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OP - Sedation - Pediatric Diagnostics - Procedure [4696]

OP - Sedation - Pediatric Diagnostics - Procedure [4696] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Diagnostics/Sedation


OP - Sedation - Pediatric Diagnostics - Procedure [4696]
Patient Care Orders
Respiratory [126359]
Pulse Oximetry [NURMON0009] SEE COMMENTS, Routine, Every *** hours., Peds
Diagnostic
Oxygen Therapy [RT0032] CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Peds Diagnostic
Medications
Sedative - Hypnotic and Anxiolytics [126329]
chloral hydrate syrup [780033] 30-100 mg/kg, Oral, ONCE PRN For 1 Doses, sleep,
Sedation induction per policy 8.56, Peds Diagnostic
dexmedetomidine (PRECEDEX) infusion - PEDS
- LOAD [157210]
12 mcg/kg/hr, Intravenous, CONTINUOUS
LOAD: Administer over 5 to 10 minutes (1 to 2
mcg/kg/dose) per Sedation Policy 8.56
Peds Diagnostic
dexmedetomidine (PRECEDEX) infusion PEDS
[157210]
1-2 mcg/kg/hr, Intravenous, CONTINUOUS
Sedation Policy 8.56
Peds Diagnostic
dexmedetomidine (PRECEDEX) injection
[158965]
Intramuscular, ONCE PRN For 1 Doses, Sedation
induction per policy 8.56
dexmedetomidine (PRECEDEX) 100 mcg/mL
intraNASAL soln [785204]
1-4 mcg/kg, Nasal, ONCE PRN For 1 Doses, Sedation
induction per policy 8.56
Administer via atomizer
Peds Diagnostic
dexmedetomidine (PRECEDEX) soln [785136] 1-4 mcg/kg, Buccal, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56, Peds Diagnostic
dexmedetomidine (PRECEDEX) soln [785136] 2-4 mcg/kg, Oral, ONCE PRN For 1 Doses, Sedation
induction per policy 8.56, Peds Diagnostic
midazolam (VERSED) syrup - NOTE: Maximum
Dose - 20 mg [60487]
0.2-0.75 mg/kg, Oral, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56
NOTE: Maximum Dose - 20 mg
Peds Diagnostic
midazolam (VERSED) 5 MG/ML intraNASAL soln
- NOTE: Maximum dose - 4 mg [785196]
0.2-0.4 mg/kg, Nasal, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56
Administer via atomizer
NOTE: Maximum dose - 4 mg
Peds Diagnostic
midazolam (VERSED) injection - NOTE:
Maximum dose - 4 mg [800197]
0.05-0.1 mg/kg, Intravenous, ONCE PRN For 1
Doses, sedation, Sedation induction per policy 8.56
NOTE: Maximum dose - 4 mg
Peds Diagnostic
pentobarbital (NEMBUTAL) injection [40837] 2-6 mg/kg, Intravenous, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56
Maximum single dose = 160 mg
If ordered IV: push rate 50 mg/minute.
Peds Diagnostic
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 8/10/2017 11:04:27 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

