IR Central Venous Access [ ] Pre Procedure
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1 IR Central Venous Access [ ] Pre Procedure Case Request/Scheduling Procedure Enter IR Case Request if not already completed (All hospitals except Grant Medical Center) [ ] Case Request IR Lab Scheduling/ADT, Scheduling/ADT Labs [ ] PT/INR Once For 1 Occurrences, [ ] Platelet Count Once For 1 Occurrences, Patient Care by Procedure Type [ ] Temporary (non tunneled) Catheter Insertion or Exchange [ ] Place order for PT/INR, Platelet Count (if results not available pre-procedure) [ ] Notify physician (Interventional Radiologist if platelet count less than 50 K/mcL) Routine, Until discontinued, Starting S Order: PT/INR Condition: prior to I.R. procedure, if not drawn this admission or if not ordered/resulted for outpatient in past 30 days Temperature greater than: Temperature less than: Systolic BP greater than: Systolic BP less than: Diastolic BP greater than: Diastolic BP less than: Heart rate greater than: Heart rate less than: Respiratory rate greater than: Respiratory rate less than: SpO2 less than: Other: Interventional Radiologist if platelet count less than 50 K/mcL [ ] Nursing stop Heparin infusion 1 hour prior to procedure Specify: stop Heparin infusion 1 hour prior to procedure [ ] Maintain IV access Routine, Continuous Patient should have patent IV access (saline lock) for I.R. central venous catheter procedure; if none available, nurse to place order for saline lock., [ ] Vital signs Routine, Every 30 min For 4 Occurrences INPATIENT - Every 15 minutes x2; then every 30 minutes x2; then resume per prior order. OUTPATIENT - Every 15 minutes x2; then every 30 minutes x1 or until discharged., Page 1 of 9
2 [ ] Post procedure site assessment Routine, Every 30 min, Starting S For 4 Occurrences Specify: Assess catheter site with vital signs., [ ] Hold pressure Routine, As needed For 1 Days Remove dressing if needed to evaluate catheter insertion site; apply manual pressure x20 minutes continuously, if bleeding or hematoma. NOTIFY I.R. provider if UNCONTROLLED BLEEDING occurs., [ ] Nursing - resume previous IV orders (INPATIENT); including Heparin Infusion if stopped prior to procedure Specify: - resume previous IV orders (INPATIENT); including Heparin Infusion at previous rate if stopped prior to procedure. [ ] Change dressing dialysis catheter Routine, As needed Specify site: dialysis catheter Dressing type: Other (comments) Product(s): Secure with: Cleanse site with: Irrigate wound/area with: Pack wound with: Dressing changes per Inpatient or Outpatient Dialysis nurse with each treatment or more often if dressing becomes wet or non-occlusive; maintain strict aseptic technique at all times., [ ] OK to use central venous catheter at once if placed in I.R. lab Specify: central venous catheter at once if placed in I.R. lab If catheter placed while patient on unit, do not use until xray confirmation., [ ] Discharge criteria Specify: OUTPATIENT - discharge when bedrest duration completed; VS within pre-procedure baseline; no bleeding at insertion site and discharge instructions provided; INPATIENT - return to unit after procedure [ ] Tunneled Catheter Insertion [ ] Place order for PT/INR, Platelet Count (if results not available pre-procedure) Order: PT/INR Condition: prior to I.R. procedure, if not drawn this admission or if not ordered/resulted for outpatient in past 30 days Page 2 of 9
