/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/radiology/,

/clinical/cckm-tools/content/order-sets/inpatient/radiology/name-97975-en.cckm

20170369

page

100

UWHC,UWMF,

Tools,

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

IP - IR - Post Local Thrombolytic - Venous - Adult - Postprocedure [1126]

IP - IR - Post Local Thrombolytic - Venous - Adult - Postprocedure [1126] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Post Local Thrombolytic - Venous - Adult - Postprocedure [1126]
Patient Care Orders
Vital Signs [221786]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then Every 30 minutes
times 4, then per routine.
Patient Monitoring [19102]
Monitor Entry Site [NURWND0018] SEE COMMENTS, Starting today For Until specified,
Monitor entry site for hematoma or new bleeding
every 15 minutes times 4, then every 30 minutes
times 4, then every hour.
Site: ***
Location: {right/left/bilaterally:4001510}
Monitor Threatened Extremity [NURWND0018] CONTINUOUS, Starting today, Monitor threatened
extremity for circulation, motor and sensory function
every 15 minutes times 4, then every 30 minutes
times 4, then every hour.
Site: ***
Location: {right/left/bilateral:4001510}
Check Pulse [NURMON0008] SEE COMMENTS, Starting today For Until specified,
Routine
Method:
Pulse Side:
Pulse Location: Pedal
Every 15 minutes times 4, then every 30 minutes
times 4, then every hour.
Activity [14344]
Bedrest [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees):
Less than (degrees): 30
Other options:
Routine, CONTINUOUS, Starting today
Nutrition [14345]
Page 1 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 3/10/2017 8:41:15 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

NPO Except Ice Chips [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO with Ice Chips/Sips of Water
Bedside Meal Instructions:
Room Service Class:
Non-Categorized Patient Care Orders [14346]
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today, Routine, To
discontinue this order, enter a new order for
"Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order.
Type:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Contingency Parameters [14347]
Notify Service Resident On Call [NURCOM0001] CONTINUOUS
Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 100 during first
24 hours postprocedure
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5 during first 24 hours
postprocedure
If temperature < (C):
If heart rate > (bpm): 120 during first 24 hours
postprocedure
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Patient develops new onset of back pain or
pelvic pain,Entry site hematoma or new
bleeding,Hemoglobin decreases by more than 2
gram/deciliter from baseline,Fibrinogen is less than
150 Activated Partial ,Thromboplastin Time is greater
than 70 seconds,Mental status change,Loss of pulses
or skin changes on treated extremity,Signs of HIT as
defined by an absolute platelet drop of 50% or greater
Intravenous Therapy
IV Fluids [18018]
sodium chloride 0.9 % infusion [64367] at 25 mL/hr, Other, CONTINUOUS
Give via IR venous sheath side port
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 3/10/2017 8:41:15 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Maintain PICC [NURVAD0050] CONTINUOUS, Routine
Device Status:
PICC Secured With:
Number of Lumens:
Flush With(Must also enter separate medication order
to obtain drug):
Site Assessment Frequency:
Care Frequency:
Wash With:
Primary Dressing:
Secondary Dressing:
Supplemental Orders
Refer to Interventional Radiology PICC Placement Postprocedural Order Set
Medications
Order Set and Supplemental" -Adult -Refer to "Heparin Anticoagulation -Heparin Orders For
OptionTitration Heparin Infusion -Select Non
Single Catheter - Alteplase [219384]
alteplase (ACTIVASE) 10 mg in sodium chloride
0.9 % 250 mL infusion [700974]
Intravenous, CONTINUOUS
Infuse alteplase through infusion catheter in *** at ***
mg/hr for *** hours, then at *** mg/hr for *** hrs, then
infuse at *** mg/hr.
Dual Catheter - Alteplase [219386]
Dual Catheter - Alteplase [219388]
alteplase (ACTIVASE) 10 mg in sodium chloride
0.9 % 250 mL infusion [700974]
Intravenous, CONTINUOUS
Infuse alteplase through infusion catheter in *** at
*** mg/hr for *** hours, then at *** mg/hr for *** hrs,
then infuse at *** mg/hr.
alteplase (ACTIVASE) 10 mg in sodium chloride
0.9 % 250 mL infusion [700974]
Intravenous, CONTINUOUS
Infuse alteplase through infusion catheter in *** at
*** mg/hr for *** hours, then at *** mg/hr for *** hrs,
then infuse at *** mg/hr.
Laboratory
Every 6 Hours While Alteplase is Infusing [14349]
FIBRINOGEN [GM1320] 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? Every 6 Hours While
Alteplase is Infusing
HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Every 6 Hours While
Alteplase is Infusing
FIBRINOGEN [GM1320] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Other Labs [14350]
ELECTROLYTES [LYTE] 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 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 3/10/2017 8:41:15 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Blood Products
[996]" Order SetSupplemental -Adult -Blood Transfusion -Blood Products Refer to "IP For
Type and Screen [16486]
TYPE AND SCREEN [HCTS] NEXT DRAW, Starting today For 1 Occurrences,
Routine, As good clinical practice and for patient
safety, the Transfusion Service will automatically
crossmatch 2 packed RBCs on all patients with
antibodies to ensure blood would be available in the
event it is needed. If you would like to opt out of this
automatic order for this patient please contact the
UWHC Blood Bank at (608) 263-8367 or The
American Center Lab at (608) 234-6600 as
appropriate.
Follow-up
Follow-up [14357]
Schedule Appointment for Follow-up Venogram
[NURCOM0026]
Reason for Hospital Follow Up Appointment: Deep
Venous Thrombosis, History of Venous Thrombolysis
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Page 4 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 3/10/2017 8:41:15 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org