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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98251-en.cckm

201712342

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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,Hospital-wide

IP - Venous Access Team - PICC Placement Request - Adult - Supplemental [1339]

IP - Venous Access Team - PICC Placement Request - Adult - Supplemental [1339] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Venous Access Team - PICC Placement Request - Adult - Supplemental
[1339]
for Adult Patients OnlyIntended
UH Health Clinical Policy- Insertion, Maintenance,
and Discontinuation of Central Vascular Access
Devices for Prevention of Central Line-Associated
Bloodstream Infection (CLABSI) Policy Number:
2.3.14
URL: https://uconnect.wisc.edu/policies/clinical/uw-
health-clinical/gen-care/procedures/2314.policy
PICC Placement Request
PICC Placement Request [17753]
PICC Placement Request [NURVAD0051] ONCE, Routine
PICC Line Placement Reason:
PICC Line Placement Duration:
Mastectomy?
Dialysis Graft/Shunt?
Thrombosis?
Existing Venous Access Device(s)?
Over 400 lbs?
Number of Lumens:
Restrictions for use:
Additional information about restrictions for use:
Premedications
Premedication [18917]
lidocaine 1 % vial - NOTE: Suggested dose 2-4
mL/dose Do NOT use use if history of lidocaine
allergy [39034]
Subcutaneous, ONCE For 1 Doses
NOTE: Suggested dose 2-4 mL/dose
Patient Care Orders - Post PICC Placement
Catheter Care [17754]
Replace All IV Tubing Before Connecting to New
PICC [NURVAD0053]
ONCE, Starting today For 1 Occurrences
Maintain PICC [NURVAD0050] CONTINUOUS, Starting today, Routine
Device Status: Not Ready For Use
Site:
PICC Secured With: Statlock (Change with Routine
Dressing Changes)
Flush With(Must also enter separate medication order
to obtain drug):
Site Assessment Frequency: EVERY 8 HOURS
Provide Patient Education "Preparing and Caring
for Your Midline or PICC Catheter" (HFFY#5093)
[NURCOM0025]
ONCE, Starting today For 1 Occurrences, Routine
Contingency Parameters [17755]
Notify Venous Access Team (pager # 5151)
[NURCOM0022]
ONCE, Notify venous access team for catheter
migration and/or malposition of catheter noted on
x-ray
Medications
Flushes - NOTE: Order saline flush for heparin-induced thrombocytopenia or heparin allergy (Single
Response) [18918]
sodium chloride 0.9% flush 10 mL injection -
NOTE: Order saline flush for heparin-induced
thrombocytopenia or heparin allergy [785055]
Flush, PRN, flush/line care
Flush per VAD guidelines
NOTE: Order saline flush for heparin-induced
thrombocytopenia or heparin allergy
heparin lock flush 10 units/mL 5 mL injection
[75031]
1-150 units, Flush, PRN, flush/line care
Heparin lock/dwell per VAD guidelines
Page 1 of 2
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:02:33 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [17759]
X-RAY CHEST AP VIEW [R71010] CONDITIONAL, Starting today For 3 Days, Routine
Current signs and symptoms? s/p PICC line
placement
What specific question(s) would you like answered by
this exam? Evaluate PICC Tip Termination and/or for
retained guidewire
Relevant recent/past history? s/p PICC line placement
Is patient pregnant?
If being performed remotely, where? Bedside
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate PICC Tip
Termination and/or for retained guidewire
Last patient weight? (will auto pull in value and date in
comment):
Consults
Consults [150644]
Consult Venous Access Team (Inpatient)
[CON0124]
ONCE, Starting today For 1 Occurrences, Routine
Reason for consult: PICC Placement
Page 2 of 2
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:02:33 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org