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/clinical/cckm-tools/content/order-sets/ambulatory/girenal/name-98577-en.cckm

201608221

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UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,GI/Renal

Cardiac Cath-EP - Interventional Nephrology - Adult - Pre/Postprocedure [2860]

Cardiac Cath-EP - Interventional Nephrology - Adult - Pre/Postprocedure [2860] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, GI/Renal


Cardiac Cath/EP - Interventional Nephrology - Adult - Pre/Postprocedure [2860]
for Adult Patients OnlyIntended
Patient Care Orders
Glucose POC and Hypoglycemia Management [208749]
Order if patient is diabetic. Select BOTH orders when ordering.
Glucose, POC - if patient is diabetic
[IPGLUCOSE]
ONCE, Starting today For 1 Occurrences, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Prior to procedure, Cardiac Cath/EP
Hypoglycemia Management (Adult) [191576]
Adult Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97511-en.cckm
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until
specified, Routine, Glucose, POC should always be
ordered in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Cardiac Cath/EP
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today For Until specified,
Routine, Glucose, POC should always be ordered
in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less
than 40 mg/dL), recheck glucose after 1 hour to
ensure glucose remains greater than or equal to
70mg/dL. After resolution of mild hypoglycemia
(i.e., glucose 40-69 mg/dL), consider rechecking
after 1 hour if patient has signs/symptoms of
hypoglycemia or is at risk for a subsequent
hypoglycemic event (e.g., previously administered
insulin still active, altered renal status, altered
mental status, NPO or interrupted nutrition, or any
other condition that increases hypoglycemia risk),
Cardiac Cath/EP
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Cardiac Cath/EP
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose
less than 40mg/dL and patient able to eat/swallow
safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Cardiac Cath/EP
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Cardiac Cath/EP
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
40-69 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
Cardiac Cath/EP
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
less than 40 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
Cardiac Cath/EP
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia
Algorithm
Cardiac Cath/EP
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely
AND has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia
Algorithm
Cardiac Cath/EP
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less
than 40 mg/dL and patient unable to eat/swallow
safely AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia
Algorithm
Cardiac Cath/EP
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting today For
7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Cardiac Cath/EP
Page 2 of 5
Printed by LIND, JANNA S [JSL237] at 7/29/2016 11:39:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting 8/6/16 For
7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Cardiac Cath/EP
Non-Categorized Patient Care Orders [89070]
Measure Height [NURMON0052] ONCE, Starting today For 1 Occurrences, Routine,
Prior to Procedure, Cardiac Cath/EP
Measure Weight [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
Prior to Procedure, Cardiac Cath/EP
Patient Monitoring [89104]
Access Site/Neurovascular Assessment
[NURMON0060]
SEE COMMENTS, Starting today, Starting post-
procedure: Every 15 minutes times 4, then every 30
minutes times 4, then until hemostasis., Cardiac
Cath/EP
Hematoma/Persistent Bleeding [NURMON0060] SEE COMMENTS, Starting today, Apply direct
pressure to procedure site and notify attending
physician., Cardiac Cath/EP
Prior to Discharge [209462]
Patient Must Be Seen by Attending Prior to
Discharge [NURMON0083]
ONCE, Starting today For 1 Occurrences, Routine,
Cardiac Cath/EP
Patient Must Be Seen by Resident Prior to
Discharge [NURMON0082]
ONCE, Starting today For 1 Occurrences, Routine,
Cardiac Cath/EP
Contingency Parameters [89108]
Notify Nephrologist Fellow On-Call
[NURCOM0001]
Routine, If there are any complications postprocedure
(i.e. bleeding, pain, fevers/chills) call operator (608-
263-6400) for Nephrologist Fellow on call.
Intravenous Therapy
Premedications for Needle Insertion [209407]
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
Page 3 of 5
Printed by LIND, JANNA S [JSL237] at 7/29/2016 11:39:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

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 based on
patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Cardiac Cath/EP
Intravenous Therapy [89004]
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS
Begin on call to Cath Lab
Cardiac Cath/EP
Insert and Maintain Peripheral IV for
Thrombectomy and Catheter
Placement/Exchange Procedures
[NURVAD0013]
CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Cardiac Cath/EP
Medications
For Patients With Contrast Dye Allergy [89028]
hydrocortisone sod suc in sodium chloride 0.9%
injection [800189]
100 mg, Intravenous, ONCE For 1 Doses, Cardiac
Cath/EP
diphenhydramine (BENADRYL) injection
[800106]
25 mg, Intravenous, ONCE For 1 Doses, Cardiac
Cath/EP
Intra-Procedure [208759]
alteplase (ACTIVASE) injection [760006] 2 mg, Intravenous, ONCE For 1 Doses
Given by the physician during the procedure
Tube to station 630 as soon as possible
Cardiac Cath/EP
heparin 1000 UNIT/ML injection [45303] 2,000 units, Intravenous, ONCE For 1 Doses, Cardiac
Cath/EP
Analgesics (Single Response) [89036]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab RANGE [750021]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain, severe
pain, Cardiac Cath/EP
acetaMINOPHEN (TYLENOL) tab RANGE
[750000]
325-650 mg, Oral, EVERY 6 HOURS PRN,
pain/fever, Mild to moderate pain, multi-modal
therapy, or fever, Cardiac Cath/EP
Anti-emetics (Single Response) [208758]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting, First line therapy, Cardiac Cath/EP
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting, First line therapy when unable to
take orally, Cardiac Cath/EP
Laboratory
Laboratory - Pregnancy Test [209475]
Page 4 of 5
Printed by LIND, JANNA S [JSL237] at 7/29/2016 11:39:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

surgery is pelvic, renal, pregnancy test if female between menarche & menopause and any of: (1) Obtain
intercourse, (3) patient missed menses, (4) patient says abdominal, (2) patient had unprotected -or intra
she "could" be pregnant.
Urine, Pregnancy Test [UPREG] 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
Laboratory [146974]
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT 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
Page 5 of 5
Printed by LIND, JANNA S [JSL237] at 7/29/2016 11:39:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org