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201610277

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100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Cardiology/CT Surgery

ED/IP - Pulmonary Embolism Thrombolytic Therapy - Adult - Supplemental [6111]

ED/IP - Pulmonary Embolism Thrombolytic Therapy - Adult - Supplemental [6111] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


ED/IP - Pulmonary Embolism Thrombolytic Therapy - Adult - Supplemental
[6111]
Systemic fibrinolysis is reasonable for patients with massive pulmonary embolism (PE) and
acceptable risk for bleeding complication (Class IIa, Level of Evidence B).
have clinical fibrinolysis may be considered for patients with submassive PE judged to Systemic
worsening respiratory evidence of adverse prognosis (new hemodynamic instability,
or major myocardial necrosis) and a low risk insufficiency, severe right ventricular dysfunction,
(Class IIb, Level of Evidence C)for bleeding complications
Absolute Contraindications to Thrombolytic Therapy
Prior hemorrhagic CVA•
Any cerebrovascular events < 1 Year•
Active bleeding•
• Known intracranial neoplasm
• Suspected aortic dissection
Relative Contraindications to Thrombolytic Therapy
• Blood Pressure >180/110mmHg
• Use of anticoagulants
compressible vascular punctures-Non•
Prolonged CPR >10 minutes•
Prior gastrointestinal hemorrhage•
Pregnancy•
Recent Trauma•
Recent Surgery•
Patient Care Orders
Vital Signs [208157]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Starting with Alteplase infusion: Every 15 minutes for
two hours, every 30 minutes for two hours, then every
hour for three hours.
Assess Neurologic Status Using UWHC
Abbreviated NIHSS Flow Sheet [NURMON0006]
SEE COMMENTS, Routine, Starting with Alteplase
infusion: Every 15 minutes for two hours, every 30
minutes for two hours, then every hour for three
hours.
Patient Monitoring [208158]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Starting today, Routine
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Activity [208159]
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org

Activity - Bedrest [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Bed rest during Alteplase administration and for 12
hours post alteplase completion.
Contingency Parameters [208160]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
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: Any change in neurologic status
Intravenous Therapy
IV Fluids [208161]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed? Yes
Insert and maintain 2 total peripheral IVs. Check and
document patency, tubing change, site assessment,
and dressing change per policy.
Medications
Thrombolytics/Anticoagulation Therapy [208166]
Supplemental [4373] to order the –Adult –Heparin Anticoagulation –Use order set IP/ED
treated with alteplase, new mechanical valves Patients “heparin infusion. Select the regimen,
admission), high bleeding risk (recent surgery, trauma, hepatic (placed during current
dysfunction).”
Administer the Alteplase first. Administer heparin infusion after Alteplase infusion is complete.
Alteplase and Sodium Chloride Bolus [208298] "And" Linked Panel
alteplase (ACTIVASE) in sterile water 100 mL
bag [700131]
100 mg, Intravenous, ONCE For 1 Doses
Administer over 2 hours
sodium chloride 0.9% BOLUS [730003] 50 mL, Intravenous, ONCE For 1 Doses
Near end of the infusion as the infusing alteplase
bottle/bag is nearly empty, replace the empty
alteplase bottle/bag with the sodium chloride 0.9%
50 mL bag to ensure the total alteplase dose is
infused over the programmed 120 minute infusion.
Page 2 of 3
Printed by LIND, JANNA S [JSL237] at 9/8/2016 2:23:35 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org

Page 3 of 3
Printed by LIND, JANNA S [JSL237] at 9/8/2016 2:23:35 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2016CCKM@uwhealth.org