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/clinical/cckm-tools/content/order-sets/inpatient/bmtoncologyhematology/name-97861-en.cckm

20170106

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100

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IP – Stem Cell Infusion – Adult – Supplemental [2216]

IP – Stem Cell Infusion – Adult – Supplemental [2216] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, BMT/Oncology/Hematology


SmartSet: IP - STEM CELL INFUSION - ADULT - SUPPLEMENTAL (ID:2216)
General Information
Display name: IP - Stem Cell Infusion - Adult - Supplemental
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. .ONC
SmartSet notes:
Description: Intended for Adult Patients Only
Web information: Title URL
1.
Questionnaire:
Configuration
Infusion Agent
Autologous
Autologous Stem Cell, DMSO Depleted ONCE, Starting S For 1 Occurrences
Autologous Stem Cell, DMSO ONCE, Starting S For 1 Occurrences
Autologous Bone Marrow ONCE, Starting S For 1 Occurrences
Allogeneic
Allogeneic, Related Stem Cell ONCE, Starting S For 1 Occurrences
Allogeneic, Unrelated Stem Cell ONCE, Starting S For 1 Occurrences
Allogeneic, Related Bone Marrow ONCE, Starting S For 1 Occurrences
Allogeneic, Unrelated Bone Marrow ONCE, Starting S For 1 Occurrences
Allogeneic, Related Donor Lymphocyte Infusion
(DLI)
ONCE, Starting S For 1 Occurrences
Allogeneic, Unrelated Donor Lymphocyte
Infusion (DLI)
ONCE, Starting S For 1 Occurrences
Allogeneic, Umbilical Cord Blood ONCE, Starting S For 1 Occurrences
Allogeneic, Other ONCE, Starting S For 1 Occurrences
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 1/3/2017 9:31:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Umbilical Cord Stem Cells ONCE, Starting S For 1 Occurrences
Patient Care Orders
Vital Signs
Vital Signs SEE COMMENTS, Starting S, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes, starting at the beginning of stem
cell infusion and continue every 15 minutes for 60
minutes post stem cell/bone marrow infusion.
Intravenous Therapy
IV Fluids
sodium chloride 0.9% infusion at 20 mL/hr, Intravenous, CONTINUOUS For 2 Hours
To establish line for infusion of stem cells.
Discontinue when stem cell infusion complete. No
extension tubing or filter needed
sodium chloride 0.9% BOLUS - NOTE: Order for
products with DMSO
1,000 mL, Intravenous, ONCE For 1 Doses
Administer over 2 hours before infusion into largest
port of central venous catheter or peripheral IV. No
extension tubing or filter needed
NOTE: Order for products with DMSO
sodium chloride 0.9% infusion - NOT BOLUS -
Dose equals 125 mL/m2/hr
Intravenous, CONTINUOUS For 10 Hours
Administer over 4 hours before infusion into the
largest port of central venous catheter, continuing for
6 hours following the infusion. No extension tubing or
filter needed.
NOTE: Order for umbilical cord stem cells
Medications
Pre-infusion - NOTE; Order for Patients With Products Containing DMSO
diphenhydramine (BENADRYL) injection 50 mg, Intravenous, ONCE For 1 Doses
Give 30 minutes prior to stem cell infusion
hydrocortisone sod suc in sodium chloride 0.9%
injection
100 mg, Intravenous, ONCE For 1 Doses
Give 30 minutes prior to stem cell infusion
acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE For 1 Doses
Give 30 minutes prior to stem cell infusion
ondansetron (ZOFRAN) injection 8 mg, Intravenous, ONCE For 1 Doses
Give 30 minutes prior to stem cell infusion
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 1/3/2017 9:31:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

lorazepam (ATIVAN) injection 1 mg, Intravenous, ONCE PRN For 48 Hours,
agitation
Give 30 minutes prior to stem cell infusion
If ordered IV: push rate 2 mg/minute
Adverse Reactions - NOTE: Order for Patients With ABO Incompatibility
acetaMINOPHEN - diphenhydramine -
hydrocortisone
acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE PRN For 48 Hours, infusion
reaction
diphenhydramine (BENADRYL) injection 50 mg, Intravenous, ONCE PRN For 48 Hours,
infusion reaction
hydrocortisone sod suc in sodium chloride 0.9%
injection
100 mg, Intravenous, ONCE PRN For 48 Hours,
infusion reaction
Criteria
Suggestions: UWIP C LOGIN DEPT IP ONCOLOGY/HEMATOLOGY/BMT[3001756]
Filter: UWIP ORDER SET RESTRICTION - HOSPITAL ENCOUNTERS EXCEPT ED -
NOT IP DC[3000400]
Restrict SmartSet:
Settings
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 1/3/2017 9:31:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org