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201606170

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UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,BMT/Oncology/Hematology

IP - Oncology Chemotherapy Vesicant Extravasation [3216]

IP - Oncology Chemotherapy Vesicant Extravasation [3216] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, BMT/Oncology/Hematology


IP - Oncology Chemotherapy Vesicant Extravasation [3216]
UWHC Guidelines for the Management of
Extravasation of Antineoplastic Agents
URL: https://uconnect.wisc.edu/servlet/Satellite?
cid=1126664234984&pagename=B_EXTRANET_UWH_HOME%
2FFlexMemberFile%2FLoad_File&c=FlexMemberFile
Patient Care Orders


Contingency Parameters [97992]

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Vesicant extravasation
For Anthracycline Extravasation


Patient Care Orders [97989]

Extravasation Management [NURTRT0008] SEE COMMENTS, Starting today, Routine
Site:
Apply ice pack for 60 minutes and then every 6 hours for 20
minutes for 48 hours to affected site as instructed and protect
site from ultraviolet light by covering the area or using a sun
block cream (if skin surface is not open). Elevate affected arm
and report arm or hand swelling or stiffness. Monitor site and
notify provider of fever, chills, blistering or peeling skin or
worsening pain.
Dexrazoxane - For patients with creatinine clearance greater than 40 mL/minute [97984]

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Days 1 and 2 [700436]
1,000 mg/m2, Intravenous, EVERY 24 HOURS For 2 Doses
Administer into opposite extremity of extravasation. Remove
ice packs 15 minutes prior to infusion

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Day 3 [700436]
500 mg/m2, Intravenous, ONCE Starting 6/8/12 For 1 Doses
Administer over 2 hours into opposite extremity of
extravasation. Administer approximately 24 hours after Day 2
dose

Note: If patient discharged before therapy complete
apply Beacon Supportive Care Plan for extravasation
with appropriate dates [950018]
EVERY 24 HOURS For 3 Doses
Dexrazoxane - For patients with creatinine clearance 40 mL/minute or less [97985]

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Days 1 and 2 [700436]
500 mg/m2, Intravenous, EVERY 24 HOURS For 2 Doses
Administer into opposite extremity of extravasation. Remove
ice packs 15 minutes prior to infusion

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Day 3 [700436]
250 mg/m2, Intravenous, ONCE Starting 6/8/12 For 1 Doses
Administer over 2 hours into opposite extremity of
extravasation. Administer approximately 24 hours after Day 2
dose

Note: If patient discharged before therapy complete EVERY 24 HOURS For 3 Doses
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 6/6/2012 12:23:45 PM
Copyright © 2012 University of Wisconsin Hospital and Clinics Authority


apply Beacon Supportive Care Plan for extravasation
with appropriate dates [950018]
For Mechlorethamine (Nitrogen Mustard) Extravasation


Patient Care Orders [97990]

Extravasation Management [NURTRT0008] CONTINUOUS, Starting today For 6 Hours, Routine
Site:
Apply ice pack for continuously for 6 hours to affected site as
instructed and protect site from ultraviolet light by covering
the area or using a sun block cream (if skin surface is not
open). Elevate affected arm and report arm or hand swelling
or stiffness. Monitor site and notify provider of fever, chills,
blistering or peeling skin or worsening pain.
Sodium thiosulfate [97982]

sodium thiosulfate 4% injection [760311] 1-10 mL, Other, ONCE For 1 Doses
Administer intradermal or subcutaneous as 5-20 separate
injections 0.2 mL each into/around the site of extravasation
using 25-gauge or smaller needle. Change needle with each
injection
For Vinca Alkaloid Extravasation


Patient Care Orders [97991]

Extravasation Management [NURTRT0017] SEE COMMENTS, Starting today, Routine
Site:
Apply warm compass 30-60 mninutes them for 15-20 minutes
at least 4 times per day for the first 24-48 hours to affected
site as instructed and protect site from ultraviolet light by
covering the area or using a sun block cream (if skin surface
is not open). Elevate affected arm and report arm or hand
swelling or stiffness. Monitor site and notify provider of fever,
chills, blistering or peeling skin or worsening pain
Hyaluronidase [97979]

hyaluronidase (VITRASE) injection [760324] 150 units, Other, ONCE For 1 Doses
Administer intradermal or subcutaneous as 5 separate
injections into/around the site of extravasation using 25-
gauge or smaller needle. Change needle with each injection
Consults
Consults [15751]

Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Evaluate and follow during chemotherapy.

PICC Placement Request [NURVAD0051] ONCE, Starting today For 1 Occurrences, Routine
PICC Line Placement Reason:
PICC Line Placement Duration:
Mastectomy?:
Dialysis Graft/Shunt?:
Thrombosis?:
Existing Venous Access Device(s)?:
Over 400 lbs?:
Number of Lumens:
Do Not Use:
Do Not Use Reason:

Consult Venous Access Team (Inpatient) [CON0124] ONCE, Starting today For 1 Occurrences, Routine
Reason for consult:

Consult Occupational Therapy (Inpatient) Eval and Treat
[CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 6/6/2012 12:23:45 PM
Copyright © 2012 University of Wisconsin Hospital and Clinics Authority



Consult Physical Therapy (Inpatient) Eval and Treat
[CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:

Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Nutrition Assessment w/
Recommendations
Delegate to Initiate and Manage Tube Feeding:
Delegate to Initiate Feeding Tube Placement Order Set:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 6/6/2012 12:23:45 PM
Copyright © 2012 University of Wisconsin Hospital and Clinics Authority