/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/pain-management/,

/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-124250-en.cckm

20180112

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Pain Management

IP - Procedural Sedation - Pediatric - Supplemental [6393]

IP - Procedural Sedation - Pediatric - Supplemental [6393] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Procedural Sedation - Pediatric - Supplemental [6393]
Patient Care Orders
Respiratory [240207]
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Intravenous Fluid Therapy
Premedication for Needle Insertion [231702]
Lidocaine [152737]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle sticks
to reduce pain. See "LMX Use Instructions" order in
Active Orders report or the Admin Instructions for
application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Details
Intravenous Therapy [240373]
sodium chloride 0.9% BOLUS [730003] 10 mL/kg, Intravenous, PRN For 3 Doses,
Hypotension during procedure
Medications
Sedative - Hypnotic and Anxiolytics [238704]
dexmedetomidine (PRECEDEX) infusion - PEDS
- LOAD [157210]
1 mcg/kg/hr, Intravenous, CONTINUOUS
Administer over 10 minutes
dexmedetomidine (PRECEDEX) infusion PEDS
[157210]
1 mcg/kg/hr, Intravenous, CONTINUOUS
May administer up to 3 doses within the first 2 hours of
infusion.
dexmedetomidine (PRECEDEX) 100 mcg/mL
intraNASAL soln [785204]
1-4 mcg/kg, Nasal, ONCE PRN For 1 Doses, Sedation
Administer via atomizer
dexmedetomidine (PRECEDEX) soln [785136] 1-4 mcg/kg, Buccal, ONCE PRN For 1 Doses,
Sedation
dexmedetomidine (PRECEDEX) soln [785136] 2-4 mcg/kg, Oral, ONCE PRN For 1 Doses, Sedation
midazolam (VERSED) syrup - NOTE: Maximum
Dose - 20 mg [60487]
0.25-0.5 mg/kg, Oral, PRN For 2 Doses, Sedation
NOTE: Maximum Dose - 20 mg
midazolam (VERSED) 5 MG/ML intraNASAL soln
- NOTE: Maximum dose - 10 mg [785196]
0.2-0.4 mg/kg, Nasal, PRN For 2 Doses, Sedation
Administer via atomizer
NOTE: Maximum dose - 4 mg
midazolam (VERSED) injection - NOTE:
Maximum dose - 2 mg [800197]
0.05-0.1 mg/kg, Intravenous, PRN For 3 Doses,
sedation, Sedation
NOTE: Maximum dose - 2 mg
Peds Diagnostic
Lidocaine - Propofol [238743]
lidocaine 1 % vial [39034] 10 mg, Intravenous, ONCE PRN For 1 Doses
Add 10 mg of lidocaine to propofol loading dose.
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 1/8/2018 11:31:30 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

propofol (DIPRIVAN) 10 mg/mL IV BOLUS
[730017]
1-4 mg/kg, Intravenous, ONCE PRN For 1 Doses,
Sedation
Load at 1-2 mg/kg per minute to achieve desired
level of sedation.
propofol (DIPRIVAN) 10 mg/mL IV BOLUS
[730017]
0.5 mg/kg, Intravenous, PRN, Sedation
May repeat PRN arousal or movement. RN to
document total dose administered.
propofol (DIPRIVAN) 10 mg/mL infusion [800260] 100-150 mcg/kg/min, Intravenous, CONTINUOUS
May repeat arousal or movement. RN to document
total dose administered.
Sedatives - Analgesics [238747]
FENTanyl PF injection RANGE [750047] 0.5-2 mcg/kg, Intravenous, PRN For 3 Doses,
Sedation, for 3-5 Minutes
FENTanyl PF 50 mcg/mL intraNASAL soln
[785209]
1.5 mcg/kg, Nasal, PRN For 3 Doses, Sedation
Administer via atomizer
ketAMINE (KETALAR) injection - NOTE:
Maximum Dose - 100 mg/dose [800191]
2-6 mg/kg, Intravenous, ONCE PRN For 1 Doses,
Sedation
ketAMINE injection [800191] 2-6 mg, Intramuscular, ONCE PRN For 1 Doses,
Sedation induction per policy 8.56
ketAMINE (KETALAR) soln - NOTE: Maximum
100 mg/dose. [785017]
2-8 mg/kg, Nasal, PRN For 3 Doses, Sedation
Administer via atomizer
ketamine (KETALAR) infusion PEDS [800149] 0.1 mg/kg/hr, Intravenous, PRN For 3 Doses,
Sedation
Notify ordering provider for titration instructions.
MORPHine PF injection RANGE - NOTE:
Maximum Dose = 6 mg [750057]
0.05-0.2 mg/kg, Intravenous, PRN For 3 Doses, pain,
Sedation, for 4 Minutes
Anti-emetics [238785]
ondansetron (ZOFRAN) soln [54843] 0.15 mg/kg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting
For first line therapy
ondansetron (ZOFRAN) injection [800202] 0.15 mg/kg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
For 2nd line therapy. Administer if patient unable to
tolerate orally.
Secretions [238786]
atropine soln [780019] 0.02 mg/kg, Oral, ONCE PRN For 1 Doses,
Secretions
Obtain and scan injectable vial from AcuDose cabinet
for oral administration
glycopyrrolate (ROBINUL) injection [37960] 10 mcg/kg, Intravenous, ONCE PRN For 1 Doses,
Secretions
Glycopyrrolate (ROBINUL) 1 MG/5ML soln
[143874]
100 mcg/kg, Oral, ONCE PRN For 1 Doses,
Secretions
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 1/8/2018 11:31:30 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org