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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98218-en.cckm

20170376

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP - Lumbar Puncture - Bedside - Adult - Pre/Postprocedure [2467]

IP - Lumbar Puncture - Bedside - Adult - Pre/Postprocedure [2467] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Lumbar Puncture - Bedside - Adult - Pre/Postprocedure [2467]
for Adult Patients OnlyIntended
Lumbar Puncture - The New England Journal of
Medicine 2006;355:e12 (September 28, 2006)
URL: http://content.nejm.org/cgi/reprint/355/13/e12.pdf
Lumbar Puncture - Seminars in Neurology,
Volume 23, Number 1, 2003 (Karen L. Roos,
M.D.)
URL: http://www.thieme-
connect.de/ejournals/pdf/sin/doi/10.1055/s-2003-
40758.pdf
Patient Care Orders - Preprocedure
Vital Signs [80271]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Prior to procedure.
Neurovascular Assessment [NURMON0045] ONCE, Starting today For 1 Occurrences, Routine,
Prior to procedure. Recommended to perform
especially to monitor strength in lower extremities
Non-Categorized Patient Care Orders [80272]
Confirm Signed Consent on Chart
[NURCOM0022]
ONCE, Starting today For 1 Occurrences
LUMBAR PUNCTURE (PERFORMED BY
BEDSIDE PROCEDURE SERVICE) [NWIP0005]
ONCE
Reason for Exam:
Provider Call-back Number:
To be performed at bedside.
Medication - Preprocedure
Preprocedure Medications [149390]
lidocaine 1 % vial [39034] ONCE For 1 Doses
Laboratory - Preprocedure
Laboratory [80273]
PROTHROMBIN TIME/INR [PT] NEXT DRAW, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HEMATOCRIT [HCT] NEXT DRAW, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PLATELET COUNT [PLT] NEXT DRAW, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Diagnostic Tests and Imaging - Preprocedure
Radiology [80274]
Page 1 of 6
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

CT HEAD W/ O IV CONTRAST [R70450] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value
in comment):
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Patient Care Orders - Postprocedure
Vital Signs [80280]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Once after procedure and as needed.
Neurovascular Assessment [NURMON0045] SEE COMMENTS, Starting today, Routine, Once
after procedure and as needed.
Activity [80281]
Bed Rest for 1 Hour [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:
For one hour. If patient develops post-lumbar
puncture headache, resume bedrest.
Site Care [80282]
Inspect Puncture Site [NURWND0018] SEE COMMENTS, Starting today, Once after
procedure, then every 8 hours times 24 hours.
Apply Bandaid to Puncture Site [NURWND0018] SEE COMMENTS, Starting today, Once after
procedure and as needed.
Contingency Parameters [80283]
Page 2 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:22:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] CONTINUOUS
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: Post-lumbar puncture headache,Pain not
controlled with ordered analgesics or ordered
interventions,Change in level of consciousness,Lower
extremity motor or sensory changes,Persistent
bleeding or drainage of clear, serious fluid at the
puncture site
Laboratory - Postprocedure - Common CSF Labs
Labs - Cerebrospinal Fluid [80365]
Nursing Communication - Lab [NURCOM0055] ONCE, Starting today For 1 Occurrences, Routine,
Cerebrospinal fluid specimens to be labeled STAT &
immediately hand-carried to the lab. Follow Policy
#5.06 Acceptance Policy for Specimen Identification.
LABS - CSF Studies Other [148253]
LACTATE, CSF [HCCFLACT] ONCE, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
LD, TOTAL, CSF [GM2750] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Labs - CSF Studies Tube One - STAT [80368]
CELL COUNT, CSF, TUBE 1 [HCCCTUB1] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Labs - CSF Studies Tube Two - STAT [80369]
CULTURE, CSF WITH GRAM STAIN [GM4210] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine, For UWHC Only: Culture for
Propionibacterium for ventricular and shunt fluid only.
For LP specimens order Culture, CSF with Gram
stain.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Labs - CSF Studies Tube Three - STAT [80370]
Page 3 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:22:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

