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/clinical/cckm-tools/content/order-sets/inpatient/radiology/name-97996-en.cckm

201708234

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UWHC,UWMF,

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

IP - IR - Pre Portal Vein Embolization - Adult - Preprocedure [3512]

IP - IR - Pre Portal Vein Embolization - Adult - Preprocedure [3512] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Pre Portal Vein Embolization - Adult - Preprocedure [3512]
Intended for Adult Patients Only
Patient Care Orders
Vital Signs [143149]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
On arrival
Patient Monitoring [143177]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: 18 Gauge
Does this need to be inserted/placed?
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, 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: Indwelling Single Lumen
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Nutrition [143327]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
May have clear liquid diet up to 4 hours prior to
procedure as per anesthesia guidelines for
outpatients.
Intake and Output [143151]
Void Prior to Transport [NURELM0061] ONCE For 1 Occurrences
Non-Categorized Patient Care Orders [103363]
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Nursing Communication [NURCOM0022] ONCE, Procedure to be performed ***.
For Diabetic Patients [142889]
Glucose, POC [IPGLUCOSE] CONDITIONAL - RN COLLECT For 5 Occurrences,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition? On Arrival and every
60 minutes for prior glucose less than 60 or greater
than 300 mg/dL.
Page 1 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:30:24 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

GLUCOSE [GLU] CONDITIONAL - 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? Obtain if POC glucose
less than 40 mg/dL or greater than 400 mg/dL.
Contingency Parameters [103364]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg): 60
If temperature > (C):
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 300
If blood glucose < (mg/dL): 90
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: International normalized ratio (INR) is greater
than 1.5,Platelet count is less than 50,000/microliter
Intravenous Therapy
Premedications for Needle Insertion [124125]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is within 1 minute. Choice of medication should be based on patient’s previous
experience/preference, history of lidocaine allergy and ease of access.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 mL, Intradermal, PRN, peripheral line insertion
- see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Page 2 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:30:24 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
IV Fluids [103489]
sodium chloride 0.9% infusion [64367] at 150 mL/hr, Intravenous, CONTINUOUS
Medications
Anti-emetics [103492]
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE For 1 Doses
Non-Categorized [118974]
lidocaine (STERILE UROJECT) 2 % gel [785049] Urethral, ONCE For 1 Doses
Surgical Prophylaxis
IR Delivery Note [140285]
Note: Pharmacy: Please tube anti-infective to
Radiology Prep/Recovery at #434 [950018]
ONCE For 1 Doses
First Line [28240]
ampicillin/sulbactam (UNASYN) intraVENOUS
[800010]
3 g, Intravenous, ONCE For 1 Doses
Patients with MRSA (Single Response) [151213]
Patients who are greater than 40 kg [228207]
ampicillin/sulbactam (UNASYN) intraVENOUS
[800010]
3 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS (Max
dose = 2000 mg) [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [228208]
Patients who are 40-120 kg [230363]
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS - Note:
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Patients who are 121 kg and greater [230366]
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
750 mg, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS - Note:
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Laboratory
Laboratory [103365]
WHITE CELL COUNT [WBC] 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 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:30:24 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

HEMATOCRIT [HCT] 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?
PLATELET COUNT [PLT] 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?
PROTHROMBIN TIME/INR [PT] 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?
CBC WITHOUT DIFFERENTIAL [HEMO] 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?
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?
CREATININE [CRET] 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?
AST/SGOT [AST] 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?
ALT/SGPT [ALT] 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?
BILIRUBIN, TOTAL [TBIL] 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?
ALKALINE PHOSPHATASE [ALKP] 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?
GGT [GGT] 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 4 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:30:24 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

TYPE AND SCREEN [HCTS] STAT - RN COLLECT, 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.
HCG, QUALITATIVE, URINE [UPREG] 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 5 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:30:24 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org