/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/pulmonary/,

/clinical/cckm-tools/content/order-sets/inpatient/pulmonary/name-98024-en.cckm

201606175

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UWHC,UWMF,

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

IP – Bronchoscopy Specimens – Adult – Supplemental [1637]

IP – Bronchoscopy Specimens – Adult – Supplemental [1637] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pulmonary


IP - Bronchoscopy Specimens - Adult - Supplemental [1637]
BAL Tests
Frequently Ordered [22907]
CELL COUNT, BAL [HCBALCC] ONCE, 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?
CULTURE, BAL, QUANT WITH GRAM STAIN
[HCBALC]
ONCE, 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?
CULTURE, FUNGAL, WITH SMEAR [HCFCULTS] ONCE, Starting today For 1 Occurrences, Routine, Smears
not routinely performed on CSF. If CSF, order Culture,
Fungal.
Indicate source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AFB SMEAR AND CULTURE [201510]
AFB SMEAR [AFBSMR] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AFB CULTURE [AFBCX] ONCE For 1 Occurrences, Routine, Smear and culture
should be ordered for diagnostic specimens.
M. avium complex PCR is performed on the first smear
positive respiratory specimen from patients not previously
diagosed with tuberculosis. Susceptibility testing is
performed automatically on all initial M. tuberculosis
isolates. Susceptibility testing for some non-tuberculous
mycobacteria is available.
The initial M. tuberculosis isolate from each patient is also
genotyped as part of the CDC Universal Genotyping
Program.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Isolation - Airborne - TB-Pulmonary Confirmed/Suspect
[ISO0003]
CONTINUOUS
Isolation - Airborne - Negative Pressure Room
[NURCOM0108]
CONTINUOUS
CULTURE, LEGIONELLA [LEGCX] ONCE, 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?
Additional Tests [22908]
CULTURE, NOCARDIA [HCNCULT] ONCE, Starting today For 1 Occurrences, Routine
Indicate source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
GALACTOMANNAN, BAL [HCGLACTB] STAT - RN COLLECT, 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?
Page 1 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 2/22/2016 9:40:07 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org

PNEUMOCYSTIS JIROVECII STAIN, BAL [HCTBOBAL] ONCE, 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?
P JIROVECI, PCR [HCPJPCR] ONCE, 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?
RESPIRATORY VIRUS DETECTION [130093]
RESPIRATORY VIRUS PANEL, PCR [HCRVPPCR] ONCE For 1 Occurrences, Routine, The Respiratory Virus
Panel test includes detection of: Influenza A, Influenza A
subtype H1, Influenza A subtype H3, Influenza A subtype
2009 H1N1, Influenza B, RSV A, RSV B, Parainfluenza 1,
Parainfluenza 2, Parainfluenza 3, human
metapneumovirus (nMPV), human rhinovirus, Adenovirus
B/E, Adenovirus C.
This test is most appropriate for transplant and select other
immunocompromised patients. All others should consider
'Influenza A, Influenza B, and RSV by PCR'- [HCFLURSV].
During peak influenza season consider ordering 'Influenza
A, Influenza B, and RSV by PCR'- [HCFLURSV].
For UWHC only: Collect Nasopharyngeal Minitip swab
(flocked swab) and place in UTM. BAL is also acceptable.
Room temperature M4 (M4RT) is not acceptable.
For UWMF only: Collect Nasopharyngeal (flocked swab)
and place in refrigerated M4 viral media. BAL is also
acceptable. Room temperature M4 (M4RT) is not
acceptable.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Isolation - Contact and Droplet - Respiratory Infection
[ISO0045]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
HISTOPLASMA AG [HCHISTAG] ONCE For 1 Occurrences, Routine
Indicate specimen source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CMV QUALITATIVE BY PCR, BAL [HCCMVBAL] ONCE, 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?
HERPES SIMPLEX VIRUS BY PCR [HCHSVPCR] ONCE, Starting today For 1 Occurrences, Routine
Indicate specimen source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Micro Brush
Micro Brush [114659]
CULTURE, BODY FLUID, AER WITH GRAM STAIN
[HCBFC]
ONCE, Starting today For 1 Occurrences, Routine, For
peritoneal, pericardial, pleural, synovial and dialysate fluids
order Culture, Body Fluid, Aer/Ana with Gram stain and use
blood culture bottles.
Page 2 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 2/22/2016 9:40:07 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org

