/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/diagnosticssedation/,

/clinical/cckm-tools/content/order-sets/hod/diagnosticssedation/name-111727-en.cckm

20170117

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,HOD,Diagnostics/Sedation

OP - General Medications - Pediatric Diagnostics - Supplemental [4612]

OP - General Medications - Pediatric Diagnostics - Supplemental [4612] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Diagnostics/Sedation


OP - General Medications - Pediatric Diagnostics - Supplemental [4612]
Intravenous Therapy
IV Fluids [126386]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Peds Diagnostic
dextrose 5%-NaCl 0.2% infusion [51615] Intravenous, CONTINUOUS, Peds Diagnostic
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, Peds Diagnostic
dextrose 5%-NaCl 0.45% with KCl 10 mEq/L
infusion [44908]
Intravenous, CONTINUOUS, Peds Diagnostic
dextrose 5%-NaCl 0.2% with KCl 20 mEq/L
infusion [44909]
Intravenous, CONTINUOUS, Peds Diagnostic
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
Intravenous, CONTINUOUS, Peds Diagnostic
sodium chloride 0.45 % infusion [42187] Intravenous, CONTINUOUS, Peds Diagnostic
sodium chloride 0.9% infusion [730003] Intravenous, CONTINUOUS, Peds Diagnostic
Medications
Pre-Medications [126390]
acetaMINOPHEN (TYLENOL) disintegrating tab -
Maximum Dose = 650 mg - Suggested Dose 15
mg/kg/dose [64412]
Oral, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
acetaMINOPHEN (TYLENOL) tab - Maximum
Dose = 650 mg - Suggested Dose 15 mg/kg/dose
[34149]
Oral, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - Maximum Dose = 650 mg [800005]
15 mg/kg, Oral, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
acetaMINOPHEN (TYLENOL) suppository -
Maximum Dose = 650 mg - Suggested Dose 15
mg/kg/dose [43994]
Rectal, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
dexamethasone (DECADRON) intraVENOUS
[800037]
Intravenous, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
diphenhydramine (BENADRYL) cap - Maximum
Dose = 25 mg - Suggested Dose 0.5 mg/kg/dose
[36791]
Oral, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
diphenhydramine (BENADRYL) injection -
Maximum Dose = 25 mg [800106]
0.5 mg/kg, Intravenous, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
diphenhydramine (BENADRYL) elixir - Maximum
Dose = 25 mg [36793]
0.5 mg/kg, Oral, ONCE For 1 Doses
Administer as a Pre-medication
Peds Diagnostic
lorazepam (ATIVAN) injection [800053] Intravenous, ONCE For 1 Doses
Administer as a Pre-Medication
If ordered IV: push rate 2 mg/minute.
Peds Diagnostic
lorazepam (ATIVAN) tab [720081] Oral, ONCE For 1 Doses
Administer as a Pre-Medication
Peds Diagnostic
Flushes [126393]
Flushing/Locking of Venous Access Devices –
Adult/Pediatric – Inpatient/Ambulatory - Clinical
Practice Guidelines
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?
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path=/content/cpg/medications/name-97566-
en.cckm
heparin lock flush 10 UNIT/ML injection [75031] 1-150 units, Flush, PRN, flush/line care, Peds
Diagnostic
heparin lock flush 100 UNIT/ML injection [64978] Flush, PRN, flush/line care, Peds Diagnostic
Anti-infectives [126391]
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose - 2000 mg [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Peds
Diagnostic
cefepime (MAXIPIME) intraVENOUS - Maximum
Dose = 2000 mg [800016]
50 mg/kg, Intravenous, ONCE For 1 Doses, Peds
Diagnostic
ceftriaxone (ROCEPHIN) intraVENOUS -
Maximum Dose = 1000 mg [800027]
50 mg/kg, Intravenous, ONCE For 1 Doses, Peds
Diagnostic
Analgesics (Single Response) [126394]
acetaMINOPHEN (TYLENOL) disintegrating tab -
Maximum Dose = 650 mg - Suggested Dose 15
mg/kg/dose [64412]
Oral, ONCE PRN For 1 Doses, pain, Peds Diagnostic
acetaMINOPHEN (TYLENOL) tab - Maximum
Dose = 650 mg - Suggested Dose 15 mg/kg/dose
[34149]
Oral, ONCE PRN For 1 Doses, pain, Peds Diagnostic
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - Maximum Dose = 650 mg [800005]
15 mg/kg, Oral, ONCE PRN For 1 Doses, pain, Peds
Diagnostic
acetaMINOPHEN (TYLENOL) suppository -
Maximum Dose = 650 mg - Suggested Dose 15
mg/kg/dose [43994]
Rectal, ONCE PRN For 1 Doses, pain, Peds
Diagnostic
Anti-emetics (Single Response) [126395]
ondansetron (ZOFRAN) injection - NOTE: Order
for patients less than 40 kg - Maximum Dose = 4
mg [800202]
0.1 mg/kg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting, Peds Diagnostic
ondansetron (ZOFRAN) injection - NOTE: Order
for patients 40 kg or greater [800202]
4 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting, Peds Diagnostic
ondansetron (ZOFRAN) tab [45939] 4 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting, Peds Diagnostic
ondansetron (ZOFRAN) tab [45939] 8 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting, Peds Diagnostic
Hypnotics (Single Response) [126396]
lorazapam (ATIVAN) injection [800053] Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting, Peds Diagnostic
lorazepam (ATIVAN) tab [720081] Oral, ONCE PRN For 1 Doses, nausea/vomiting,
Peds Diagnostic
Infusion Reaction (Single Response) [126397]
methylprednisolone sodium succ (SOLU-
MEDROL) intraVENOUS [800058]
Intravenous, ONCE PRN For 1 Doses, Infusion
reaction or anaphylaxis, Peds Diagnostic
epINEPHrine (ANAPHYLAXIS) injection [800185] Intramuscular, ONCE PRN For 1 Doses, Infusion
reaction
Laboratory
Laboratory [127104]
ALBUMIN [ALB] 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?
Peds Diagnostic
Page 2 of 8
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:45:34 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

