/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/hod/,/clinical/cckm-tools/content/order-sets/hod/cardiac-cath-and-electrophysiology-labs/,

/clinical/cckm-tools/content/order-sets/hod/cardiac-cath-and-electrophysiology-labs/name-97805-en.cckm

201711317

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,HOD,Cardiac Cath and Electrophysiology Labs

Cardiac Cath/EP – Study/Ablation Delegation Protocol – Adult – Preprocedure [5181]

Cardiac Cath/EP – Study/Ablation Delegation Protocol – Adult – Preprocedure [5181] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Cardiac Cath and Electrophysiology Labs


Cardiac Cath/EP - Study/Ablation - Delegation Protocol - Adult - Preprocedure
[5181]
for Adult Patients OnlyIntended
Delegation Protocol URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/delegationpractice-
protocols/ambulatory-delegation-protocols/name-
97369-en.cckm
Patient Care Orders
Vital Signs [139633]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location: Bilateral Arms
BP Position:
BP Restrictions:
Obtain upon admission, Cardiac Cath/EP
Nutrition [139634]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Cardiac Cath/EP
Non-Categorized Patient Care Orders [146740]
Glucose, POC [IPGLUCOSE] STAT, 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? Patients with Diabetes
Cardiac Cath/EP
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today, 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: Indwelling Single Lumen
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
To be placed by Electrophysiology Lab staff once
patient is sedated.
Urinary Catheter Removal Protocol does NOT apply
to Urology, Gynecology, spinal cord injured patients,
patients with catheters placed by Urology on prior
admission, or to patients with chronic foley catheters.
Not appropriate for Pediatric patients., Cardiac
Cath/EP
Intravenous Therapy
Premedications for Needle Insertion [139592]
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:33:47 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

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 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, Routine
Peripheral IV Size: RN Discretion
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
General Medications [190086]
acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, ONCE For 1 Doses, Cardiac Cath/EP
Laboratory
On Arrival [139600]
ACTIVATED CLOTTING TIME, POC
[HCACTPOC]
STAT For 1 Occurrences, Routine
If Conditional, What Condition?
Cardiac Cath/EP
Laboratory [139601]
MAGNESIUM [MAG] STAT, 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
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:33:47 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

ELECTROLYTES [LYTE] STAT, 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, 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, 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, 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
Taking Warfarin [139603]
PROTHROMBIN TIME/INR [PT] STAT, Starting today For 1 Occurrences, Routine
If Conditional, What Condition? For patients on
warfarin
Cardiac Cath/EP
Laboratory - Pregnancy Test [121729]
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
pregnant. she "could" be
Urine, Pregnancy Test [UPREG] 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?
Cardiac Cath/EP
Blood Bank
Conditional-Patients with Atrial Fibrillation [139616]
TYPE AND SCREEN [HCTS] STAT, Starting today For 1 Occurrences, Routine, As
good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2
packed RBCs on all patients with antibodies to ensure
blood would be available in the event it is needed. If
you would like to opt out of this automatic order for this
patient please contact the UWHC Blood Bank at (608)
263-8367 or The American Center Lab at (608) 234-
6600 as appropriate., Cardiac Cath/EP
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [139625]
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, Routine
Reason for exam:
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:33:47 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org