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/clinical/cckm-tools/content/beacon-protocols/supportive-care/name-122902-en.cckm

201711331

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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,Supportive Care

CSC SC BMT Aledesleukin (Interleukin-2) 84D1-56 Ver 11-20-17 (HL 5271)

CSC SC BMT Aledesleukin (Interleukin-2) 84D1-56 Ver 11-20-17 (HL 5271) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Supportive Care


CSC SC BMT ALDESLEUKIN (INTERLEUKIN-2) (84D:1-56) VER: 11-20-17 –  Properties
Cycle 1 –  11/21/2017 through 2/12/2018 (84 days), Planned
Day 1, Cycle 1 –  Planned for 11/21/2017
Treatment Plan Information
Reference Information (1)
BMT: Koreth J, et al. N Eng J Med 2011;365(22):2055-66.
Treatment Plan Summary
DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S Approximate, Expires: S+397, Routine
BUN
Expected: S Approximate, Expires: S+397, Routine
CREATININE
Expected: S Approximate, Expires: S+397, Routine
CALCIUM
Expected: S Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S Approximate, Expires: S+397, Routine
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 1 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+397, Routine
TSH
Expected: S Approximate, Expires: S+365, Routine
T4, FREE
Expected: S 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
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Patient Instructions(1)
Teach patient how to self-administer a subcutaneous injection.
Treatment Medications
aldesleukin (PROLEUKIN) injection 1 Million Units/m2 (Treatment Plan)
1 Million Units/m2, Subcutaneous, ONCE, 1 dose Starting when released
Use patient's own supply. Do not administer IV push. Do not Filter.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): aldesleukin (Proleukin) dispensed
Day 1 and Day 29 of each cycle.
Take Home Medications
aldesleukin (PROLEUKIN) 22000000 units injection
Inject 1 Million Units/m2 under skin one time daily. Day 1 through 56., 1 Million Units/m2, Disp-28 mL, R-0, 1 X
DAILY starting S
Process as 28D supply.  Syringe Exp 14D Refrigerate  Oncology Clinic to prepare syringes every 14 days.
Follow-Up
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT,
Alkaline Phosphatase.
DAY 29 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium,
Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
DAY 43 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT,
Alkaline Phosphatase.
DAY 57 FOLLOW-UP
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 2 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT,
Alkaline Phosphatase, TSH, T4 Free.
DAY 85 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, TSH, T4 Free.
Lab Only Day 15, Cycle 1 –  Planned for 12/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
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
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
CALCIUM
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
ALBUMIN
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
PROTEIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
Follow-Up
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 3 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 29, Cycle 1 –  Planned for 12/19/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 4 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): aldesleukin (Proleukin) dispensed
Day 1 and Day 29 of each cycle.
Take Home Medications
aldesleukin (PROLEUKIN) 22000000 units injection
Inject 1 Million Units/m2 under skin one time daily. Day 1 through 56., 1 Million Units/m2, Disp-28 mL, R-0, 1 X
DAILY starting S
Process as 28D supply.  Syringe Exp 14D Refrigerate  Oncology Clinic to prepare syringes every 14 days.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only Day 43, Cycle 1 –  Planned for 1/2/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
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
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 5 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

CREATININE
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
CALCIUM
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
ALBUMIN
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
PROTEIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Normal, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only Day 57, Cycle 1 –  Planned for 1/16/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 6 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
TSH
Expected: S+28 Approximate, Expires: S+365, Routine
T4, FREE
Expected: S+28 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 –  2/13/2018 through 5/7/2018 (84 days), Planned
Day 1, Cycle 2 –  Planned for 2/13/2018
Treatment Plan Information
Reference Information (1)
BMT: Koreth J, et al. N Eng J Med 2011;365(22):2055-66.
Treatment Plan Summary
DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
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
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 7 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Expected: S+56 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+56 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+56 Approximate, Expires: S+397, Routine
BUN
Expected: S+56 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+56 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+56 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+56 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+56 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+56 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+56 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+56 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+56 Approximate, Expires: S+397, Routine
TSH
Expected: S+56 Approximate, Expires: S+365, Routine
T4, FREE
Expected: S+56, 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
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
aldesleukin (PROLEUKIN) injection 1 Million Units/m2 (Treatment Plan)
1 Million Units/m2, Subcutaneous, ONCE, 1 dose Starting when released
Use patient's own supply. Do not administer IV push. Do not Filter.
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 8 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): aldesleukin
(Proleukin) dispensed Day 1 and Day 29 of each cycle.
Take Home Medications
aldesleukin (PROLEUKIN) 22000000 units injection
Inject 1 Million Units/m2 under skin one time daily. Day 1 through 56., 1 Million Units/m2, Disp-28 mL, R-0, 1 X
DAILY starting S
Process as 28D supply.  Syringe Exp 14D Refrigerate  Oncology Clinic to prepare syringes every 14 days.
Follow-Up
DAY 29 FOLLOW-UP
RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium,
Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
DAY 57 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT,
Alkaline Phosphatase, TSH, T4 Free.
DAY 85 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, TSH, T4 Free
Day 29, Cycle 2 –  Planned for 3/13/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 9 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, 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
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): aldesleukin (Proleukin) dispensed
Day 1 and Day 29 of each cycle.
Take Home Medications
aldesleukin (PROLEUKIN) 22000000 units injection
Inject 1 Million Units/m2 under skin one time daily. Day 1 through 56., 1 Million Units/m2, Disp-28 mL, R-0, 1 X
DAILY starting S
Process as 28D supply.  Syringe Exp 14D Refrigerate  Oncology Clinic to prepare syringes every 14 days.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only Day 57, Cycle 2 –  Planned for 4/10/2018
Treatment Plan Information
Treatment Plan Summary
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 10 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

DISEASE: Chronic Graft versus Host Disease (cGVHD); THERAPY: aldesleukin 1 Million units/m2 subcutaneous daily Day
1 through 56; CYCLE LENGTH: 84 days (8 weeks on and 4 weeks off); COURSE: indefinite. NOTE: May continue therapy
at initial dose level indefinitely if patient experiences clinical benefit.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
TSH
Expected: S+28 Approximate, Expires: S+365, Routine
T4, FREE
Expected: S+28 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,Fiona F [2462287]
11/21/2017 9:53:37 AM Page 11 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
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