propofol (DIPRIVAN) bolus - loading dose
[730017]
1-5 mg/kg, Intravenous, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56
Load at 1-2 mg/kg per minute to achieve sedation
level 4.
Peds Diagnostic
propofol (DIPRIVAN) 10 mg/mL IV BOLUS
[730017]
0.5-1 mg/kg, Intravenous, PRN, Sedation induction
per policy 8.56
May repeat PRN arousal or movement. RN to
document total dose administered.
Peds Diagnostic
propofol (DIPRIVAN) 10 mg/mL infusion [800260] 50-250 mcg/kg/min, Intravenous, CONTINUOUS
Load at 1-2 mg/kg per minute to achieve sedation
level 4 then infuse 100-150 mcg/kg/min per pediatric
sedation policy 8.56.
Peds Diagnostic
Nitrous Oxide [NURTRT0066] ONCE For 1 Occurrences, Routine, 1. Apply mask to
child's face, covering nose, administer O2 at 100%.
2. Begin N2O 10-70%.
3. Adjust N2O by increments of 10% every 2 - 3
minutes (maximum 70% N2O / 30% O2) to desired
clinical effect.
4. At end of N2O administration, deliver 100% O2 for 5
minutes.
5. After 5 minutes of 100% O2, perform finger to nose
test (if appropriate).
5. After 5 minutes of 100% O2, perform finger to nose
test (if appropriate)., Peds Diagnostic
Sedative - Analgesic [126330]
FENTanyl PF injection RANGE [750047] 0.5-2 mcg/kg, Intravenous, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56, for 3-5 Minutes,
Peds Diagnostic
FENTanyl PF 50 mcg/mL intraNASAL soln
[785209]
1.5 mcg/kg, Nasal, ONCE PRN For 1 Doses, Sedation
induction per policy 8.56
Administer via atomizer
Peds Diagnostic
ketAMINE (KETALAR) injection [800191] 0.5 mg/kg, Intravenous, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56, Peds Diagnostic
ketAMINE injection [800191] 2-6 mg, Intramuscular, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56
ketAMINE (KETALAR) soln [785017] 4-10 mg/kg, Oral, ONCE PRN For 1 Doses, Sedation
induction per policy 8.56, Peds Diagnostic
ketAMINE (KETALAR) soln [785017] 4-10 mg/kg, Rectal, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56, Peds Diagnostic
ketAMINE (KETALAR) soln [785017] 2-8 mg/kg, Nasal, ONCE PRN For 1 Doses, Sedation
induction per policy 8.56
Administer via atomizer
Peds Diagnostic
ketamine (KETALAR) infusion PEDS [800149] 0.1-0.2 mg/kg/hr, Intravenous, ONCE PRN For 1
Doses, Sedation Induction per policy 8.56, Peds
Diagnostic
MORPHine PF injection RANGE [750057] 0.05-0.2 mg/kg, Intravenous, ONCE PRN For 1
Doses, pain, Sedation induction per policy 8.56, for 4
Minutes, Peds Diagnostic
Miscellaneous Drugs [126331]
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 8/10/2017 11:04:27 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

atropine injection [800178] 0.02 mg/kg, Intravenous, ONCE PRN For 1 Doses,
bradycardia, Secretions
Maximum dose = 0.5mg
Peds Diagnostic
atropine soln [780019] 0.02 mg/kg, Oral, ONCE PRN For 1 Doses,
Secretions
Obtain and scan injectable vial from AcuDose cabinet
for oral administration
Peds Diagnostic
glycopyrrolate (ROBINUL) injection [37960] 10 mcg/kg, Intravenous, ONCE PRN For 1 Doses,
Secretions, Peds Diagnostic
Glycopyrrolate (ROBINUL) 1 MG/5ML soln
[143874]
100 mcg/kg, Oral, ONCE PRN For 1 Doses,
Secretions, Peds Diagnostic
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension [800005]
15 mg/kg, Oral, ONCE PRN For 1 Doses, pain, Peds
Diagnostic
ibuprofen (MOTRIN) susp [45376] 10 mg/kg, Oral, ONCE PRN For 1 Doses, pain, Peds
Diagnostic
ketOROLAC (TORADOL) injection [800050] 0.5 mg/kg, Intravenous, ONCE PRN For 5 Days, pain
Maximum dose = 15mg
If ordered IV: push over 15-30 seconds
Peds Diagnostic
lidocaine 1 % vial [39034] 0.5 mg/kg, Intravenous, ONCE PRN For 1 Doses
Add 10mg lidocaine to 100mg (10mL) of propofol
loading dose.
Peds Diagnostic
lidocaine (STERILE UROJECT) 2 % gel [785049] Topical, ONCE PRN For 1 Doses, Urinary catheter
placement, Peds Diagnostic
ondansetron (ZOFRAN) soln [54843] 0.15 mg/kg, Oral, ONCE For 1 Doses, Peds
Diagnostic
ondansetron (ZOFRAN) injection [800202] 0.15 mg/kg, Intravenous, ONCE For 1 Doses, Peds
Diagnostic
sucrose (SWEET-EASE) 24 % buccal soln
[794009]
Buccal, ONCE For 1 Doses, Peds Diagnostic
ibuprofen (MOTRIN) tab [38353] 200 mg, Oral, ONCE PRN For 1 Doses, pain
Intravenous Fluid Therapy
Premedications for Needle Insertion [126859]
Lidocaine [152737]
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
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 8/10/2017 11:04:27 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Peds Diagnostic
Intravenous Therapy [186215]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, Peds Diagnostic
sodium chloride 0.9% IV BOLUS [730003] 10 mL/kg, Intravenous, ONCE For 1 Doses
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 8/10/2017 11:04:27 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org