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CSC SC Immune Globulin IV - 400 mg/kg X 4 Days Idiopathic Thrombocytopenia Purpura (ITP) Ver 11-20-17 (HL 1859)

CSC SC Immune Globulin IV - 400 mg/kg X 4 Days Idiopathic Thrombocytopenia Purpura (ITP) Ver 11-20-17 (HL 1859) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Supportive Care


CSC SC IMMUNE GLOBULIN IV - 400 MG/KG X 4 DAYS FOR IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)
VER:11-20-17 –  Properties
Cycle 1 –  11/21/2017 through 11/27/2017 (7 days), Planned
Day 1, Cycle 1 –  Planned for 11/21/2017
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to immune globulin can occur. For first and second dose, patient should be treated in a
location to optimize emergency care. See Emergency Medications.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
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
famotidine (PEPCID) 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
Supportive Care Medications
immune globulin 10% (GAMMAGARD LIQ) 400 mg/kg (Ideal)
400 mg/kg, Intravenous, ONCE, 1 dose Starting when released
Refer to IVIG Guideline for Administration Recommendations. The IVIG infusion line may be flushed with NS or D5W.  A
filter is not required for administration.
Day 2, Cycle 1 –  Planned for 11/22/2017
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to immune globulin can occur. For first and second dose, patient should be treated in a
location to optimize emergency care. See Emergency Medications.
Hydration
sodium chloride 0.9 % infusion
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Zztestonc,Fiona F [2462287]
11/21/2017 10:30:04 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

at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
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
famotidine (PEPCID) 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
Supportive Care Medications
immune globulin 10% (GAMMAGARD LIQ) 400 mg/kg (Ideal)
400 mg/kg, Intravenous, ONCE, 1 dose Starting when released
Refer to IVIG Guideline for Administration Recommendations. The IVIG infusion line may be flushed with NS or D5W.  A
filter is not required for administration.
Day 3, Cycle 1 –  Planned for 11/23/2017
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to immune globulin can occur. For first and second dose, patient should be treated in a
location to optimize emergency care. See Emergency Medications.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
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,Fiona F [2462287]
11/21/2017 10:30:04 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

10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) 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
Supportive Care Medications
immune globulin 10% (GAMMAGARD LIQ) 400 mg/kg (Ideal)
400 mg/kg, Intravenous, ONCE, 1 dose Starting when released
Refer to IVIG Guideline for Administration Recommendations. The IVIG infusion line may be flushed with NS or D5W.  A
filter is not required for administration.
Day 4, Cycle 1 –  Planned for 11/24/2017
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to immune globulin can occur. For first and second dose, patient should be treated in a
location to optimize emergency care. See Emergency Medications.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to immune globulin.
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
famotidine (PEPCID) 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
Supportive Care Medications
immune globulin 10% (GAMMAGARD LIQ) 400 mg/kg (Ideal)
400 mg/kg, Intravenous, ONCE, 1 dose Starting when released
Refer to IVIG Guideline for Administration Recommendations. The IVIG infusion line may be flushed with NS or D5W.  A
filter is not required for administration.
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Zztestonc,Fiona F [2462287]
11/21/2017 10:30:04 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