3 [ ] Notify physician (Interventional Radiologist if platelet count less than 50 K/mcL) [ ] Hold Medication Dose [all anticoagulants, antithrombotics, thrombolytic therapy, antiplatelets] for 12 hours prior [ ] Hold Medication Dose [Enoxaparin (LOVENOX) and Aspirin] for 12 hours prior Other: (Interventional Radiologist if platelet count less than 50 K/mcL) Temperature greater than: Temperature less than: Systolic BP greater than: Systolic BP less than: Diastolic BP greater than: Diastolic BP less than: Heart rate greater than: Heart rate less than: Respiratory rate greater than: Respiratory rate less than: SpO2 less than: Hold doses for which medication? Other Type in Medication Name: all anticoagulants, antithrombotics, thrombolytic therapy, antiplatelets Which Doses to Hold? (date and time): for 12 hours prior to I.R. procedure Routine, Once Hold doses for which medication? Other Type in Medication Name: Enoxaparin (LOVENOX) and Aspirin Which Doses to Hold? (date and time): for 12 hours prior to I.R. Procedure (Tunneled CVC Insertion) [ ] Nursing stop Heparin infusion 1 hour prior to procedure Specify: stop Heparin infusion 1 hour prior to procedure [ ] Maintain IV access Routine, Continuous Patient should have patent IV access (saline lock) for I.R. central venous catheter procedure; if none available, nurse to place order for saline lock., [ ] Diet NPO (after midnight prior to procedure) Diet effective midnight, Starting S+1 at 12:01 AM Except: ICE CHIPS Prior to I.R. procedure, [ ] Vital signs Routine, Every 30 min For 4 Hours INPATIENT - every 15 minutes x2; then every 30 minutes x2; then resume per prior order. OUTPATIENT - every 15 minutes x2; then every 30 minutes x1 or until discharged., [ ] Post procedure site assessment Routine, Every 30 min For 4 Hours Specify: Assess catheter insertion site with vital signs., Page 3 of 9
4 [ ] Hold pressure Routine, As needed Remove dressing if needed to visualize central catheter insertion site; hold pressure x20 minutes continuously, if bleeding or hematoma at site. NOTIFY I.R. provider if UNCONTROLLED BLEEDING occurs., [ ] Nursing - resume previous IV orders (INPATIENT); resume Heparin Infusion 1 hr after procedure, if stopped prior Specify: - resume previous IV orders (INPATIENT); resume Heparin Infusion at previous rate 1 hr after procedure, if stopped prior [ ] Change dressing dialysis catheter Routine, As needed Specify site: dialysis catheter Dressing type: Product(s): Secure with: Cleanse site with: Irrigate wound/area with: Pack wound with: Dressing changes per Inpatient or Outpatient Dialysis nurse with each treatment or more often if dressing becomes wet or non-occlusive; maintain strict aseptic technique at all times., [ ] OK to use central venous catheter at once after placement in I.R. Specify: central venous catheter at once after placement in I.R. [ ] Discharge criteria Specify: OUTPATIENT - discharge when bedrest duration completed; VS within pre-procedure baseline; no bleeding at insertion site and discharge instructions provided; INPATIENT - return to unit after procedure [ ] Removal [ ] Place order for PT/INR, Platelet Count (if results not available pre-procedure) Routine, Until discontinued, Starting S Order: PT/INR Condition: prior to I.R. procedure, if not drawn this admission or if not ordered/resulted for outpatient in past 30 days Page 4 of 9
5 [ ] Notify physician (Interventional Radiologist if platelet count less than 50 K/mcL) [ ] Hold Medication Dose (all anticoagulants, antithrombotics, thrombolytic therapy, antiplatelets) for 12 hours Temperature greater than: Temperature less than: Systolic BP greater than: Systolic BP less than: Diastolic BP greater than: Diastolic BP less than: Heart rate greater than: Heart rate less than: Respiratory rate greater than: Respiratory rate less than: SpO2 less than: Other: Interventional Radiologist if platelet count less than 50 K/mcL Hold doses for which medication? Other Type in Medication Name: all anticoagulants, antithrombotics, thrombolytic therapy, antiplatelets Which Doses to Hold? (date and time): for 12 hours prior to I.R. procedure [ ] Nursing stop Heparin infusion 1 hour prior to procedure Specify: stop Heparin infusion 1 hour prior to procedure [ ] Vital signs Routine, Every 15 min For 2 Occurrences, [ ] Post procedure site