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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Ambulatory Delegation Protocols,Related

Cardiac Cath/EP - Implantable Devices - Adult - Preprocedure

Cardiac Cath/EP - Implantable Devices - Adult - Preprocedure - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols, Related


Cardiac Cath/EP - Implantable Devices - Adult - Preprocedure [5180]
Intended for Adult Patients Only
Patient Care Orders
Vital Signs [139665]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Upon arrival, Cardiac Cath/EP
Nutrition [139634]
Diet - NPO [NUT0001] EFFECTIVE NOW, Starting today, Routine
NPO (If patient receiving tube feeding see question 25): NPO
EXCEPT MEDICATIONS
Cardiac Cath/EP
Surgical Site Care [139610]
Chlorhexadine Scrub [NURTRT0020] ONCE, Starting today, Routine, Shave chest if needed.,
Cardiac Cath/EP
For Patients With Diabetes [139609]
Glucose, POC [IPGLUCOSE] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If Conditional, What Condition? Patients with Diabetes
Cardiac Cath/EP
Intravenous Therapy
Premedications for Needle Insertion [139592]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30 minutes time prior to needing
to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV access; onset is within 1 minute.
Choice of medication should be based on patient’s previous experience/preference, history of lidocaine allergy and ease
of access.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line insertion - see
Admin Instructions
Do NOT apply to area greater than 200 square centimeters
(maximum 2.5 g/site; maximum 4 sites per hour, 6 times per
day). Do NOT leave on longer than 2 hours. Use for stable
patient, no allergies to lidocaine, with at least 30 minutes time
prior to IV use
Cardiac Cath/EP
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 mL, Intradermal, PRN, peripheral line insertion - see
Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Cardiac Cath/EP
sodium chloride (bacteriostatic) 0.9 % injection [50585] 0.05-0.1 mL, Intradermal, PRN, peripheral line insertion - see
Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Cardiac Cath/EP
Intravenous Fluids [139628]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Device:
Peripheral IV Location:
Peripheral IV Size:
Peripheral IV Status:
Does this need to be inserted/placed?
Cardiac Cath/EP
sodium chloride 0.9 % infusion [64367] at 20 mL/hr, Intravenous, CONTINUOUS, Cardiac Cath/EP
Medications
Antimicrobial Prophylaxis (Single Response) [139598]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, ON CALL For 1 Doses, Cardiac Cath/EP
vancomycin (VANCOCIN) intraVENOUS - For Patients<
80 kg and with MRSA and Immediate/Severe Reaction
to Penicillin or Known Cephalosporin Allergies [800084]
1 g, Intravenous, ON CALL For 1 Doses
Administer over 1 hour
Cardiac Cath/EP
vancomycin (VANCOCIN) intraVENOUS - For Patients
80-125 kg and with MRSA and Immediate/Severe
Reaction to Penicillin or Known Cephalosporin Allergies
[800084]
1,500 mg, Intravenous, ON CALL For 1 Doses
Add to Admin Inst. Administer over 90 minutes
Cardiac Cath/EP
vancomycin (VANCOCIN) intraVENOUS - For Patients >
125 kg and with MRSA and Immediate/Severe Reaction
to Penicillin or Known Cephalosporin Allergies [800084]
2 g, Intravenous, ON CALL For 1 Doses
Administer over 2 hours
Cardiac Cath/EP
Anti-infective Irrigation [139611]
tobramycin irrigation POUR bottle 300 mg/1000 mL
[700535]
Irrigation, ONCE For 1 Doses, Cardiac Cath/EP
Laboratory
Laboratory [139627]
ELECTROLYTES [LYTE] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
BUN [BUN] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
CREATININE [CRET] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
CBC WITHOUT DIFFERENTIAL [HEMO] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
MAGNESIUM [MAG] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
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Pr i nted by SPENCER, L INDSEY M [LMS033] at 3/17/2014 11:23:34 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
Taking Warfarin [139603]
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If Conditional, What Condition? For patients on warfarin
Cardiac Cath/EP
Blood Bank
Conditional-Lead Extraction Patients [139613]
TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
As good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2 packed
RBC's on all patients with antibodies. Do you want to opt out
of this automatic order for this patient? No
Cardiac Cath/EP
Blood Products [142770]
Red Blood Cells (Adult) [BLB0006] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD verifies that
the clinical situation is sufficiently urgent to require release of
blood before completion of compatibility testing and agrees to
hold UWHC harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Cardiac Cath/EP
Plasma (Adult) [BLB0003] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Cardiac Cath/EP
Platelets (Adult) [BLB0004] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Does patient require single donor platelets (If yes, Blood Bank
MD approval required): No
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Has consent been obtained?
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Date Consent Obtained (Valid for 1 year):
Cardiac Cath/EP
Cryoprecipitate (Adult) [BLB0005] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products):
Date Product Needed:
Has consent been obtained?
Fibrin Glue, mLs Needed:
Date Consent Obtained (Valid for 1 year):
Cardiac Cath/EP
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [139667]
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: PRE-OPERATIVE
Cardiac Cath/EP
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Pr i nted by SPENCER, L INDSEY M [LMS033] at 3/17/2014 11:23:34 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority