/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/neurosciences/,

/clinical/cckm-tools/content/order-sets/inpatient/neurosciences/name-120905-en.cckm

201709263

page

100

UWHC,UWMF,

Tools,

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

IP - Neuromuscular Blocking Agent Continuous Infusion - Adult - Supplemental [6449]

IP - Neuromuscular Blocking Agent Continuous Infusion - Adult - Supplemental [6449] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neuromuscular Blocking Agent Continuous Infusion - Adult - Supplemental
[6449]
Neuromuscular Blocking Agent Continuous
Infusion - Adult - Inpatient
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/delegationpractice-
protocols/inpatient-delegation-protocols/name-
97298-en.cckm
Patient Care Orders
Patient Care Orders [223252]
Do NOT initiate spontaneous awakening
trial/physician directed weaning [NURCOM0022]
CONTINUOUS, Starting today
Goal Richmond Agitation-Sedation Scale (RASS)
Score [NURCOM0022]
ONCE, Goal RASS: -4 to -5 (deep sedation to
unarousable); if possible, achieve this RASS score
prior to starting neuromuscular blocking infusion.
Note to Nursing [NURCOM0022] ONCE, 1) Discontinue spontaneous awakening trial
orders
2) Discontinue previous goal Richmond Agitation-
Sedation Scale (RASS) orders
3) Discontinue all previous pain/agitation/delirium
(PAD) orders
Note-Notify Pharmacy [NURCOM0022] ONCE For 1 Occurrences, 1) Discontinue
spontaneous awakening trial orders
2) Discontinue previous goal Richmond Agitation-
Sedation Scale (RASS) orders
3) Discontinue all previous pain/agitation/delirium
(PAD) orders
Apply Brace/Splint, Lower Body [NURTRT0009] CONTINUOUS, Routine, If ordering a Bledsoe Boot or
Hip Abduction Brace, please contact the cast room
technician at 265-0746.
Type: PRAFO
Left/Right/Bilateral?
Wearing schedule:
Consult Orthotics (Inpatient) [CON0051] ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Patient Monitoring [223240]
Train of Four monitoring [NURMON0060] CONTINUOUS, Obtain baseline train of four prior to
initiating NMBA infusion. Goal: highest possible train
of four while maintaining clinical endpoint (see
neuromuscular blocking agent admin instructions).
Reference clinical practice guideline.
Bispectral Index (BIS) monitoring [NURMON0060] CONTINUOUS, Attempt to achieve baseline BIS prior
to initiating NMBA infusion. Assess at least every 2
hours. Goal 40-60.
Respiratory [232591]
Respiratory Therapy Communication [RT0073] ONCE For 1 Occurrences, Routine, Discontinue
spontaneous breathing trial orders
Medications
Sedation and Analgesia [224004]
propofol (DIPRIVAN) 10 mg/mL infusion [800260] 10-70 mcg/kg/min, Intravenous, CONTINUOUS
Initiate/Titrate/Bolus per Assessment and Treatment of
Pain, Agitation, and Delirium Continuous Infusion
Titration - Adult - Inpatient Practice Protocol
Page 1 of 2
Printed by WILLIAMS, HEATHER R [HRS0] at 9/18/2017 8:56:36 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

midazolam (VERSED) 50 mg in dextrose 5 % 50
mL infusion [700236]
1-10 mg/hr, Intravenous, CONTINUOUS
Initiate/Titrate/Bolus per Assessment and Treatment of
Pain, Agitation, and Delirium Continuous Infusion
Titration - Adult - Inpatient Practice Protocol
FENTanyl infusion [800264] 25-200 mcg/hr, Intravenous, CONTINUOUS
Initiate/Titrate/Bolus per Assessment and Treatment of
Pain, Agitation, and Delirium Continuous Infusion
Titration - Adult - Inpatient Practice Protocol
Neuromuscular Blocking Agents (For patients with hepatic or renal insufficiency or on systemic steroid
therapy) (Single Response) [223869]
atracurium (TRACRIUM) 200 mg in dextrose 5 %
100 mL infusion [700150]
4-15 mcg/kg/min, Intravenous, CONTINUOUS
Neuromuscular Blocking Agents (For patients without hepatic or renal insufficiency, and not on
systemic steroid therapy) [223868]
vecuronium (NORCURON) 100 mg in dextrose 5
% 100 mL infusion [700292]
0.4-3 mcg/kg/min, Intravenous, CONTINUOUS
rocuronium (ZEMURON) 200 mg in sodium
chloride 0.9 % 100 mL infusion [700437]
3-12.5 mcg/kg/min, Intravenous, CONTINUOUS
Neuromuscular Blocking Agents (For patients who experience tachyphylaxis to atracurium AND with
hepatic or renal insufficiency or on systemic steroid therapy) (Single Response) [225998]
cisatracurium (NIMBEX) 260 mg/130 mL infusion
[700343]
0.3-10 mcg/kg/min, Intravenous, CONTINUOUS
Non-categorized [223871]
artificial tears PF ophthalmic ointment [157764] Eyes (Each), EVERY 4 HOURS
Apply a thin layer to inside of lower lid while on
neuromuscular blocking infusion
Laboratory
Baseline Labs [223253]
CK, TOTAL [CPK] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every 48 hours labs [223254]
CK, TOTAL [CPK] EVERY 2 DAYS, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Conditional while
patient on neuromuscular blocking agent
Page 2 of 2
Printed by WILLIAMS, HEATHER R [HRS0] at 9/18/2017 8:56:36 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org