, EVERY 48 HOURS Starting when released
Dose = 28 mcg/day (Total dose = 56 mcg over 48 hours). Administer with non-PVC tubing and 0.2 or 0.22 micron filter.
Do NOT administer other medications or fluids through the same line. Do NOT flush the line that blinatumomab is
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 93 of 95

infusing through, ensure line does not contain blinatumomab prior to flushing. Use a PICC line only. Administer as a
continuous infusion. Hypersensitivity to blinatumomab can occur. See Emergency Medications.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 29 (Pump Disconnect) , Cycle 5 –  Planned for 5/21/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+2 Approximate, Expires: S+365, Routine
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
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Do NOT flush line while there is still blinatumomab in the line, it may result in overdose and complications. To remove
the drug from the line, attach empty 10 mL syringe to the PICC lumen. Draw back 5mL. Dispose of 10mL syringe per
policy 5.27 "Waste Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-
Pediatric/Adult Guideline.
Treatment Medications
Pump Disconnection Procedures
Disconnect pump upon completion of 48-hour blinatumomab infusion. Do NOT flush line while there is still
blinatumomab in the line, it may result in overdose and complications. To remove the drug from the line, attach empty
10 mL syringe to the PICC lumen. Draw back 5 mL. Dispose of 10 mL syringe per policy 5.27 "Waste
Management".  Then you may flush line according to Flushing/Locking of Venous Access Devices-Pediatric/Adult
Guideline.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 36, Cycle 5 –  Planned for 5/28/2018
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Zztestonc,Jeff J [2507481]
11/6/2017 10:06:38 AM Page 94 of 95

Treatment Plan Information
Treatment Plan Summary
DISEASE: B-Cell Precursor Acute Lymphocytic Leukemia (Relapsed/ Refractory); THERAPY: blinatumomab 9 mcg
continuous infusion IV over 24 hours Days 1 through 7, blinatumomab 28 mcg continuous infusion IV over 24 hours
Days 8 through 28 followed by 2 weeks off; CYCLE LENGTH: 42 days; COURSE: 1 cycle followed by THERAPY:
blinatumomab 28 mcg continuous infusion IV over 24 hours Days 1 through 28 followed by 2 weeks off; CYCLE
LENGTH: 42 days; COURSE: up to 4 cycles
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+7 Approximate, Expires: S+365, Routine
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]
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