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CSC SC GI Hepatic Arterial Infusion Heparin for HAI Pump Maintenance (7-14D1) Ver 11-20-17 (HL 5248)

CSC SC GI Hepatic Arterial Infusion Heparin for HAI Pump Maintenance (7-14D1) Ver 11-20-17 (HL 5248) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Supportive Care


CSC SC GI HEPATIC ARTERIAL INFUSION HEPARIN FOR HAI PUMP MAINTENANCE (7-14D:1) VER: 11-20-
17 –  Properties
Heparin for HAI Pump Maintenance –  11/21/2017 through 11/27/2017 (7 days), Planned
Day 1, Heparin for HAI Pump Maintenance –  Planned for 11/21/2017
Treatment Plan Information
Reference Information (1)
COLORECTAL CANCER: Kemeny N, et al. N Engl J Med 1999; 341(27):2039-48
Reference Information (2)
COLORECTAL CANCER: Kemeny N, et al. J Clin Oncol 2006; 24(9):1395-1403
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced); THERAPY DELIVERED VIA CONTINUOUS HEPATIC ARTERIAL INFUSION PUMP
heparin 30,000 units (fixed dose); CYCLE LENGTH: 7 to 14 days; COURSE: As needed for HAI pump maintenance.
Treatment Plan Summary (2)
FOR PATIENTS RESUMING CHEMOTHERAPY use treatment plan CSC GI HEPATIC ARTERIAL INFUSION FLOXURIDINE
(28D:1-14)
Nursing Procedure, Assessment and Monitoring
NURSING COMMUNICATION
ONCE Starting when released
Calculate pump rate and enter information into the HAI Pump Rate Calculation order on Day 1 of the next cycle.
Pre-Medications
lidocaine (LMX) 4% topical dressing kit
Topical, ONCE, 1 dose Starting when released
Apply 30 minutes prior to to HAI port/pump access.
Treatment Medications
heparin 30,000 units in sodium chloride 0.9 % 30 mL injection
30,000 units, Intraarterial, ONCE, 1 dose Starting when released
Follow-Up
FOLLOW-UP
(Day 1 of next cycle) CHEMOTHERAPY ROOM APPOINTMENT: hepatic arterial infusion pump refill (heparinized saline)
for 60 minutes
Heparin for HAI Pump Maintenance –  11/28/2017 through 12/4/2017 (7 days), Planned
Day 1, Heparin for HAI Pump Maintenance –  Planned for 11/28/2017
Treatment Plan Information
Reference Information (1)
COLORECTAL CANCER: Kemeny N, et al. N Engl J Med 1999; 341(27):2039-48
Reference Information (2)
COLORECTAL CANCER: Kemeny N, et al. J Clin Oncol 2006; 24(9):1395-1403
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced); THERAPY DELIVERED VIA CONTINUOUS HEPATIC ARTERIAL INFUSION PUMP
heparin 30,000 units (fixed dose); CYCLE LENGTH: 7 to 14 days; COURSE: As needed for HAI pump maintenance.
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Zztestonc,Fiona F [2462287]
11/21/2017 10:27:01 AM Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Treatment Plan Summary (2)
FOR PATIENTS RESUMING CHEMOTHERAPY use treatment plan CSC GI HEPATIC ARTERIAL INFUSION
FLOXURIDINE (28D:1-14)
Nursing Procedure, Assessment and Monitoring
HAI Pump Rate Calculation
HAI PUMP RATE CALCULATION:
(A) Volume withdrawn from pump: *** mL on ***/***/***
(B) Volume from pump infused: *** mL (30 mL minus answer in part A)
(C) Number of days since last refill: *** days
(D) Volume from pump infused per day (actual pump rate): *** mL/day (answer in part B divided by answer in part C)
NURSING COMMUNICATION
ONCE Starting when released
Calculate pump rate and enter information into the HAI Pump Rate Calculation order on Day 1 of the next cycle.
Pre-Medications
lidocaine (LMX) 4% topical dressing kit
Topical, ONCE, 1 dose Starting when released
Apply 30 minutes prior to to HAI port/pump access.
Treatment Medications
heparin 30,000 units in sodium chloride 0.9 % 30 mL injection
30,000 units, Intraarterial, ONCE, 1 dose Starting when released
Follow-Up
FOLLOW-UP
(Day 1 of next cycle) CHEMOTHERAPY ROOM APPOINTMENT: hepatic arterial infusion pump refill (heparinized saline)
for 60 minutes
Heparin for HAI Pump Maintenance –  12/5/2017 through 12/11/2017 (7 days), Planned
Day 1, Heparin for HAI Pump Maintenance –  Planned for 12/5/2017
Treatment Plan Information
Reference Information (1)
COLORECTAL CANCER: Kemeny N, et al. N Engl J Med 1999; 341(27):2039-48
Reference Information (2)
COLORECTAL CANCER: Kemeny N, et al. J Clin Oncol 2006; 24(9):1395-1403
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced); THERAPY DELIVERED VIA CONTINUOUS HEPATIC ARTERIAL INFUSION PUMP
heparin 30,000 units (fixed dose); CYCLE LENGTH: 7 to 14 days; COURSE: As needed for HAI pump maintenance.
Treatment Plan Summary (2)
FOR PATIENTS RESUMING CHEMOTHERAPY use treatment plan CSC GI HEPATIC ARTERIAL INFUSION FLOXURIDINE
(28D:1-14)
Nursing Procedure, Assessment and Monitoring
HAI Pump Rate Calculation
HAI PUMP RATE CALCULATION:
(A) Volume withdrawn from pump: *** mL on ***/***/***
(B) Volume from pump infused: *** mL (30 mL minus answer in part A)
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Zztestonc,Fiona F [2462287]
11/21/2017 10:27:01 AM Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

(C) Number of days since last refill: *** days
(D) Volume from pump infused per day (actual pump rate): *** mL/day (answer in part B divided by answer in part C)
NURSING COMMUNICATION
ONCE Starting when released
Calculate pump rate and enter information into the HAI Pump Rate Calculation order on Day 1 of the next cycle.
Pre-Medications
lidocaine (LMX) 4% topical dressing kit
Topical, ONCE, 1 dose Starting when released
Apply 30 minutes prior to to HAI port/pump access.
Treatment Medications
heparin 30,000 units in sodium chloride 0.9 % 30 mL injection
30,000 units, Intraarterial, ONCE, 1 dose Starting when released
Follow-Up
FOLLOW-UP
(Day 1 of next cycle) CHEMOTHERAPY ROOM APPOINTMENT: hepatic arterial infusion pump refill (heparinized saline)
for 60 minutes
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Zztestonc,Fiona F [2462287]
11/21/2017 10:27:01 AM Page 3 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org