/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-98083-en.cckm

201708223

page

100

UWHC,UWMF,

Tools,

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

IP - Lidocaine Continuous Subcutaneous Titration Infusion - Adult - Supplemental [2195]

IP - Lidocaine Continuous Subcutaneous Titration Infusion - Adult - Supplemental [2195] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Lidocaine Continuous Titration Infusion - Adult - Supplemental [2195]
for Adult Patients OnlyIntended
Policy 3.5.5 Pain Management URL: https://uconnect.wisc.edu/policies/clinical/uw-
health-clinical/med-records/patient-
assessment/355.policy
Patient Care Orders
Vital Signs [32105]
Vital Signs (Blood Pressure, Pulse Rate,
Respiratory Rate) [NURMON0013]
SEE COMMENTS, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 4 hours and as needed if patient develops mild
or moderate side effects (temperature not needed)
Patient Monitoring [32108]
Assess Pain Rating Every 4 Hours
[NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess pain rating every 4 hours
Assess for Lidocaine Adverse Effects Every 4
Hours [NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess for lidocaine adverse effects every 4 hours
Measure Pain Rating and Associated Symptoms
as Needed if Patient Develops Adverse or
Moderate Side Effects from Lidocaine
[NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Measure pain rating and associated symptoms as
needed if patient develops mild or moderate side
effects from Lidocaine
Medications
Infusion Agent - Maintenance [32088]
lidocaine PF 4000 mg/100 mL subcutaneous
infusion [785152]
Subcutaneous, CONTINUOUS
Infusion Reaction: If mild or moderate adverse effects
develop hold infusion for 15 minutes or until resolved,
whichever is sooner. Resume infusion at 1/2 rate. If
adverse effects have not resolved in 10-15 minutes,
discontinue infusion. If adverse effects re-surface
when infusion restarted, discontinue infusion.
Document total dose infused, any adverse effects and
other pertinent information.
Note: Assessment for Lidocaine Titration [950018] EVERY 8 HOURS
Assess for lidocaine titration: every 8 hours, if pain
rating is greater than or equal to 3, increase lidocaine
infusion by 20%. If pain rating is less than 3, do not
change lidocaine infusion rate
Nursing Communication [NURCOM0022] CONTINUOUS, If lidocaine infusion rate is greater
than 3 mL/hr, use second site to branch the infusion
into two sites using male to male adapter. Use only
one infusion pump and one lidocaine bag. Page
"PAIN" CNS for male to male adaptor
Laboratory
Once If Patient Develops Side Effects (Single Response) [32112]
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 8/7/2017 9:44:37 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

LIDOCAINE LEVEL [HCLIDO] CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw once if patient
develops mild or moderate adverse effects
Consults
Consults [32111]
Consult Case Management (Inpatient) [CON0013] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: HOME HEALTH CARE
Notify Chartwell at 831-8555 on admission
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 8/7/2017 9:44:37 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org