assessment Routine, Every 15 min For 2 Occurrences Specify: With vital sign check., [ ] Hold pressure Routine, As needed For 1 Days Remove dressing; apply manual pressure x 20 minutes continuously if bleeding or hematoma at catheter removal site. NOTIFY I.R. provider if UNCONTROLLED bleeding occurs., [ ] Discharge criteria Specify: Vital signs stable and no bleed at catheter removal site OUTPATIENT may be discharged after 30 minutes with discharge instructions; INPATIENT may return to unit after procedure., [ ] Nursing - Resume previous IV orders (INPATIENT) Specify: - Resume previous IV orders (INPATIENT), resume Heparin infusion at previous rate 1hr after procedure, if stopped prior IV Fluids Pre Procedure Saline Lock with 0.9% NS flush Pre Procedure [ ] Saline lock with 0.9% NaCl flush Preop (Panel) "And" Linked Panel Page 5 of 9
6 [ ] Saline lock Routine, Continuous, [ ] sodium chloride 0.9 % (NS) flush 5 ml, Intravenous, As needed, line care, [ ] sodium chloride 0.9 % (NS) flush 5 ml, Intravenous, Every 8 hours, Saline lock IV Fluids () (Single Response) ( ) sodium chloride 0.9% (NS) infusion 75 ml/hr, Intravenous, Continuous, ( ) sodium chloride 0.9% (NS) infusion 25 ml/hr, Intravenous, Continuous, KVO ( ) sodium chloride 0.45% (HALF SALINE) infusion 25 ml/hr, Intravenous, Continuous, KVO Medications (Pre-procedure) Pre-procedure Antibiotics (Single Response) Vancomycin to be reserved for patients with known MRSA colonization or risk factors for MRSA (patients with recent hospitalization, nursing home residents, hemodialysis patients). ( ) cefazolin (ANCEF) IVPB 2,000 mg, Intravenous, Once, For 1 Doses, [] 60 minutes pre-procedure Indication (PRE PROCEDURE): Vascular ( ) IF beta-lactam allergic: clindamycin (CLEOCIN) IVPB 900 mg, Intravenous, Once, For 1 Doses, [] 60 minutes pre-procedure. Indication (PRE PROCEDURE): Vascular ( ) vancomycin (VANCOCIN) IVPB 1000 mg Pre-procedure (for patients weighing less than 80kg) [ ] vancomycin (VANCOCIN) IVPB 1,000 mg, Intravenous, Once, For 1 Doses, [] 2 hours pre-procedure. Indication (PRE PROCEDURE): Indication (PRE PROCEDURE): Vascular ( ) vancomycin (VANCOCIN) IVPB 1500 mg Pre-procedure (for patients weighing 80kg or more) [ ] vancomycin (VANCOCIN) IVPB 1,500 mg, Intravenous, Once, For 1 Doses, [] 2 hours pre-procedure. Indication (PRE PROCEDURE): Indication (PRE PROCEDURE): Vascular Fibrinolytics (Single Response) ( ) Single Lumen Catheter: alteplase 10 mg in sodium chloride (NS) 0.9 % 100 ml infusion ( ) Dual Lumen Catheter: alteplase 10 mg in sodium chloride 0.9% 100 ml infusion [ ] alteplase 10 mg in sodium chloride (NS) 0.9 % 100 ml infusion 2.5 mg/hr, Intracatheter, Once, For 1 Doses, [] Check for blood flow after completion of alteplase. [] Single Lumen Catheter: Infuse at 25 ml/hr. "And" Linked Panel 2.5 mg/hr, Intracatheter, Once, For 1 Doses, [] Check for blood flow after completion of alteplase. [] Dual Lumen Catheter: Infuse at 25 ml/hr in each port. Page 6 of 9
7 [ ] alteplase 10 mg in sodium chloride (NS) 0.9 % 100 ml infusion 2.5 mg/hr, Intracatheter, Once, For 1 Doses, [] Check for blood flow after completion of alteplase. [] Dual Lumen Catheter: Infuse at 25 ml/hr in each port. Post Procedure Central Line Care [ ] Change dressing Routine, Weekly, Starting S+1 at 9:00 AM Specify site: central venous access site (central line, tunnelled catheter, implanted port, or PICC) Dressing type: Transparent Product(s): Secure with: Cleanse site with: Irrigate wound/area with: Pack wound with: Change dressing 24 hr after insertion and then every 7 days (transparent drsg) or every 48 hr (guaze). Replace steri-strip (may use sterile tape in CVC drsg kit) and securement device (e.g. Stat-Lock). Change more frequently if non-occlusive or drainage., [ ] sodium chloride (NS) 0.9 % flush (order for ALL central line types) ml, Intracatheter, As needed, line care, Flush central