/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/ambulatory/,/clinical/cckm-tools/content/order-sets/ambulatory/radiology/,

/clinical/cckm-tools/content/order-sets/ambulatory/radiology/name-113737-en.cckm

20180103

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Radiology

OP - AFCH Diagnostic Imaging and Therapeutic Services Delegation Protocol - Pediatric - Procedure [5309]

OP - AFCH Diagnostic Imaging and Therapeutic Services Delegation Protocol - Pediatric - Procedure [5309] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Radiology


OP - AFCH Diagnostic Imaging and Therapeutic Services Delegation Protocol -
Pediatric - Procedure [5309]
Patient Care Orders
Diet [148474]
NPO for Procedure - Hold Diet [DIE0007] CONTINUOUS NPO For 4 Hours, Routine
NPO For Which Procedure?
Modifiers: NPO WITH SIPS OF WATER
Clear liquids and breast milk are okay., Peds
Diagnostic
Non-Categorized Patient Care Orders [148476]
Nursing Communication [NURCOM0022] ONCE For 1 Occurrences, Please call nuclear
medicine at 255-6094 with the patient's current weight
and height upon arrival., Peds Diagnostic
Nuclear Medicine Kidney Scan with Flow and Function
All patients [148477]
Intravenous Therapy [236145]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Peds Diagnostic
sodium chloride 0.9% BOLUS [730003] 10 mL/kg, Intravenous, CONTINUOUS
Administer 30 minutes prior to diuretic
(Furosemide/Lasix). Once hydration is complete IV
fluids should be run at 8 mL/kg/hour.
lidocaine (LMX) 4% topical dressing kit PEDS
[236081]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle sticks
to reduce pain. See "LMX Use Instructions" order in
Active Orders report or the Admin Instructions for
application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
Peds Diagnostic
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Peds Diagnostic
Patients < 10 years of age, sedated, with vesicoureteral reflux or with neurogenic bladder [148914]
All Patients [236146]
Page 1 of 3
Printed by SPENCER, LINDSEY M [LMS033] at 12/21/2017 5:30:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Routine, To discontinue this order,
enter a new order for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order.
Type:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
To discontinue this order, enter a new order for
"Discontinue Urinary Catheter".
To modify this order enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order., Peds Diagnostic
lidocaine (XYLOCAINE JELLY) 2 % gel [39030] Topical, ONCE For 1 Doses, Peds Diagnostic
Genitourinary Voiding Cystourethrogram (VCUG)
Medications [148914]
All Patients [236146]
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Routine, To discontinue this order,
enter a new order for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order.
Type:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
To discontinue this order, enter a new order for
"Discontinue Urinary Catheter".
To modify this order enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order., Peds Diagnostic
lidocaine (XYLOCAINE JELLY) 2 % gel [39030] Topical, ONCE For 1 Doses, Peds Diagnostic
Other Procedures Requiring Administration of Contrast
Intravenous Therapy [148925]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Peds Diagnostic
lidocaine (LMX) 4% topical dressing kit PEDS
[236085]
Page 2 of 3
Printed by SPENCER, LINDSEY M [LMS033] at 12/21/2017 5:30:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle sticks
to reduce pain. See "LMX Use Instructions" order in
Active Orders report or the Admin Instructions for
application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
Peds Diagnostic
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Peds Diagnostic
Page 3 of 3
Printed by SPENCER, LINDSEY M [LMS033] at 12/21/2017 5:30:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org