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Pericardial Fluid Lab Ordering – Adult – Inpatient/Ambulatory [150]

Pericardial Fluid Lab Ordering – Adult – Inpatient/Ambulatory [150] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number:   150 
Delegation Protocol Title:  
Pericardial Fluid Lab Ordering – Adult – Inpatient/Ambulatory  
Delegation Protocol Applies To:  
University Hospital Cardiac Catheterization Laboratory  
Target Patient Population:  
Adult patients with pericardial effusion   
Delegation Protocol Champion: 
Giorgio Gimelli, MD – Department of Medicine – Cardiology 
Delegation Protocol Reviewer: 
Christine Smith, CNS ‐ Cardiology 
Responsible Department: 
Department of Medicine ‐ Cardiology 
Purpose Statement: 
This protocol delegates authority from the procedure provider to the Registered Nurse (RN) to place 
orders for laboratory testing.   
Who May Carry Out This Delegation Protocol: 
RNs who have been trained in the use of this delegation protocol.  
Guidelines for Implementation: 
1. This protocol is initiated when a patient presents for aspiration of pericardial effusion.
2. Clinic staff will review the patient’s medical record to identify previously entered orders to minimize
duplication.
3. RN will use order set to place orders listed below:
Amylase, Body Fluid   AFB Smear and Culture  
Cholesterol, Body Fluid   Fungal Smear and Culture  
Glucose, Body Fluid 
Protein, Body Fluid
Aerobic and Anaerobic Culture including Gram Stain  
Cytology, Non‐GYN 
Hematocrit, Body Fluid  
CBC with Differential  
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

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Order Mode:  Cosign Required, Protocol/Policy 
   
References: 
1. Hoit BD. Diagnosis and treatment of pericardial effusion. In: UpToDate, LeWinter MM, Sexton DJ
(Eds), UpToDate, Waltham, MA. (Accessed on August 17, 2016.) 
 
Collateral Documents/Tools:   
IP – Pericardial Fluid Laboratory Ordering Delegation Protocol – Adult – Supplemental [6417] Order Set 
 
Approved By: 
UW Health Ambulatory Protocol Committee: September 2016 
UW Health Laboratory Practices Committee: September 2016 
UW Health Clinical Knowledge Council: October 2016 
UWHC Medical Board: November 2016 
UW Health Chief Clinical Officer: November 2016 
 
Effective Date: November 2016 
 
Scheduled for Review:  November 2019 
 
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org