/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/girenal/,

/clinical/cckm-tools/content/order-sets/inpatient/girenal/name-98299-en.cckm

20170126

page

100

UWHC,UWMF,

Tools,

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

IP - Peritoneal Dialysis - Pediatric - Supplemental [1453]

IP - Peritoneal Dialysis - Pediatric - Supplemental [1453] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, GI/Renal


IP - Peritoneal Dialysis - Pediatric - Supplemental [1453]
Procedure Management
Procedure Orders [20477]
Continuous Cycling Peritoneal Dialysis (CCPD) -
Pediatric [NURTRT0065]
CONTINUOUS, Routine
Total Treatment Time (hours):
Fill Volume (mL):
Volume of Last Fill (mL):
Dwell Time (Minutes):
Dialysate Solution: 1.5% Dextrose Quantity:
Dialysate Solution: 2.5% Dextrose Quantity:
Dialysate Solution: 4.25% Dextrose Quantity:
Number of Exchanges Per Night:
Treatment Mode:
Patient Care Orders
Fluid Monitoring [20478]
Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Routine
Measure Weight Daily After Cycler Complete
[NURMON0015]
1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Obtain after cycler complete.
Nursing Communication - Monitoring
[NURMON0060]
CONTINUOUS, In Doc Flowsheets, document
peritoneal drain fluid characteristics and full or empty
weight.
Nursing Communication - Ultrafiltration
[NURMON0060]
CONTINUOUS, In Doc Flowsheets, document
ultrafiltration for each cycle.
Exit Site Care [20493]
Nursing Communication - Wound Care - Wound
Less Than 4 Weeks Old [NURWND0018]
1X DAILY, If new peritoneal dialysate catheter exit
site is less than 4 weeks old, dressing care will be
done by PD nurse, super user, or trained parent per
Wisconsin Dialysis, Inc protocol.
Nursing Communication - Wound Care - Wound
Greater Than 4 Weeks Old [NURWND0018]
1X DAILY, Exit care - Cleanse with sodium
hypochlorite 0.114% (ExSept) solution provided by
PD nurse. Allow to dry for 2 minutes. Apply Antibiotic
cream with sterile cotton swab. Redress with 2x2's
and patient's choice of tape. Secure catheter well to
ABD to avoid pulling on the site.
Contingency Parameters [20497]
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: If drain amount is less than half of the previous
fill volume
Page 1 of 3
Printed by LIND, JANNA S [JSL237] at 12/8/2016 10:29:43 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Notify Home Dialysis Nurse on Call
[NURCOM0001]
Provider to Notify: Other (Comment)
During business hours Monday-Friday 8:00am -
4:30pm call 608-270-5643 or during the evening and
on weekends call 608-262-2122 and ask for the
PD/Home Dialysis Nurse on call for any of the
following:
-If the drain bag is cloudy
-If the drain amount is less than half of the previous fill
volume
-If multiple cycler alarms
-If dressing is soiled, wet, or loose.
Medications - General
Medications-Procedure Specific-Continuous Cycling Peritoneal Dialysis [20095]
gentamicin 0.1 % cream [37857] Topical, 1 X DAILY
Apply to peritoneal dialysis exit site, after exit site
care.
Tube Care [127254]
Sodium Hypochlorite 0.55% (Alcavis) Solution
[NURCOM0022]
ONCE For 1 Occurrences, When connecting and
disconnecting from cycler soak end of transfer set in
sodium hypochlorite 0.55% solution (Alcavis) per
Wisconsin Dialysis, Inc protocol.
Non Peritonitis Dialysis Solution [208703]
peritoneal dialysis soln LOADING PEDS
[700624]
Intraperitoneal, ONCE Starting today at 3:00 PM For
1 Doses
peritoneal dialysis soln Dianeal LC/1.5%
Dextrose MAINTENANCE PEDS [700623]
Intraperitoneal, CONTINUOUS Starting today at 3:00
PM
peritoneal dialysis soln Dianeal LC/2.5%
Dextrose MAINTENANCE PEDS [700623]
Intraperitoneal, CONTINUOUS Starting today at 3:00
PM
peritoneal dialysis soln Dianeal LC/4.25%
Dextrose MAINTENANCE PEDS [700623]
Intraperitoneal, CONTINUOUS Starting today at 3:00
PM
Peritonitis Treatment [127256]
Loading Dose = 500 mg/L-Cefazolin
Maintenance Dose = 125 mg/L-Cefazolin
Loading Dose = 1000 mg/L-Vancomycin
Maintenance Dose = 25 mg/L-Vancomycin
Loading Dose = 500 mg/L-Ceftazidine
Maintenance Dose = 125 mg/L-Ceftazidine
Loading Dose = 8 mg/L-Gentamicin
Maintenance Dose = 4 mg/L-Gentamicin
NOTE: Dosing is based on mg/L ******
peritoneal dialysis soln LOADING PEDS
[700624]
Intraperitoneal, ONCE Starting today at 3:00 PM For
1 Doses
peritoneal dialysis soln Dianeal LC/1.5%
Dextrose MAINTENANCE PEDS [700623]
Intraperitoneal, CONTINUOUS Starting today at 3:00
PM
peritoneal dialysis soln Dianeal LC/2.5%
Dextrose MAINTENANCE PEDS [700623]
Intraperitoneal, CONTINUOUS Starting today at 3:00
PM
peritoneal dialysis soln Dianeal LC/4.25%
Dextrose MAINTENANCE PEDS [700623]
Intraperitoneal, CONTINUOUS Starting today at 3:00
PM
Fungal Prophylaxis (Single Response) [208681]
nystatin (MYCOSTATIN) susp - NOTE - For
patients 1 year old or less. Suggested dose 2 mL
[40456]
Swish & Swallow, 4 X DAILY
ONLY for duration of antibiotic therapy
NOTE - For patients 1 year old or less. Suggested
dose 2 mL
Page 2 of 3
Printed by LIND, JANNA S [JSL237] at 12/8/2016 10:29:43 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

nystatin (MYCOSTATIN) susp - NOTE - For
patients greater than 1 year old [40456]
5 mL, Swish & Swallow, 4 X DAILY
ONLY for duration of antibiotic therapy
NOTE - For patients greater than 1 year old
fluconazole (DIFLUCAN) susp - NOTE: Maximum
Dose = 200 mg [800222]
3 mg/kg, Oral, EVERY 24 HOURS
For duration of antibiotic therapy only
fluconazole (DIFLUCAN) intraVENOUS - NOTE:
Maximum Dose = 200 mg [800044]
3 mg/kg, Intravenous, EVERY 24 HOURS
For duration of antibiotic therapy
Laboratory
Laboratory [127258]
CELL COUNT, PERITONEAL FLUID [HCPECC] ONCE For 1 Occurrences, Routine
Indicate specimen source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CULTURE, BODY FLUID, AER/ANA WITH
GRAM STAIN [HCWABF]
ONCE, Starting today For 1 Occurrences, Routine,
UWHC Only: Use blood culture bottles for peritoneal,
pericardial, pleural, synovial and dialysate fluids.
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 3 of 3
Printed by LIND, JANNA S [JSL237] at 12/8/2016 10:29:43 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org