line(s) with 10ml before and after medication, and with 20ml after parenteral nutrition, blood products, or blood draws., [ ] Multi-lumen Central Venous Catheter Care [ ] sodium chloride (NS) 0.9 % flush 10 ml, Intracatheter, Every 8 hours, Flush UNUSED central venous catheter lumens. [ ] Line care Multi-lumen Central Venous Catheter Routine, As needed Specify: Multi-lumen Central Venous Catheter Can use line when tip placement is confirmed in the Superior Vena Cava or Cavoatrial junction. Replace cap every Monday, or if cap is damaged or removed. Clamp when catheter not in use. RN draw for labs., [ ] Groshong Chest Catheter care [ ] sodium chloride (NS) 0.9 % flush 10 ml, Intracatheter, Every 7 days, Flush Groshong catheter every 7 days if NOT used. [ ] Line care Groshong catheter Routine, As needed Specify: Groshong catheter Can use line when tip placement is confirmed in the Superior Vena Cava or Cavoatrial junction. Replace cap every Monday, or if cap is damaged or removed. RN draw for labs., [ ] Implanted Port Care Page 7 of 9
8 [ ] sodium chloride (NS) 0.9 % flush 10 ml, Intracatheter, As needed, line care, Prior to discharge and needle removal, flush Implanted Port with 10ml NS and then 500 units/5ml Heparin. Do NOT use heparin if patient has heparin-induced thrombocytopenia, flush only with 10ml NS. [ ] heparin, porcine (PF) 100 unit/ml injection 500 Units, Intracatheter, Once as needed, other, Implanted port, For 1 Doses, Prior to discharge and needle removal, flush Implanted Port with 10ml NS and then 500 units/5ml Heparin. Do NOT use heparin if patient has heparin-induced thrombocytopenia, flush only with 10ml NS. [ ] Line care Implanted Port Routine, As needed Specify: Implanted Port Change Implanted Port needle and cap every 7 days. RN draw for labs., [ ] Peripherally Inserted Central Catheter (PICC) Care [ ] sodium chloride (NS) 0.9 % flush 10 ml, Intracatheter, Every 8 hours, Flush UNUSED PICC lumens. [ ] Line care PICC Routine, As needed Specify: PICC Can use line when tip placement is confirmed in the Superior Vena Cava or Cavoatrial junction. Replace cap every Monday, or if cap is damaged or removed. Clamp when catheter not in use (except Groshong PICCs). Place sign above bed: "No B/P or lab sticks in (left/right) arm". RN draw for labs., [ ] alteplase (CATH FLO) injection for occluded central line 2 mg, Other, As needed, occluded central line catheter, Use for occlusion or absence of blood return, unless allergy or infected line. May repeat 2 mg if no blood return obtained after 120 minutes. Patient Care - Nursing [ ] Elevate HOB Routine, Continuous For 1 Hours Specify: may elevate at 30 degrees immediately post procedure [ ] Bedrest Routine, Continuous For 1 Hours If sedated during procedure; if no sedation given, then bedrest for 30 minutes post I.R. procedure, [ ] Nursing - patient may resume previous diet Specify: - patient may resume previous diet Imaging - Placement Confirmation if Temporary Catheter Inserted at Bedside Page 8 of 9
9 [ ] XR Chest 1 View Routine, 1 time imaging For 1 Occurrences Portable? Yes Reason for Exam: confirm central venous catheter placement Is the patient pregnant? [ ] OK to use dialysis catheter after xray confirmation of placement PRN Medications Specify: dialysis catheter after xray confirmation of placement [ ] acetaminophen (TYLENOL) (Single Response) ( ) acetaminophen (TYLENOL) tablet Once PRN 650 mg, Oral, Once as needed, mild pain, For 1 Doses, ( ) acetaminophen (TYLENOL) tablet every 4 hours PRN 650 mg, Oral, Every 4 hours PRN, mild pain, [ ] ondansetron (ZOFRAN) (Single Response) ( ) ondansetron (ZOFRAN) injection Once PRN 4 mg, Intravenous, Once as needed, nausea, vomiting, For 1 Doses, ( ) ondansetron (ZOFRAN) injection every 6 hours PRN 4 mg, Intravenous, Every 6 hours PRN, nausea, vomiting, Page 9 of 9
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