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CSC SC Denosumab (Xgeva) Every 4 Weeks Ver 11-20-17 (HL 4754)

CSC SC Denosumab (Xgeva) Every 4 Weeks Ver 11-20-17 (HL 4754) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Supportive Care


CSC SC DENOSUMAB (XGEVA) EVERY 4 WEEKS VER: 11-20-17 –  Properties
Cycle 1 –  11/22/2017 through 12/19/2017 (28 days), Planned
Day 1, Cycle 1 –  Planned for 11/22/2017
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
CALCIUM
Expected: S Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S Approximate, Expires: S+365, Routine
Treatment Conditions
Treatment Condition A
Notify authorizing prescriber for Magnesium, Calcium, or Phosphate below normal limits.
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
denosumab (XGEVA) 120 MG/1.7ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Cycle 2 –  12/20/2017 through 1/16/2018 (28 days), Planned
Day 1, Cycle 2 –  Planned for 12/20/2017
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,Andrew [2428787]
11/22/2017 12:52:56 PM Page 1 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Pre-Labs
CALCIUM
Expected: S+28 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Treatment Condition A
Notify authorizing prescriber for Magnesium, Calcium, or Phosphate below normal limits.
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
denosumab (XGEVA) 120 MG/1.7ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Cycle 3 –  1/17/2018 through 2/13/2018 (28 days), Planned
Day 1, Cycle 3 –  Planned for 1/17/2018
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
CALCIUM
Expected: S+28 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
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ZZtestonc,Andrew [2428787]
11/22/2017 12:52:56 PM Page 2 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Treatment Condition A
Notify authorizing prescriber for Magnesium, Calcium, or Phosphate below normal limits.
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
denosumab (XGEVA) 120 MG/1.7ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Cycle 4 –  2/14/2018 through 3/13/2018 (28 days), Planned
Day 1, Cycle 4 –  Planned for 2/14/2018
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
CALCIUM
Expected: S+28 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Treatment Condition A
Notify authorizing prescriber for Magnesium, Calcium, or Phosphate below normal limits.
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
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
ZZtestonc,Andrew [2428787]
11/22/2017 12:52:56 PM Page 3 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
denosumab (XGEVA) 120 MG/1.7ML injection 120 mg
120 mg, Subcutaneous, ONCE, 1 dose Starting when released
Actions
Actions
Actions
ZZtestonc,Andrew [2428787]
11/22/2017 12:52:56 PM Page 4 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org