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Cardiac Cath/EP - Vascular - Adult - Preprocedure [6008]

Cardiac Cath/EP - Vascular - Adult - Preprocedure [6008] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Vascular Surgery


Cardiac Cath/EP - Vascular - Adult - Preprocedure [6008]
For Carotid Stent or Carotid Endarterectomy Preprocedure orders use one of the following order sets:
FDS - Carotid Endarterectomy - Adult - Preprocedure [5292]
FDS - Carotid Stent Placement (Neuro Suite/OR) - Adult - Preprocedure [5295]
FDS - Carotid Stent Placement (Cath Lab) - Adult - Preprocedure [5322]
Patient Care Orders
Vital Signs [201541]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location: Bilateral Arms
BP Position:
BP Restrictions:
On admission, Cardiac Cath/EP
Glucose Point of Care (POC) and Hypoglycemia Management [201542]
If ordering Glucose, POC order(s), also select Hypoglycemia Management (Adult)
Glucose, POC - On Admission [IPGLUCOSE] ONCE, Starting today For 1 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 admission., Cardiac Cath/EP
Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting today, 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?
Cardiac Cath/EP
Hypoglycemia Management (Adult) [191576]
Adult Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/diabetes-and-
endocrinology/resources/name-77827-en.file
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until specified,
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?
Cardiac Cath/EP
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA TREATMENT,
Starting today For Until specified, 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?
Per hypoglycemia treatment algorithm Recheck glucose
15 minutes after providing treatment until glucose is
greater than or equal to 70 mg/dL. If patient has been
critically low (i.e., glucose less than 40 mg/dL), recheck
glucose after 1 hour to ensure glucose remains greater
than or equal to 70mg/dL. After resolution of mild
hypoglycemia (i.e., glucose 40-69 mg/dL), consider
rechecking after 1 hour if patient has signs/symptoms of
hypoglycemia or is at risk for a subsequent hypoglycemic
event (e.g., previously administered insulin still active,
altered renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that increases
Page 1 of 6
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2016CCKM@uwhealth.org

hypoglycemia risk), Cardiac Cath/EP
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Cardiac Cath/EP
Hypoglycemia Treatment for blood glucose less than 40
mg/dL and patient able to eat/swallow safely
[NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose less than
40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice). Repeat
treatment until glucose is 70 mg/dL or greater., Cardiac
Cath/EP
Hypoglycemia Treatment for blood glucose between 40
to 69 mg/dL and patient able to eat/swallow safely
[NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69 mg/dL
and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice). Repeat
treatment until glucose is 70 mg/dL or greater., Cardiac
Cath/EP
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN, hypoglycemia,
Hypoglycemia, For blood glucose 40-69 mg/dL
Use in patients able to safely eat/swallow but unable to
tolerate volume of fruit juice or per patient preference.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater.
Cardiac Cath/EP
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN, hypoglycemia,
Hypoglycemia, For blood glucose less than 40 mg/dL
Use in patients able to safely eat/swallow but unable to
tolerate volume of fruit juice or per patient preference.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater.
Cardiac Cath/EP
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less than 69
mg/dL and patient unable to eat/swallow safely AND has
NO IV access
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
Cardiac Cath/EP
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69 mg/dL
and patient unable to eat/swallow safely AND has IV
access
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
Cardiac Cath/EP
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than 40
mg/dL and patient unable to eat/swallow safely AND has IV
access.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
Cardiac Cath/EP
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting today For 7 Days,
STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is
less than 40 mg/dL or greater than 400 mg/dL.
Cardiac Cath/EP
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting 4/16/16 For 7
Days, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is
less than 40 mg/dL or greater than 400 mg/dL.
Page 2 of 6
Printed by LIND, JANNA S [JSL237] at 4/8/2016 11:07:33 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2016CCKM@uwhealth.org

