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IP/OP - Coronary CT Angiography - Adult - Procedure [2236]

IP/OP - Coronary CT Angiography - Adult - Procedure [2236] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Cardiac Cath and Electrophysiology Labs


IP/OP - Coronary CT Angiography - Adult - Procedure [2236]
for Adult Patients OnlyIntended
Pre-Angiography - Patient Care Orders
Vital Signs [31367]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
On arrival.
After Oral Metoprolol Administration [31368]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 2, then every 30 minutes after
oral metoprolol administration.
After Intravenous Metoprolol Administration [31369]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 5 minutes times 3, then every 15 minutes times
3 after intravenous metoprolol administration.
After Diltiazem Administration [186775]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 10 minutes times 3 then every 15 minutes times
2 after intravenous diltiazem administration.
Patient Monitoring [31370]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication: Other (Comment Required)
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Check rate and rhythm.
Page 1 of 4
Printed by BENNETT, SARA J [SJB008] at 11/17/2017 11:05:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

ECG - 12 Lead [EKG0008] PRN, Routine
Reason for exam: Atrial Arrhythmia,Ventricular
Tachycardia/Ventricular Fibrillation
Disclaimer for University Hospital Only: A Stat status
for an ECG is in reference to the timing of the ECG.
The goal is to perform a STAT ECG within 10 minutes
of the order being placed. It is the responsibility of the
ordering provider to review the STAT ECGs. All ECGs
(stat or routine) will be formally reviewed within one
business day.
For irregular rhythm. If ECG shows a rhythm other
than sinus, call cardiology attending.
Nutrition [31371]
NPO for Procedure - Hold Diet [DIE0007] CONTINUOUS NPO, Starting today For 6 Hours,
Routine
NPO For Which Procedure? CT Angiography
Modifiers:
Non-Categorized Patient Care Orders for Diabetic Patients [31372]
Glucose, POC [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?
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, 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 or greater than 400 mg/dL.
Contingency Parameters [31374]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm): 45
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Irregular heart rate is identified,,If maximum IV
metoprolol (50 mg) is reached,,or if systolic blood
pressure less than 100 mmHg,,Previous adverse
reaction to nitroglycerin,Current use of PDE inhibitors
(sildenafil, tadalafil),,Patient has history of NON-
anaphylactic reaction (hives, itching, rash) to contrast
dye and has NOT taken methylprednisilone prior to
procedure,,Patient has history of anaphylactic reaction
(airway compromise)
Notify Cardiology Attending
Page 2 of 4
Printed by BENNETT, SARA J [SJB008] at 11/17/2017 11:05:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Pre-Angiography - Medications
Intravenous Therapy [31356]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified,
Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Insert 16-18 gauge intravenous catheter in antecubital
or larger vein (right preferred).
Attach high pressure 3 inch extension or high
pressure stopcock [NURVAD0053]
ONCE, Starting today For 1 Occurrences
Oral Metoprolol Protocol (Single Response) [31338]
metoprolol tartrate (LOPRESSOR) tab [720094] Oral, ONCE PRN For 1 Doses, For resting heart rate
GREATER than 70 beats/minute one hour prior to
procedure. Do NOT administer IF 50 mg dose has
already been GIVEN.
metoprolol tartrate (LOPRESSOR) tab [720094] Oral, ONCE PRN For 1 Doses, For resting heart rate
BETWEEN 60 and 69 beats/min one hour prior to
procedure. Do NOT administer IF 100 mg dose has
already been GIVEN.
IV Metoprolol Protocol [31340]
metoprolol (LOPRESSOR) injection [800274] 5 mg, Intravenous, EVERY 5 MINUTES PRN For 10
Doses, for heart rate greater than 60 beats/minute.
Give first dose 20 minutes prior to procedure.
(maximum 50 mg)
If the maximum dose of 50 mg of intravenous
metoprolol is not reached and heart rate less than
60 beats per minute achieved, bring 25 mg IV
metoprolol or remaining IV doses of metoprolol up
to 50 mg (whichever is less) to Radiology. If less
than 45 minutes until scan time, page Cardiology
attending to clarify [NURCOM0022]
ONCE, Starting today For 1 Occurrences
Calcium Channel Blockers [136472]
diltiazem (CARDIZEM) injection - The Coronary
CT Angiography Procedure should be performed
20-35 minutes after diltiazem is given. Peak effect
of the medication is reached 20 minutes after
administration and the effect diminishes in
another 20-30 minutes. [135458]
20 mg, Intravenous, PRN
Nitroglycerin [31342]
nitroglycerin (NITROSTAT) sublingual tab [40283] 0.4 mg, Sublingual, SEND TO PERIOP/PROC AREA
For 2 Doses
Give first dose in unit 15 minutes before scan. Give
second dose upon arrival to the scanner. Hold if
systolic blood pressure is less than 100 mmHg, severe
aortic stenosis or for previous intolerance.
Post-Angiography
Vital Signs [31375]
Page 3 of 4
Printed by BENNETT, SARA J [SJB008] at 11/17/2017 11:05:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
After patient returns to unit: If oral metoprolol was
given - Vital signs every 30 minutes times 3 after last
dose. If IV metoprolol or IV diltiazem was given - Vital
signs every 30 minutes times 2 after last IV dose.
Page 4 of 4
Printed by BENNETT, SARA J [SJB008] at 11/17/2017 11:05:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org