GLUCOSE, CSF [GM2740] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN, CSF [GM2745] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Labs - CSF Studies Tube Four - STAT [80371]
CELL COUNT, CSF, TUBE 4 [HCCCTUB4] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Laboratory - Postprocedure - Optional CSF Labs
Labs - CSF Studies - Specialty - Optional [80372]
ENTEROVIRUS, QUALITATIVE, PCR, CSF
[HCCFEVPCR]
ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HERPES SIMPLEX VIRUS BY PCR
[HCHSVPCR]
STAT - RN COLLECT, Starting today 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?
NOTE: CSF STUDIES- SPECIALTY
AFB SMEAR AND CULTURE [130496]
AFB SMEAR [AFBSMR] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
AFB CULTURE [AFBCX] ONCE For 1 Occurrences, Routine, Smear and
culture should be ordered for diagnostic specimens.
M. avium complex PCR is performed on the first
smear positive respiratory specimen from patients
not previously diagosed with tuberculosis.
Susceptibility testing is performed automatically on
all initial M. tuberculosis isolates. Susceptibility
testing for some non-tuberculous mycobacteria is
available.
The initial M. tuberculosis isolate from each patient
is also genotyped as part of the CDC Universal
Genotyping Program.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Isolation - Airborne - TB-Pulmonary
Confirmed/Suspect [ISO0003]
CONTINUOUS
Isolation - Airborne - Negative Pressure Room
[NURCOM0108]
CONTINUOUS
Page 4 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:22:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Lyme Ab, IgG and IgM reflex Immunoblot
[220889]
onset.antibody is not recommended beyond 4 weeks after symptom IgM
Test Directory link for Lyme Ab, IgG URL:
Test Directory link for Lyme Ab, IgM URL:
LYME AB, IGG, W/ REFLEX TO IMMUNOBLOT
[LYMIGGR]
ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
LYME AB, IGM, W/ REFLEX TO IMMUNOBLOT
[LYMIGMR]
ONCE, Starting today For 1 Occurrences, Routine,
IgM antibody is not recommended beyond 4 weeks
after symptom onset. There currently is no test of
cure for Lyme disease, and this test should not be
ordered for that purpose. This test also should not
be used to assess response to therapy.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
CRYPTOCOCCAL AG WITH TITRATION IF
POSITIVE [CRAG]
ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CULTURE, FUNGAL [HCFCULT] ONCE, Starting today For 1 Occurrences, Routine
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CMV QUALITATIVE BY PCR,SPINAL FLUID
[HCCMVCF]
ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
EBV QUALITATIVE BY PCR, CSF [HCCFEBV] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PYRUVIC ACID, CSF [HCPYRCSF] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
STREP PNEUMONIAE AG, CSF [HCCFSPAG] ONCE, Starting today For 1 Occurrences, Routine, A
CSF bacterial culture must be ordered prior to or in
conjunction with this test.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
TOXOPLASMA GONDII BY PCR [HCTGPCR] ONCE, Starting today For 1 Occurrences, Routine
Indicate source if body fluid or tissue:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Panel - Varicella Zoster, PCR - Contact and
Airborne - For disseminated disease and/or
immunocompromised patient [150411]
Page 5 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:22:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

VARICELLA ZOSTER, PCR [HCVZVPCR] 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?
Isolation - Contact and Airborne - Varicella
[ISO0058]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Isolation - Airborne - Negative Pressure Room
[NURCOM0108]
CONTINUOUS
VDRL, CSF [CFVDRL] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
WEST NILE VIRUS RNA [HCWNVPCR] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
WEST NILE AB, IGG, CSF [HCWNVGCF] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
WEST NILE AB, IGM, CSF [HCWNVMCF] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
WEST NILE AB, IGG/IGM, CSF [HCWNVCSF] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
M. AVIUM COMPLEX PCR [MACPCR] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
M. TUBERCULOSIS PCR [TBPCR] ONCE, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 6 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:22:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org