Indicate source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Please perform QUANTITATIVE cultures on this protected
specimen micro brush
Transbronchial Biopsy (TBBX)
TBBX [114585]
CULTURE, BODY FLUID, AER WITH GRAM STAIN
[HCBFC]
ONCE For 1 Occurrences, Routine, For peritoneal,
pericardial, pleural, synovial and dialysate fluids order
Culture, Body Fluid, Aer/Ana with Gram stain and use blood
culture bottles.
Indicate source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, FUNGAL, WITH SMEAR [HCFCULTS] ONCE, Starting today For 1 Occurrences, Routine, Smears
not routinely performed on CSF. If CSF, order Culture,
Fungal.
Indicate source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AFB SMEAR AND CULTURE [201514]
AFB SMEAR [AFBSMR] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AFB CULTURE [AFBCX] ONCE For 1 Occurrences, Routine, Smear and culture
should be ordered for diagnostic specimens.
M. avium complex PCR is performed on the first smear
positive respiratory specimen from patients not previously
diagosed with tuberculosis. Susceptibility testing is
performed automatically on all initial M. tuberculosis
isolates. Susceptibility testing for some non-tuberculous
mycobacteria is available.
The initial M. tuberculosis isolate from each patient is also
genotyped as part of the CDC Universal Genotyping
Program.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Isolation - Airborne - TB-Pulmonary Confirmed/Suspect
[ISO0003]
CONTINUOUS
Isolation - Airborne - Negative Pressure Room
[NURCOM0108]
CONTINUOUS
Fine Needle Aspirate (ASP) - Lymph Node
Fine Needle Aspirate (ASP) [114660]
CULTURE, BODY FLUID, AER WITH GRAM STAIN
[HCBFC]
ONCE, Starting today For 1 Occurrences, Routine, For
peritoneal, pericardial, pleural, synovial and dialysate fluids
order Culture, Body Fluid, Aer/Ana with Gram stain and use
blood culture bottles.
Indicate source if other: Lymph node fine needle aspirate
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, FUNGAL, WITH SMEAR [HCFCULTS] ONCE, Starting today For 1 Occurrences, Routine, Smears
Page 3 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 2/22/2016 9:40:07 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org

not routinely performed on CSF. If CSF, order Culture,
Fungal.
Indicate source if other: Lymph node fine needle aspirate
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AFB SMEAR AND CULTURE [201517]
AFB SMEAR [AFBSMR] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AFB CULTURE [AFBCX] ONCE For 1 Occurrences, Routine, Smear and culture
should be ordered for diagnostic specimens.
M. avium complex PCR is performed on the first smear
positive respiratory specimen from patients not previously
diagosed with tuberculosis. Susceptibility testing is
performed automatically on all initial M. tuberculosis
isolates. Susceptibility testing for some non-tuberculous
mycobacteria is available.
The initial M. tuberculosis isolate from each patient is also
genotyped as part of the CDC Universal Genotyping
Program.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Isolation - Airborne - TB-Pulmonary Confirmed/Suspect
[ISO0003]
CONTINUOUS
Isolation - Airborne - Negative Pressure Room
[NURCOM0108]
CONTINUOUS
Cytology
Cytology BAL [114909]
CYTOLOGY, NON-GYN [HCPATHM] ONCE, Starting today For 1 Occurrences, Routine, For any
questions please refer to U-Connect Test Directory or contact
UWHC Cytology at (608)263-3205.
Specimen Source Description: Bronchoalveolar lavage
Please indicate laterality if appropriate:
Method of Collection - Urine specimens only:
Other cytology tests not related to malignancy:
Clinical History:
FLOW CYTOMETRY, CD4 AND CD8 [HCFCD48] ONCE For 1 Occurrences, Routine, For blood specimens a
WBC and Differential must be ordered.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
FLOW CYTOMETRY, HEMEPATH CONSULT
[HCFLOWHM]
STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine, Used for flow cytometry of suspected hematologic
malignancy.
For blood specimen order CBC with Differential.
Suspected Diagnosis:
Indicate specimen source if other: Bronchoalveolar lavage
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
FLOW CYTOMETRY, HEMEPATH CONSULT
[HCPATHI]
STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine, Used for flow cytometry of suspected hematologic
Page 4 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 2/22/2016 9:40:07 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2016CCKM@uwhealth.org

malignancy.
For blood specimen order CBC with Differential.
Specimen Source Description:
Clinical Hx/ Suspected Dx:
Requested Flow Test:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Cytology Brush [114910]
CYTOLOGY, NON-GYN [HCPATHM] ONCE, Starting today For 1 Occurrences, Routine, For any
questions please refer to U-Connect Test Directory or contact
UWHC Cytology at (608)263-3205.
Specimen Source Description: Endobronchial cytology brush
Please indicate laterality if appropriate:
Method of Collection - Urine specimens only:
Other cytology tests not related to malignancy:
Clinical History:
Cytology Fine Needle Aspiration (FNA) [114911]
FINE NEEDLE ASP [HCPATHF] ONCE, Starting today For 1 Occurrences, Routine, Call
UWHC Cytology to schedule appointment- (608) 263-3205.
Specimen Source Description:
Please indicate laterality if appropriate:
Clinical History:
Other pertinent information:
Surgical Pathology
Surgical Pathology [114664]
SURGICAL PATHOLOGY [HCPATHS] ONCE, Starting today For 1 Occurrences, Routine, This order
is to be used for fresh or formalin-fixed (for gross and micro
evaluation) tissues.
Slides and/or paraffin-embedded blocks coming from outside
institutions needing second opinion pathology review should
be ordered as Surgical Pathology Consult [HCPATHSP].
Specimen Source Description:
Number of containers:
Clinical Diagnosis:
Reason for procedure:
Other pertinent information:
Frozen section call back number:
Type of procedure: Gross and Micro
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Diagnostics and Imaging
Radiology [189455]
X-RAY CHEST AP VIEW - NOW STAT BEDSIDE
[R71010]
ONCE-RAD NEXT AVAILABLE, STAT
Current signs and symptoms? s/p bronch
What specific question(s) would you like answered by this
exam? Question Pneumothorax
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
Page 5 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 2/22/2016 9:40:07 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2016CCKM@uwhealth.org

Page 6 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 2/22/2016 9:40:07 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2016CCKM@uwhealth.org