Cardiac Stress Test [ ] Procedures. Cardiac Studies Stress Tests (Single Response)

Transcription

1 Cardiac Stress Test [ ] Procedures Cardiac Studies Stress Tests (Single Response) ( ) EKG Only Exercise Stress Test - Treadmill Do Not Order if: Baseline ST segment abnormalities on EKG (LBBB, Pacemaker, LVH) or currently on Digoxin. If ST segment abnormalities or on Digoxin, then order Imaging Stress Test Mobility limitations (must be able to walk 3 minutes unassisted). If limited mobility, order Pharmacologic Stress Test Contraindications: Uncontrolled HTN (greater than 200/115), unstable angina, recent MI, severe aortic stenosis. If contraindications, consider discussing with cardiologist [ ] Stress test only, exercise Routine, Once, Starting S+1 For 1 Occurrences [ ] Nursing please send patient with comfortable clothing Routine, Once For 1 Occurrences and shoes for Exercise or Treadmill Stress Test orders. Specify: please send patient with comfortable clothing and shoes for Exercise or Treadmill Stress Test orders. ( ) Echocardiogram Stress Test - Treadmill Do Not Order if: Mobility limitations (must be able to walk 3 minutes unassisted). If limited mobility, order Pharmacologic Stress Test Contraindications: Uncontrolled HTN (greater than 200/115), unstable angina, recent MI, severe aortic stenosis. If contraindications, consider discussing with cardiologist Page 1 of 6

2 [ ] Echocardiogram stress test Routine, Once, Starting S+1 For 1 Occurrences Reason for exam: [ ] perflutren lipid microspheres (DEFINITY) 1.1 mg/ml injection [ ] Nursing please send patient with comfortable clothing and shoes for Exercise or Treadmill Stress Test orders. 1.3 ml, Intravenous, Once in imaging, contrast, For stress test when scheduled, IF suboptimal echo images, For 48 Hours Routine, Once For 1 Occurrences Specify: please send patient with comfortable clothing and shoes for Exercise or Treadmill Stress Test orders. ( ) Echocardiogram Stress Test - Dobutamine Stress If patient is on Beta Blocker, strongly consider discontinuing 24 hours before test Contraindications: Uncontrolled HTN (greater than 200/115), unstable angina, recent MI, severe aortic stenosis, aortic aneurysm. If contraindications, consider discussing with cardiologist [ ] Echocardiogram pharmacological stress Routine, Once, Starting S+1 For 1 Occurrences Choose Pharmacologic Agent for Exam: Dobutamine Reason for exam: Reason patient is unable to exercise and requires pharmacological stress test: [ ] DOBUTamine (DOBUTREX) infusion Intravenous, Continuous PRN, For stress test when For stress test when scheduled At the beginning of stage 3 (30 mcg/kg/min) begin isometric and motion activity If the target heart rate is 80% or less at the end of stage 3, Nurse to return IV rate to pre-procedure rate, or for outpatients, remove the IV Start drip at (mcg/kg/min): 10 mcg/kg/min Titrate drip by (mcg/kg/min): 10 mcg/kg/min Titrate every (minutes): 3 minute Maximum drip rate (mcg/kg/min): 50 mcg/kg/min OR 85% of age-predicted max HR Page 2 of 6

3 [ ] atropine injection 0.25 mg, Intravenous, As needed, For stress test when For stress test when scheduled If the target heart rate is 80% or less at the end of stage 3 dobutamine infusion, [ ] perflutren lipid microspheres (DEFINITY) 1.1 mg/ml 1.3 ml, Intravenous, Once in imaging, contrast, For stress injection test when scheduled, IF suboptimal echo images, For 48 Hours ( ) Nuclear Medicine Cardiac Perfusion Test - Exercise Cardiolite Stress Test Patient cannot be pregnant or breastfeeding Due to possible weight limitations of the equipment used, consider checking limitations for your site if patient weighs more than 350 pounds (160 kg). Do Not Order if: Mobility limitations (must be able to walk 3 minutes unassisted). If limited mobility, order Pharmacologic Stress Test Contraindications: Uncontrolled HTN (greater than 200/115), unstable angina, recent MI, severe aortic stenosis. If contraindications, consider discussing with cardiologist [ ] NM Myocardial Perfusion Multiple SPECT Routine, 1 time imaging, Starting S+1 For 1 Occurrences What type of stressing agent do you want to be used? Exercise / Treadmill Is patient breastfeeding? Is patient in isolation? Fall risk? [ ] Nursing please send patient with comfortable clothing Routine, Once For 1 Occurrences and shoes for Exercise or Treadmill Stress Test orders. Specify: please send patient with comfortable clothing and shoes for Exercise or Treadmill Stress Test orders. ( ) Nuclear Medicine Cardiac Perfusion Test - LEXISCAN (Regadenoson Cardiolite) Stress Test Page 3 of 6

