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201709272

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OP - Bone Marrow Biopsy With Sedation [2135]

OP - Bone Marrow Biopsy With Sedation [2135] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, BMT/Oncology/Hematology


OP - Bone Marrow Biopsy With Sedation [2135]
Patient Care Orders
Activity [228841]
Activity [NURACT0011] CONTINUOUS, Patient should remain supine for at
least 15 minutes after the procedure.
Nutrition [228866]
Nursing Communication - Diet [NURDIE0013] CONTINUOUS, General
Wound Care [229171]
Nursing Communication - Wound Care
[NURWND0018]
CONTINUOUS, Assess bone marrow biopsy site for
bleeding every 15 minutes x 2. If site is bleeding,
place patient in supine position and notify provider.
Contingency Parameters [229242]
Notify Provider [NURCOM0001] If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 110
If diastolic blood pressure < (mmHg): 60
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >: 30
If respiratory rate <: 8
Pulse Oximetry < (%): 90
Intravenous Therapy
Premedications for Needle Insertion [106313]
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.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Pre-Op Day Of Procedure
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
Pre-Op Day Of Procedure
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
Pre-Op Day Of Procedure
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/28/2017 4:07:29 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

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 based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Pre-Op Day Of Procedure
IV Fluids [228572]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride 0.9 % infusion [64367] at 20 mL/hr, Intravenous, CONTINUOUS
Flushes
FLUSHES for VAD - ONCOLOGY Heparin/Sodium Chloride 0.9% [28967]
Flush Venous Access Device per Guidelines
[7700126]
Details
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN Starting today, flush/line care
Flush per VAD guidelines
heparin lock flush 10 units/mL 5 mL injection
[75031]
1-150 units, Flush, PRN Starting today, flush/line care
Flush per VAD guidelines
heparin lock flush 100 units/mL 5 mL injection
[64978]
500 units, Flush, PRN Starting today, flush/line care
Implanted port use ONLY to be used when de-
accessing port. Flush per VAD guidelines
Procedure Orders
ONC CSC BMBx OP - BONE MARROW BIOPSY orders [29722]
sodium chloride 0.9% infusion [64367] at 20 mL/hr, Intravenous, CONTINUOUS
midazolam (VERSED) injection RANGE [750056] 2-10 mg, Intravenous, PRN Starting today, sedation,
procedural sedation
Administer at provider direction, once the provider has
arrived at the bedside. Titrate by 1 mg every 2 to 5
minutes for a sedation score of 3-4 (maximum total
dose 10 mg)
If ordered IV: push rate 1 mg/minute.
FENTanyl PF injection RANGE [750047] 25-100 mcg, Intravenous, PRN Starting today,
procedural pain
Administer at provider direction, once the provider has
arrived at the bedside. Titrate by 25 mcg every 2 to 5
minutes (maximum total dose 100 mcg)
for 1 Minutes
lidocaine 1 % vial [39034] 5-20 mL, Other, PRN, bone marrow biopsy
For administration by provider to prepare site for bone
marrow biopsy
BONE MARROW ASPIRATE & BIOPSY [G0364] Status: Future, Expires: 9/28/18, Normal, Routine,
Qty-1
Reversal Agents [228574]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN For 8 Doses, opioid
overdose, Over sedation from opioids
Administer 0.1 mg every three minutes PRN, up to 8
doses for respiratory rate less than 8 breaths/minute
or sedation score of 5 or greater. Max number of
doses = 8. Notify if Administered.
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/28/2017 4:07:29 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

flumazenil (ROMAZICON) injection [760105] 0.2 mg, Intravenous, PRN For 5 Doses, Oversedation
from benzodiazepines
Administer 0.2 mg over 15 seconds; repeat dose after
45 seconds (one minute intervals) PRN for sedation
reversal. Max number of doses = 5. Give naloxone
prior to flumazenil if opioids are given at the same
time. Notify provider if administered. If orders IV:
push over 15-30 seconds
Laboratory
Laboratory [229258]
HEMATOPATHOLOGY [HCPATHH] ONCE For 1 Occurrences, Routine, A CBC with
differential must be ordered in conjunction with a
request for a peripheral smear review by the
hematopathologist.
A CBC with differential and reticulocyte must be
ordered in conjunction with a request for a bone
marrow collection.
Clinical History:
Suspected Diagnosis:
Initial Diagnostic Specimen:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CBC with Differential [CBC] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Reticulocyte Count [RET] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/28/2017 4:07:29 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org