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RAD ONC - Samarium - Supplemental [4581]

RAD ONC - Samarium - Supplemental [4581] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Radiation Oncology


SmartSet: RAD ONC - SAMARIUM - SUPPLEMENTAL (ID:4581)
General Information
Display name: RAD ONC - Samarium - Supplemental
Type: General
Merge priority:
Version comment:
Content source:
Synonyms: 1. .RADONC
SmartSet notes:
Description: In addition to this order set, please complete the Radiopharmaceutical Therapy
Dose Documentation Form for Sm-153 Samarium (Quadramet). Send this form
to Nuclear Pharmacy with the applicable sections completed.
Web information: Title URL
1.
Questionnaire:
Configuration
Radiation Oncology
Vital Signs
Vital Signs ONCE For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Radiation Oncology
Premedications for Needle Insertion
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/26/2016 1:09:12 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org

lidocaine (LMX) 4% topical dressing kit 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
Radiation Oncology
lidocaine (XYLOCAINE) 1% injection 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
Radiation Oncology
sodium chloride (bacteriostatic) 0.9 % injection 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
Radiation Oncology
IV Therapy
Insert and Maintain Peripheral IV CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Radiation Oncology
sodium chloride 0.9% flush 10 mL injection Flush, PRN, flush/line care, Radiation Oncology
Medications
sodium chloride 0.9% BOLUS 500 mL, Intravenous, ONCE For 1 Doses
Administer prior to samarium
Radiation Oncology
samarium Sm-153 (QUADRAMET) injection Intravenous, ONCE For 1 Doses, for 2 Minutes,
Radiation Oncology
sodium chloride 0.9% BOLUS 500 mL, Intravenous, ONCE For 1 Doses
Administer following samarium injection
Radiation Oncology
Criteria
Suggestions:
Filter: UWIP ORDER SET RESTRICTOR - NOT TSC/MSC[3000407]
Restrict SmartSet:
Settings
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/26/2016 1:09:12 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org

Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders
display:
Release date: Use System Definitions Setting
Disallow user override:
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 9/26/2016 1:09:12 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org