4 Patient cannot be pregnant or breastfeeding Due to possible weight limitations of the equipment used, consider checking limitations for your site if patient weighs more than 350 pounds (160 kg). Absolute Contraindications 1. Reactive airway disease with active bronchospasm 2. Second or third degree AV block or sinus node dysfunction (unless patient has functioning pacemaker. Profound sinus bradycardia (HR less than 40/min) 3. Acute MI (48 hours) 4. Chest pain consistent with unstable angina 5. Hold caffeine or other xanthine derivative within 12 hours of testing. Hold dipyridimole/aggrenox within 48 hours of testing. Adjunctive medications for use in Stress Lab only 1. History of bronchospastic disease. Patients may be treated with 2 puffs of albuterol upon physician discretion prior to study. 2. Aminophylline 125 mg IVP can be given over 1 minute for attenuation of symptoms post-test. [ ] Hold Medication Dose caffeine or other xanthine Routine, Once For 1 Occurrences derivatives Hold doses for which medication? Other Type in Medication Name: caffeine or other xanthine derivatives Which Doses to Hold? (date and time): within 12 hours of Nuclear Med Cardiac Perfusion Lexiscan test [ ] Hold Medication Dose dipyridimole-containing meds (PERSANTINE/AGGRENOX) Routine, Once For 1 Occurrences Hold doses for which medication? Other Type in Medication Name: dipyridimole-containing meds (PERSANTINE/AGGRENOX) Which Doses to Hold? (date and time): within 48 hours of Nuclear Med Cardiac Perfusion Lexiscan test [ ] albuterol (PROVENTIL HFA;VENTOLIN HFA) inhaler Prior to Lexiscan cardiac stress test, IF history of bronchospastic disease, at discretion of physician [ ] aminophylline injection Post Lexiscan cardiac stress test for attenuation of symptoms post-test 2 puff, Inhalation, Once in imaging, wheezing, Prior to 125 mg, Intravenous, Once in imaging, Post Lexiscan cardiac stress test for wheezing, GI upset (nausea / vomiting / diarrhea), Headache, and/or EKG changes, For 48 Hours Give 3 minutes after Lexiscan Cardiac stress test as indicated for PRN reasons above. Page 4 of 6

5 [ ] regadenoson (LEXISCAN) injection 0.4 mg, Intravenous, Once in imaging, To be given in Stress Lab for Nuclear Perfusion Test - Vasodilator Stress Test., For 1 Doses [] Infuse over 10 seconds. [] Follow immediately with 5 ml 0.9% NaCl flush. [ ] NM Myocardial Perfusion Multiple SPECT Routine, 1 time imaging, Starting S+1 For 1 Occurrences What type of stressing agent do you want to be used? Regadenoson (Lexiscan) Is patient breastfeeding? Is patient in isolation? Fall risk? ( ) Nuclear Medicine Cardiac Perfusion Test - Dobutamine Cardiolite Stress Test Patient cannot be pregnant or breastfeeding Due to possible weight limitations of the equipment used, consider checking limitations for your site if patient weighs more than 350 pounds (160 kg) Contraindications: Uncontrolled HTN (greater than 200/115), unstable angina, recent MI, severe aortic stenosis, aortic aneurysm. If contraindications, consider discussing with cardiologist [ ] DOBUTamine (DOBUTREX) infusion Intravenous, Continuous PRN, For stress test when For stress test when scheduled At the beginning of stage 3 (30 mcg/kg/min) begin isometric and motion activity If the target heart rate is 80% or less at the end of stage 3, Nurse to return IV rate to pre-procedure rate, or for outpatients, remove the IV Start drip at (mcg/kg/min): 10 mcg/kg/min Titrate drip by (mcg/kg/min): 10 mcg/kg/min Titrate every (minutes): 3 minute Maximum drip rate (mcg/kg/min): 50 mcg/kg/min OR 85% of age-predicted max HR [ ] atropine injection 0.25 mg, Intravenous, As needed, For stress test when For stress test when scheduled If the target heart rate is 80% or less at the end of stage 3 dobutamine infusion, Page 5 of 6

6 [ ] NM Myocardial Perfusion Multiple SPECT Routine, 1 time imaging For 1 Occurrences What type of stressing agent do you want to be used? Dobutamine Is patient breastfeeding? Is patient in isolation? Fall risk? Page 6 of 6