Cardiac Cath/EP
Nutrition [201543]
NPO Except Medications [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25): NPO
EXCEPT MEDICATIONS
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Room Service Class:
Cardiac Cath/EP
Respiratory [201544]
Pulse Oximetry [NURMON0009] ONCE, Starting today For 1 Occurrences, Routine, On
admission, Cardiac Cath/EP
Intake and Output [201545]
Void On Call to Cath Lab [NURELM0022] CONTINUOUS, Starting today, Routine, Cardiac Cath/EP
Non-Categorized Patient Care Orders [201546]
Measure Height [NURMON0052] ONCE, Starting today For 1 Occurrences, Routine, On
admission., Cardiac Cath/EP
Measure Weight [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
On admission., Cardiac Cath/EP
Contingency Parameters [201547]
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Pressure,Heart Rate,Other,Blood
Glucose
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Chest pain/rhythm change
If heart rate > (bpm): 100
If heart rate < (bpm): 60
If systolic blood pressure > (mmHg): 160
Page 3 of 6
Printed by LIND, JANNA S [JSL237] at 4/8/2016 11:07:33 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2016CCKM@uwhealth.org

If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
Cardiac Cath/EP
Intravenous Therapy
Premedications for Needle Insertion [201548]
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
Cardiac Cath/EP
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
Cardiac Cath/EP
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
Cardiac Cath/EP
IV Fluids [201549]
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS, Cardiac Cath/EP
sodium chloride 0.45% infusion [42187] Intravenous, CONTINUOUS, Cardiac Cath/EP
Insert and Maintain Peripheral IV - Left Upper Extremity
[NURVAD0013]
CONTINUOUS, Starting today For Until specified, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Cardiac Cath/EP
Insert and Maintain Peripheral IV - Right Upper
Extremity [NURVAD0013]
CONTINUOUS, Starting today For Until specified, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Cardiac Cath/EP
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Second Line, Cardiac Cath/EP
Laboratory
Labs [201552]
CBC WITHOUT DIFFERENTIAL [HEMO] NEXT DRAW, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
Page 4 of 6
Printed by LIND, JANNA S [JSL237] at 4/8/2016 11:07:33 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2016CCKM@uwhealth.org

If Conditional, What Condition?
Cardiac Cath/EP
ELECTROLYTES [LYTE] NEXT DRAW, 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?
Cardiac Cath/EP
BUN [BUN] NEXT DRAW, 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?
Cardiac Cath/EP
CREATININE [CRET] NEXT DRAW, 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?
Cardiac Cath/EP
GLUCOSE [GLU] NEXT DRAW, 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?
Cardiac Cath/EP
PROTHROMBIN TIME/INR [PT] NEXT DRAW, 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?
Cardiac Cath/EP
PTT [PTT] NEXT DRAW, 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?
Cardiac Cath/EP
HEMOGLOBIN A1C [HA1C] NEXT DRAW, 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?
Administer test if not done within the past 60 days, Cardiac
Cath/EP
HCG, QUALITATIVE, URINE [UPREG] 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?
Cardiac Cath/EP
ALT/SGPT [ALT] NEXT DRAW, 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?
Cardiac Cath/EP
AST/SGOT [AST] NEXT DRAW, 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?
Cardiac Cath/EP
LIPID PANEL [LIPID] NEXT DRAW, Starting today For 1 Occurrences, Routine,
Test includes Cholesterol, Total; HDL Cholesterol;
Triglyceride; LDL cholesterol, calculated; and non-HDL
cholesterol.
Patient must fast for 10-14 hours and be heparin free for 48
Page 5 of 6
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2016CCKM@uwhealth.org

hours prior to specimen collection. The patient can only have
water, black coffee or calorie free drinks during the fasting
period.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
If the patient has not fasted for the required time, then
consider orders for total cholesterol and HDL instead of lipid
panel., Cardiac Cath/EP
PROTEIN, URINE [UTPR] 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?
Cardiac Cath/EP
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Stat every time blood glucose
monitoring (bedside) is less than 40 or greater than 400
mg/dL.
Cardiac Cath/EP
Diagnostic Testing
Cardiology [201553]
ECG - 12 Lead - Pre-Operative [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: PRE-OPERATIVE
Cardiac Cath/EP
ECG - 12 Lead - PRN for Chest Pain and Arrhythmias
[EKG0008]
PRN, Starting today, Routine
Reason for exam: CHEST PAIN,ARRHYTHMIA,
ATRIAL,ARRHYTHMIA, VENTRICULAR
Cardiac Cath/EP
Page 6 of 6
Printed by LIND, JANNA S [JSL237] at 4/8/2016 11:07:33 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2016CCKM@uwhealth.org