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CSC SC Carboplatin Desensitization Protocol Ver 11-20-17 (HL 4900)

CSC SC Carboplatin Desensitization Protocol Ver 11-20-17 (HL 4900) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Supportive Care


CSC SC CARBOPLATIN DESENSITIZATION PROTOCOL VER: 11-20-17 –  Properties
Cycle 1 –  11/21/2017, Planned
Day 1, Cycle 1 –  Planned for 11/21/2017
Treatment Plan Information
Reference Information (1)
CARBOPLATIN HYPERSENSITIVITY: Lee CW, et al. Gynecol Oncol 2004;95:370-6
Treatment Plan Summary
DISEASE: CARBOplatin Hypersensitivity; THERAPY: CARBOplatin Solution A (equal to 1/100th of the dose in 250 mL
Dextrose 5%) IV Day 1 followed by THERAPY: CARBOplatin Solution B (equal to 1/10th of the dose in 250 mL Dextrose
5%) IV Day 1 followed by THERAPY: CARBOplatin Solution C (equal to remainder of the dose in 250 mL Dextrose 5%) IV
Day 1; CYCLE LENGTH: 1 day; COURSE: 1 cycle
Dose Calculation Instructions
Calculate dose using original treatment plan order. Leave the order in the original treatment plan but do not sign or
release for use.
Dose Calculation Instructions (2)
Dose of Solution A = Original Treatment Plan Dose divided by 100. (*** mg/100 = *** mg)
Dose Calculation Instructions (3)
Dose of Solution B = Original Treatment Plan Dose divided by 10. (*** mg/10 = *** mg)
Dose Calculation Instructions (4)
Dose of Solution C = Original Treatment Plan Dose minus Dose of Solution A minus Dose of Solution B (*** mg -
***mg - *** mg = *** mg)
Note to All Staff (1)
A note must be placed in the patient's original treatment plan under the
"Treatment Plan Information" Section indicating that the patient has received the CARBOplatin Desensitization Protocol.
Treatment Conditions
Verify Medication(s) Taken at Home (1)
Verify that patient has taken dexamethasone and document in a progress note.  Notify authorizing prescriber if patient
has not taken medication as prescribed.
Nursing Procedure, Assessment and Monitoring
NURSING COMMUNICATION
ONCE Starting when released, Routine
Verify that all pre-medications and emergency medications from the original treatment plan have been released.
Pre-Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, ONCE, 1 dose Starting when released, Administer over 1 Minutes
Give 30 minutes prior to treatment.
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Give 30 minutes prior to treatment
Treatment Medications
CARBOplatin (PARAPLATIN) in dextrose 5 % 250 mL bag
Intravenous, ONCE, 1 dose Starting when released
Solution A. Start infusion at 2 mL/hr for 15 minutes, then increase to 5 mL/hr for 15 minutes, then 10 mL/hr for 15
minutes then 20 mL/hr for 15 minutes. Go to Solution B. Only part of Solution A will be administered. Discard the
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Zztestonc,Fiona F [2462287]
11/21/2017 10:05:42 AM Page 1 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

remainder of the bag.
NOTE: Pharmacist to add to label at verification: "Total Volume = 250 mL. Prime primary tubing set with drug."
CARBOplatin (PARAPLATIN) in dextrose 5 % 250 mL bag
Intravenous, ONCE, 1 dose Starting when released
Solution B. Start infusion at 5 mL/hr for 15 minutes, then increase to 10 mL/hr for 15 minutes, then 20 mL/hr for 15
minutes then 40 mL/hr for 15 minutes. Go to Solution C. Only part of Solution B will be administered. Discard the
remainder of the bag.
NOTE: Pharmacist to add to label at verification: "Total Volume = 250 mL. Prime primary tubing set with drug."
CARBOplatin (PARAPLATIN) in dextrose 5 % 250 mL bag
Intravenous, ONCE, 1 dose Starting when released
Solution C. Start infusion at 10 mL/hr for 15 minutes, then increase to 20 mL/hr for 15 minutes, then 40 mL/hr for 15
minutes then the remainder of the infusion at 75 mL/hr.
NOTE: Pharmacist to add to label at verification: "Total Volume = 250 mL. Prime primary tubing set with drug."
Take Home Medications
dexamethasone (DECADRON) 4 MG tab
Take 3 tablets by mouth every 6 hours for 4 doses prior to CARBOplatin treatment., Disp-36 tab, R-5, starting S, Local
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Zztestonc,Fiona F [2462287]
11/21/2017 10:05:42 AM Page 2 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org