ALDOLASE [XALD] 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?
Peds Diagnostic
ALKALINE PHOSPHATASE [ALKP] 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?
Peds Diagnostic
ALT/SGPT [ALT] 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?
Peds Diagnostic
AMYLASE [AMYL] 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?
Peds Diagnostic
AST/SGOT [AST] 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?
Peds Diagnostic
BILIRUBIN, DIRECT [DBIL] 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?
Peds Diagnostic
BILIRUBIN, TOTAL [TBIL] 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?
Peds Diagnostic
BK VIRUS, QUANTITATIVE BY PCR
[HCBKVPCR]
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?
Peds Diagnostic
BK VIRUS, QUANTITATIVE BY PCR, URINE
[HCBKPCR]
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?
Peds Diagnostic
BUN [BUN] 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?
Peds Diagnostic
C REACTIVE PROTEIN [CRPN] 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?
Peds Diagnostic
Page 3 of 8
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:45:34 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

C3 [XC3] 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?
Peds Diagnostic
C4 [XC4] 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?
Peds Diagnostic
CALCIUM [CA] 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?
Peds Diagnostic
CBC WITH DIFFERENTIAL [CBC] 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?
Peds Diagnostic
CBC WITHOUT DIFFERENTIAL [HEMO] 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?
Peds Diagnostic
CMV QUANTITATIVE BY PCR [HCCMVDNA] 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?
Peds Diagnostic
CREATININE [CRET] 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?
Peds Diagnostic
DNA AB, DOUBLE STRANDED [DNA] STAT - RN COLLECT For 1 Occurrences, Routine,
Order only if ANA is positive.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
EBV QUANTITATIVE BY PCR [HCEBVPCR] 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?
Peds Diagnostic
ELECTROLYTES [LYTE] 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?
Peds Diagnostic
ENA AB [HCENA] STAT - RN COLLECT For 1 Occurrences, Routine,
Order only if ANA is positive.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
Page 4 of 8
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:45:34 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

