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/clinical/cckm-tools/content/order-sets/inpatient/girenal/name-102691-en.cckm

20180236

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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,GI/Renal

IP - Hemodialysis - Adult - Procedure [5138]

IP - Hemodialysis - Adult - Procedure [5138] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, GI/Renal


IP - Hemodialysis - Adult - Procedure [5138]
for Adult Patients OnlyIntended
Patient Care Orders
Vital Signs [18620]
Vital Signs [NURMON0013] WHILE ON HEMODIALYSIS, Starting today For Until
specified, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes during procedure., Dialysis
Patient Monitoring [18621]
Blood Volume Monitoring [NURMON0060] WHILE ON HEMODIALYSIS, Starting today For Until
specified, Dialysis
Contingency Parameters [18622]
Discontinue all orders related to Hemodialysis
before patient returns to unit [NURCOM0022]
WHILE ON HEMODIALYSIS, Starting today,
Discontinue Hemodialysis Order Set after treatment.,
Dialysis
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 200
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm): 140
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:
Dialysis
Procedure Management/Equipment Settings
Procedure Settings [20469]
Page 1 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 2/2/2018 10:20:18 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

Hemodialysis [NURTRT0052] ONCE For 1 Occurrences, Routine
Modality Type:
Length of Treatment (hours):
Target Weight (kg):
Fluid Removal (L):
Access Site Location:
Access Site Side:
Membrane Dialyzer:
Blood Flow Rate (mL/min):
Dialysate Flow Rate (mL/min): 600
Dialysate Potassium (mEq/Liter) and Calcium
(mEq/Liter):
Dialysate Bicarbonate (mEq/Liter). Limits: 20 - 40
mEq/Liter: 35 mEq/L
Dialysate Sodium (mEq/Liter). Limits: 130 - 155
mEq/Liter: 139 mEq/L
Crit-line Monitor. Normal limits 3-8%: No
Dialysis
Page Nephrologist 1 Hour into Treatment to See
Patient [NURCOM0022]
ONCE For 1 Occurrences, Dialysis
Intravenous Therapy
Premedication for arteriovenous fistula (AVF) needle insertion [245998]
lidocaine 1 % vial - NOTE: Suggested Dose 2-4
mL [39034]
2-4 mL, Subcutaneous, ONCE PRN For 1 Doses,
Premedication for arteriovenous fistula (AVF) needle
(s) insertion
IV Therapy [18942]
sodium chloride 0.9% BOLUS [730003] 300 mL, Intravenous, ONCE For 1 Doses
Only while on Hemodialysis unit. Use to prime the
extracorporeal system
Dialysis
albumin human 25% infusion [44037] 12.5 g, Intravenous, EVERY 15 MINUTES PRN,
Second line therapy for systolic blood pressure less
than 90 mmHg while on Hemodialysis.
Hang to gravity. Albumin tubing needed.
Maximum number of doses 4. If maximum number of
doses given contact provider for new order.
Dialysis
sodium chloride 0.9% BOLUS [730003] 100-200 mL, Intravenous, EVERY 15 MINUTES PRN,
For clotting or first line therapy for systolic blood
pressure less than 90 mmHg while on Hemodialysis.,
Dialysis
Heparin during dialysis
Anticoagulant [18940]
heparin 1000 units/mL vial [45303] 50 Units/kg, Intravenous, ONCE For 1 Doses
Only while in hemodialysis unit
heparin 1000 units/mL vial [45303] 25 Units/kg, Intravenous, ONCE For 1 Doses
Only while in hemodialysis unit
No anticoagulation needed for Hemodialysis
[NURCOM0022]
ONCE For 1 Occurrences
Laboratory
Laboratory [154365]
Page 2 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 2/2/2018 10:20:18 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

POTASSIUM [K] CONDITIONAL For 24 Hours, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Please order
potassium STAT at dialysis initiation if not drawn in
last 24 hours.
Dialysis
HEPATITIS B CORE AB, TOTAL [HBCAB] CONDITIONAL, Starting today For 24 Hours, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If not collected within
30 days and status is unknown.
Dialysis
HEPATITIS B SURFACE AG [HBSAG] CONDITIONAL, Starting today For 24 Hours, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If not collected within
30 days and status is unknown.
Dialysis
HEPATITIS B SURFACE AB (IMMUNE STATUS)
[HBSABI]
CONDITIONAL, Starting today For 24 Hours, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If not collected within
30 days and status is unknown.
Dialysis
HEPATITIS C AB [HCV] CONDITIONAL, Starting today For 24 Hours, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If not collected within
30 days and status is unknown.
Dialysis
Albumin Prime
Albumin Prime [154367]
albumin human 25% infusion [44037] 25 g, Intravenous, ONCE For 1 Doses
Only while on Hemodialysis Unit. Use to prime the
extracorporeal system
Dialysis
Blood Bank
Blood Transfuse [153693]
Transfuse Red Blood Cells (Adult)
[NURCOM0022]
ONCE, Starting today For 1 Occurrences, Dialysis
Custom Dialysate Bath - Prepared By Pharmacy
Centrisol Part A (SB-130) [135897]
Centrisol Part A (SB-130) (K 0 mEq, bicarb 33
mEq, Ca 0 mEq, Na 137 mEq, Mg 0.75 mEq, Cl
100.75 mEq, acetate 4 mEq, dextrose 200 mg/dL)
3.78 L dialysis soln [700617]
Other, EVERY 1 HOUR For 2 Doses, Dialysis
Medications
TB Skin Test [228346]
TB Skin Test [117075] "And" Linked Panel
tuberculin (APLISOL) injection [43217] 5 units, Intradermal, ONCE PRN For 1 Doses, Skin
Test
TB Competent RN to Administer
Page 3 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 2/2/2018 10:20:18 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

TB INTRADERMAL TEST [IMM0001] ONCE, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Staff with competency in TB Testing to complete
Laboratory Orders
Laboratory [154221]
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT, Starting today For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on
the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Specimen Type:
Hemodialysis nurse to draw arterial port (Order 1 of 2),
Dialysis
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT, Starting today For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on
the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Specimen Type:
Hemodialysis nurse to draw arterial port (Order 2 of 2),
Dialysis
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT, Starting today For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on
the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Specimen Type:
Hemodialysis nurse to draw venous port (Order 1 of
2), Dialysis
Page 4 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 2/2/2018 10:20:18 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT, Starting today For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on
the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Specimen Type:
Hemodialysis nurse to draw venous port (Order 2 of
2), Dialysis
BASIC METABOLIC PANEL [BMET] CONDITIONAL, Starting today, Routine, Test includes
Sodium; Potassium; Chloride; Carbon Dioxide, Total;
Anion Gap; Glucose; BUN; Creatinine; and Calcium.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If not ordered in the
last 24 hours
Dialysis
Page 5 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 2/2/2018 10:20:18 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org