/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/neonatal/,

/clinical/cckm-tools/content/order-sets/inpatient/neonatal/name-122488-en.cckm

201711313

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Neonatal

IP - Delivery - Neonatal - Supplemental [6490]

IP - Delivery - Neonatal - Supplemental [6490] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neonatal


IP - Delivery - Neonatal - Supplemental [6490]
Intravenous Therapy
IV Fluids - Venous [234371]
dextrose 10 % infusion [36626] Intravenous, CONTINUOUS
dextrose 10%, heparin 0.5 Units/mL in water
(sterile) 500 mL [700858]
Intravenous, CONTINUOUS
IV Fluids - Arterial [234372]
heparin in sodium chloride 0.9 % 50 mL patency
line [700923]
Intraarterial, CONTINUOUS
Medications
Cardiac [234381]
EPI: 1:10,000 = 0.1 mg/mL = 1 mg/10mL
mL/kg = 0.01 mg/kg (IV dose)0.1
mL/kg = 0.1 mg/kg (ETT dose) 1
epINEPHrine (CARDIAC 1:10,000 = 0.1 mg/mL =
1 mg/10mL ) 0.1 MG/ML injection [760293]
0.01 mg/kg, Intravenous, PRN For 3 Doses, Heart
Rate < 60 bpm
Give every 3 minutes up to 3 doses
epINEPHrine (CARDIAC 1:10,000 = 0.1 mg/mL =
1 mg/10mL ) 0.1 MG/ML injection [760293]
0.1 mg/kg, Endotracheal, ONCE For 1 Doses
DOPamine (INTROPIN) infusion PEDS [800137] 3-25 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per provider direction. Initiate at ***
mcg/kg/min or current rate. Adjust by *** mcg/kg/min
every *** minutes to maintain MAP between *** to ***
mmHg. If MAP below goal at 25 mcg/kg/min, Notify
MD
milrinone (PRIMACOR) infusion PEDS [800155] 0.5 mcg/kg/min, Intravenous, CONTINUOUS
alprostadil (PROSTIN VR) infusion PEDS
[800127]
0.01 mcg/kg/min, Intravenous, CONTINUOUS
Change syringe at expiration listed on infusion
Sedation [234382]
MORPHine infusion PEDS [800156] 0.01-0.05 mg/kg/hr, Intravenous, CONTINUOUS
Initiate, titrate and bolus based on PEDS ICU
analgesia/Sedation protocol
MORPHine PF injection (Max dose = 4 mg)
[800122]
0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN,
pain, agitation
FENTanyl infusion PEDS (Max dose = 200
mcg/hr) [800143]
1-5 mcg/kg/hr, Intravenous, CONTINUOUS
Initiate, titrate and bolus based on PEDS ICU
analgesia/Sedation protocol
FENTanyl PF injection (Max dose = 50 mcg)
[800187]
0.5-2 mcg/kg, Intravenous, EVERY 2 HOURS PRN,
pain, agitation
midazolam (VERSED) injection [800197] 0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN,
sedation
rocuronium (ZEMURON) injection [800213] 0.6 mg/kg, Intravenous, EVERY 1 HOUR PRN,
movement
Non-Categorized [234376]
poractant alfa (CUROSURF) 120 MG/1.5ML
intratracheal susp [175476]
2.5 mL/kg, Endotracheal, ONCE For 1 Doses
Birth Medications [148434]
erythromycin (ROMYCIN) ophthalmic ointment
[37228]
Eyes (Each)
phytonadione (VITAMIN K1) injection - For infants
< 1.5 kg [800219]
0.3 mg/kg, Intramuscular, ONCE For 1 Doses
phytonadione (VITAMIN K1) injection - For infants
1.5 kg or more [800219]
1 mg, Intramuscular, ONCE For 1 Doses
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/8/2017 9:30:49 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Laboratory
Whole Blood Testing on Unit [234375]
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
STAT For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cord Blood Testing [234383]
Cord Blood Testing [225317]
Blood Gases, Cord Blood (ARTERIAL)
[CORDGAS]
STAT, 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?
Blood Gases, Cord Blood (VENOUS)
[CORDGAS]
STAT, 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?
Cord Blood, ABO/Rh Typing and Direct
Antiglobulin Test [CORDBB]
STAT, 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?
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?
Comparative Genomic Hybridization (Microarray)
[HCSLH890]
STAT, Starting today For 1 Occurrences, Routine,
Contact UWHC Test Referral office at (608) 262-
6388 prior to sample collection.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Collect in Sodium Heparin tube.
Hold Cord Blood for Unspecified Testing
[HOLDCORD]
STAT, 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?
Specimen to be sent to lab and held for 30 days.
Tests
Tests [234374]
TYPE AND SCREEN, NEONATAL [HCNTS] STAT 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
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/8/2017 9:30:49 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Diagnostic Tests and Imaging [234384]
X-RAY BABYGRAM (PEDS CHEST/ABD
COMBINED-LESS THAN 2 YEARS) [R07709]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Radiology Specialty Area:
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Transthoracic Resting Echocardiogram (PEDS)
[ECH0012]
ONCE, STAT
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
To whom can we send the results of the study?
(include clinician and location):
Do you want Agitated Bubble Study?
Last patient height? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
US INTRACRANIAL [R76506] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
STAT
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
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.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/8/2017 9:30:49 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org