ESR [ESR] 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?
Peds Diagnostic
FERRITIN [FER] 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?
Peds Diagnostic
FLOW CYTOMETRY, CD 19 AND 20 [HCF1920] STAT - RN COLLECT For 1 Occurrences, Routine, A
WBC and Differential must be ordered at same time.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
FLOW CYTOMETRY, CD 19 AND 20 WITH
WBC AND DIFFERENTIAL [116749]
Lab Test Directory URL: https://uconnect.wisc.edu/clinical/tools-
resources/lab-test-directory/flow-
cytometry/name-68946-en.labtest
WHITE CELL COUNT AND DIFFERENTIAL
[WBCD]
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?
Peds Diagnostic
FLOW CYTOMETRY, CD 19 AND 20 [HCF1920] STAT - RN COLLECT For 1 Occurrences, Routine,
A WBC and Differential must be ordered at same
time.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
GGT [GGT] 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?
Peds Diagnostic
GLUCOSE, FASTING [HCFSGLU] STAT - RN COLLECT For 1 Occurrences, Routine,
Patient should have nothing to eat or drink (except
water) for 8-10 hours before test.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
GLUCOSE [GLU] 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?
Peds Diagnostic
Page 5 of 8
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:45:34 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

GROWTH HORMONE [HCHGH] STAT - RN COLLECT For 1 Occurrences, Routine,
The reference laboratory has patient preparation
instructions. Refer to the ARUP reference link below
for more information on this test and discuss with
patient as appropriate.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
HEMATOCRIT [HCT] 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?
Peds Diagnostic
HEMOGLOBIN [HGB] 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?
Peds Diagnostic
IGF-1 (INSULIN-LIKE GROWTH) [XIGF1] 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?
Peds Diagnostic
IMMUNOGLOBULIN A [XIGA] 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?
Peds Diagnostic
IMMUNOGLOBULIN G [XIGG] 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?
Peds Diagnostic
IMMUNOGLOBULIN M [XGAM3] 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?
Peds Diagnostic
LD, TOTAL [LDH] 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?
Peds Diagnostic
LH [LH] 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?
Peds Diagnostic
LIPASE [LIPS] 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?
Peds Diagnostic
Page 6 of 8
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:45:34 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

MAGNESIUM [MAG] 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?
Peds Diagnostic
MYCOPHENOLATE [HCMPA] 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?
Peds Diagnostic
PHOSPHATE [PHOS] 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?
Peds Diagnostic
PLATELET COUNT [PLT] 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?
Peds Diagnostic
POTASSIUM [K] 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?
Peds Diagnostic
PROTEIN, TOTAL [TP] 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?
Peds Diagnostic
PROTEIN/CREATININE RATIO, URINE
[HCUPCRC]
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?
Peds Diagnostic
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?
Peds Diagnostic
PTT [PTT] 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?
Peds Diagnostic
RETICULOCYTE COUNT [RET] 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?
Peds Diagnostic
TACROLIMUS LEVEL [HCTAC] 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?
Peds Diagnostic
Page 7 of 8
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:45:34 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

TSH [TSH] 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?
Peds Diagnostic
URINALYSIS WITH MICROSCOPY [UA] 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?
Peds Diagnostic
URINALYSIS WITH MICROSCOPY AND
CULTURE IF >5 WBC/HPF [HCUACULT]
STAT - RN COLLECT For 1 Occurrences, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
WHITE CELL COUNT [WBC] 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?
Peds Diagnostic
Page 8 of 8
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:45:34 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org