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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98274-en.cckm

201606170

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100

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

IP - Cyclophosphamide Non-oncology Infusion - Pediatric - Supplemental [5712]

IP - Cyclophosphamide Non-oncology Infusion - Pediatric - Supplemental [5712] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - CYCLOPHOSPHAMIDE NON-ONCOLOGY INFUSION - PEDIATRIC -
SUPPLEMENTAL [5712]
Providers: please verify recent CBC results
Intended for Pediatric Patients Only
Patient Care Orders
Verify Consent [143085]
Verify informed consent has been obtained
[NURCOM0022]
ONCE, Starting today For 1 Occurrences, Verify consent form
has been obtained
Patient Monitoring and Instructions [191375]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Routine
Patient Instructions(1) [7700106] Encourage patient to void every 2 hours while awake and
every 4 hours while sleeping for the next 24 hours.
Urine Assessments [191376]
URINALYSIS, NO MICROSCOPY, POC [HCDIPSCR] AFTER EACH VOID, Starting today For 1 Days, Routine
If Conditional, What Condition?
Check for hematuria after each void and notify provider if
positive for hematuria.
SPECIFIC GRAVITY, URINE, POC [HCSGPOC] AFTER EACH VOID, Starting today For 1 Days, Routine
If Conditional, What Condition?
Obtain specific gravity after each void. If urine specific gravity
greater than 1.010 at any time, increase IV fluid rate by 25%.
Medications - Pre- Infusion
AFCH ONC FLUSHES FOR VAD - HEPARIN/SODIUM CHLORIDE .9% (ALL DEFAULTED) [192413]
sodium chloride 0.9% flush 10 mL injection [785055] Flush, PRN Starting today, flush/line care
Flush per VAD guidelines
heparin lock flush 10 units/mL 5 mL injection [74548] 1-150 units, Flush, PRN Starting today, flush/line care
Flush per VAD guidelines
heparin lock flush 100 units/mL 5 mL injection [64978] 500 units, Flush, PRN Starting today, flush/line care
Implanted port use ONLY to be used when de-accessing port.
Flush per VAD guidelines
IV Fluids [191377]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
Administer at 125 mL/m2/hour = *** mL/hour prior to
cyclophosphamide and continue for a minimum of 6 hours
post infusion. If Urine Specific Gravity is greater than 1.010,
at any time, consult with provider and increase IV fluid rate by
25%.
Anti-emetics (Single Response) [191378]
ondansetron (ZOFRAN ODT) disintegrating tab [64224] Oral, ONCE For 1 Doses
Administer 30 minutes prior to cyclophosphamide. (May give
IV formulation if unable to tolerate orally.)
ondansetron (ZOFRAN) soln [54843] 0.15 mg/kg, Oral, ONCE For 1 Doses
Administer 30 minutes prior to cyclophosphamide. (May give
IV formulation if unable to tolerate orally.)
Medications - Infusion
Treatment Medications [191379]
mesna (MESNEX) in dextrose 5 % 50 mL bag [700066] Intravenous, EVERY 4 HOURS For 3 Doses
Each mesna dose is 20% of cyclophosphamide dose for a
total daily mesna dose = 60% of cyclophosphamide dose.
Administer first dose prior to cyclophosphamide, second dose
4 hours after start of cyclophosphamide and third dose 8
hours after start of cyclophosphamide.
cyclophosphamide (CYTOXAN) bag [700050] Intravenous, ONCE For 1 Doses
Administer over 1 hour. May give when urine specific gravity
is less than or equal to 1.010.
Page 1 of 2
Pr i nt ed by SCHUHMACHER, KARI A [KAS18] at 8/4/2015 9:39:12 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Medications - Post-Infusion
Medications - Post Infusion (Single Response) [192412]
ondansetron (ZOFRAN ODT) disintegrating tab [64224] Oral, EVERY 8 HOURS PRN, nausea/vomiting
Do not administer within 6 hours of previous dose of
ondansetron. May give IV formulation if unable to tolerate by
mouth.
ondansetron (ZOFRAN) soln [54843] 0.15 mg/kg, Oral, EVERY 8 HOURS PRN, nausea/vomiting
Do not administer within 6 hours of previous dose of
ondansetron. May give IV formulation if unable to tolerate by
mouth.
Mediations - Conditional [192414]
ondansetron (ZOFRAN) injection [800202] 0.15 mg/kg, Intravenous, EVERY 8 HOURS PRN,
nausea/vomiting, If unable to tolerate oral formulations.
Do not administer within 6 hours of previous ondansetron
dose.
Page 2 of 2
Pr i nt ed by SCHUHMACHER, KARI A [KAS18] at 8/4/2015 9:39:12 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority