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/clinical/cckm-tools/content/order-sets/inpatient/vascular-surgery/name-97879-en.cckm

201606175

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UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Vascular Surgery

IP – Thoracoabdominal Aneurysm Repair – Adult – Preoperative [2699]

IP – Thoracoabdominal Aneurysm Repair – Adult – Preoperative [2699] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Vascular Surgery


IP - Thoracoabdominal Aneurysm Repair - Adult - Preoperative [2699]
Intended for Adult Patients Only
Patient Care Orders
Nutrition [84594]
Clear Liquid Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24): CLEAR LIQUID;
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):
Tube Feeding Management:
Room Service Class:
Pre-Op Day Of Procedure
NPO for Procedure - Hold Diet [DIE0007] EFFECTIVE MIDNIGHT, Starting today For 24 Hours,
Routine
NPO For Which Procedure? Thoracoabdominal Aneurysm
Repair
Modifiers: NPO EXCEPT MEDICATIONS
Effective midnight, Pre-Op Day Of Procedure
Surgical Prophylaxis
First Line (Single Response) [145975]
cefuroxime (ZINACEF) intraVENOUS - Note: Patients
who are 40-120 kg [800030]
1.5 g, Intravenous, ON CALL For 1 Doses, IntraOp
cefuroxime (ZINACEF) intraVENOUS - Note: Patients
who are greater than 121 kg [800030]
3 g, Intravenous, ON CALL For 1 Doses, IntraOp
MRSA/Documented MRSA History OR High Risk for MRSA (Implanted Device) (Single Response) [145977]
Patients who are 40-120 kg [198859]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Patients who are greater than 121 kg [198862]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Page 1 of 5
Printed by LIND, JANNA S [JSL237] at 2/25/2016 1:52:52 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org

Patients with Immediate/Severe Reaction to Penicillin or Known Cephalosporin Allergies (Single Response) [145985]
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
Medications - Pre-operative
Bowel Prep [145987]
bisacodyl (DULCOLAX) EC tab [49076] 5 mg, Oral, ONCE Starting today at 12:00 PM For 1 Doses
Administer at noon the day before surgery.
Pre-Op Day Of Procedure
Non-Categorized Medications [84608]
Note: Hold Medication Communication [950057] ONCE For 1 Doses
Stop subcutaneous heparin after the 1600 dose the day
before surgery
Pre-Op Day Of Procedure
Blood Bank
Tests [96906]
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., Pre-Op Day Of Procedure
Blood Products [83983]
Red Blood Cells (Adult) [BLB0006] 1 UNIT, Starting today For 1 Occurrences, Routine
Reason for Order: R1 Life-threatening hemorrhage or
anticipated/ongoing surgical blood loss
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD verifies that
the clinical situation is sufficiently urgent to require release of
blood before completion of compatibility testing and agrees to
hold UWHC harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Consent Status:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe)
1 Red Blood Cell Unit ~ 350 mL., Pre-Op Day Of Procedure
Plasma (Adult) [BLB0003] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Consent Status:
Date Consent Obtained (Valid for 1 year):
Page 2 of 5
Printed by LIND, JANNA S [JSL237] at 2/25/2016 1:52:52 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org

Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Pre-Op Day Of Procedure
Platelets (Adult) [BLB0004] 1 SINGLE, Starting today For 1 Occurrences, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Consent Status:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
For refractory patients, call UWHC Blood Back at (608) 263-
8307 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
1 Single Donor Unit ~ 200-250 mL.
All platelet products are leukocyte-reduced (CMV safe).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.,
Pre-Op Day Of Procedure
Cryoprecipitate (Adult) [BLB0005] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Consent Status:
Fibrin Glue, mLs Needed:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
Cryoprecipitate is stored frozen as 5 pooled units (approx
120mL). Standard adult dose = 10 units. Suggested dose =
1 unit/10 kg.
Individual cryoprecipitate units are also available for fibrin
glue (approx 10-15 mL each).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products., Pre-Op Day Of Procedure
Blood Products [83984]
Red Blood Cells (Pediatric) [BLB0013] 1 UNIT, Starting today For 1 Occurrences, Routine
If ordering < 1 unit specify the Total Volume to be transfused
Page 3 of 5
Printed by LIND, JANNA S [JSL237] at 2/25/2016 1:52:52 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org

(mL):
Reason for Order: PR1 (Patient younger than 4 months)
Acute blood loss or anticipated surgical blood loss
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD verifies that
the clinical situation is sufficiently urgent to require release of
blood before completion of compatibility testing and agrees to
hold UWHC harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Volume-Reduced (May be pre-selected based on history):
Consent Status:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe).
1 Red Blood Cell Unit ~ 350 mL. Suggested dose: 10 mL/kg
body weight., Pre-Op Day Of Procedure
Plasma (Pediatric) [BLB0010] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Consent Status:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL. Suggested dose: 10-15 mL/kg body
weight.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products., Pre-Op Day Of Procedure
Platelets (Pediatric) [BLB0011] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Volume-Reduced (May be pre-selected based on history):
Page 4 of 5
Printed by LIND, JANNA S [JSL237] at 2/25/2016 1:52:52 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org

Consent Status:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
For refractory patients, call UWHC Blood Back at (608) 263-
8307 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
Suggested dose = 10-20 mL/kg body weight for neonatal and
pediatric patients. For patients greater than 40 kg, suggested
dose is 1 Single Donor Unit. 1 Single Donor Unit = 200-250
mL. All platelet products are leukocyte-reduced (CMV safe).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.,
Pre-Op Day Of Procedure
Cryoprecipitate (Pediatric) [BLB0012] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Consent Status:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Cryoprecipitate Unit ~ 10-20 mL. Suggested dose: 1 Unit/10
kg body weight. If patient weighs less than 10 kg, give 1 Unit.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products., Pre-Op Day Of Procedure
Diagnostic Tests and Imaging
EEG Scans [84623]
Intra-operative EEG [EEG0007] ONCE, Starting today For 1 Occurrences, Routine
Procedure: Thoracic Aortic Aneurysm
Which side (if appropriate):
Reason for Monitoring:
Pre-Op Day Of Procedure
BestPractice
No Hospital Problems have yet been identified. [107349]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Pre-Op Day Of Procedure
Page 5 of 5
Printed by LIND, JANNA S [JSL237] at 2/25/2016 1:52:52 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org