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/clinical/cckm-tools/content/order-sets/inpatient/radiology/name-97997-en.cckm

201706180

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

IP - IR - Pre Subcutaneous Venous Access Port - Adult - Preprocedure [1298]

IP - IR - Pre Subcutaneous Venous Access Port - Adult - Preprocedure [1298] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Pre Subcutaneous Venous Access Port - Adult - Preprocedure [1298]
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 [143170]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Intake and Output [143151]
Void Prior to Transport [NURELM0061] ONCE For 1 Occurrences
Nutrition [117653]
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:
Patient may have solid food until 6 hours prior to
procedure. May continue to take clear liquids until 4
hours prior to procedure. Then NPO except
medications with sips of water.
Non-Categorized Patient Care Orders [143171]
Nursing Communication [NURCOM0022] ONCE, Starting today For 1 Occurrences, 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.
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.
For Female Patients [16993]
Mark Location of Bra Straps [NURCOM0022] ONCE, Starting today For 1 Occurrences
Contingency Parameters [16870]
Page 1 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 6/23/2017 1:08:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2017CCKM@uwhealth.org

Notify Interventional Radiology 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,WBC less than 2.5 or greater than
10.0,ANC is less than 800
Intravenous Therapy
Premedications for Needle Insertion [106310]
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
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 (Single Response) [140888]
dextrose 5%-NaCl 0.45% infusion [51613] at 150 mL/hr, Intravenous, CONTINUOUS
Page 2 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 6/23/2017 1:08:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

sodium chloride 0.9% infusion [64367] at 150 mL/hr, Intravenous, CONTINUOUS
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 (Single Response) [142826]
cefazolin (ANCEF) intraVENOUS - NOTE:
Patient who is 40-120 kg [800000]
2 g, Intravenous, ON CALL For 1 Doses
cefazolin (ANCEF) intraVENOUS - NOTE:
Patient who is greater than 120 kg [800000]
3 g, Intravenous, ON CALL For 1 Doses
Patients with MRSA (Single Response) [142864]
Patient who is 40-120 kg [225362]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Patient who is greater than 120 kg [225363]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [142901]
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Laboratory
Labs - If Not Done in Outpatient Oncology [16994]
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?
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?
ABSOLUTE NEUTROPHIL COUNT [HCANC] 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?
HCG, QUALITATIVE, URINE [UPREG] STAT - 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?
Page 3 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 6/23/2017 1:08:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org