PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

Transcription

1 DRUG AND TREATMENT Pre-Procedure Diet NPO NPO except for meds with sip of water, Give all medications as scheduled except diabetic medications. Nursing Orders Start IV/INT Start IV/INT To use as a dedicated line for Sodium Bicarbonate infusion Clip and Prep Bilateral Groin areas, PRE-OP, Special Instructions: Use clippers for hair removal from bilateral groin area and prep with chlorhexidine. Consent on Chart Consent On Chart With: Confirm signed consent on chart for Cardiac Cath, PTCA/STENT, Emergency CABG, Rotoblator and Blood Transfusion Complete Pre-Anesthesia Questionnaire Heart Cath/EP Lab Diabetes Pre-Procedure See order comments Comments: Day BEFORE Procedure: -Patient may take oral diabetes medications the day and evening BEFORE procedure -Take usual dose of glargine (Lantus) or Levemir on the day or evening BEFORE the procedureday of Procedure -HOLD Metformin containing medications (Glucophage, Glucovance, Glumetza, Fortament, -Riomet, Actoplus Met, Metaglip, Avandamet) on day of procedure AND 48 hours AFTER procedure -STOP oral diabetes medications the day of procedure -TAKE 1/2 dose of NPH insulin on the day of procedure -HOLD usual dose of ALL mixed insulins (Novolog Mix 70/30, Novolin 70/30, 50/50, 75/25) and switch to NPH. NPH should be 1/2 usual dose of mixed insulin in units -HOLD Humulog, Novolog or Regular insulin on day of procedure Medications If Patient is Diabetic(NOTE)* REMINDER: To order GEN Correction Insulin (Sliding Scale)(SUB)* use separate form Page 1 of 26

2 DRUG AND TREATMENT Patients with Contrast Allergy(NOTE)* SUB CARD Contrast Allergy Oral Regimen Medications Evening before the procedure(note)* Deltasone 60 mg tab PO BEDTIME, 1 dose, Clinical Instructions: Evening before the procedure Benadryl 50 mg cap PO BEDTIME, 1 dose, Clinical Instructions: Evening before the procedure Zantac 150 mg tab PO BEDTIME, 1 dose, Clinical Instructions: Evening before the procedure 1 Hour prior to procedure(note)* Deltasone 60 mg tab PO ONCE, Clinical Instructions: Administer 1 hour prior to procedure on call to Cath Lab Benadryl 50 mg cap PO ONCE, Clinical Instructions: Administer 1 hour prior to procedure on call to Cath Lab Zantac 150 mg tab PO ONCE, Clinical Instructions: Administer 1 hour prior to procedure on call to Cath Lab SUB CARD Contrast Allergy IV Regimen Medications Solu-Medrol 125 mg inj IV PUSH ONCE, Clinical Instructions: Administer 1 hour prior to procedure Benadryl 25 mg injiv PUSH ONCE, Clinical Instructions: Administer 1 hour prior to procedure Zantac 50 mg inj IV PUSH ONCE, Clinical Instructions: Administer 1 hour prior to procedure Patients with Renal Insufficiency(NOTE)* Mucomyst-20 oral solution 600 mg soln PO ONCE Comments: 1 hour prior to procedure IV Solutions Infuse Sodium Bicarbonate Drip if creatinine greater than or equal to 1.6(NOTE)* Sodium Bicarbonate. 150 meq/ Sterile Water 1000 ml IV Set (IVS)* Sterile Water (admix) IV bag Rate: 3 ml/kg/hour Comments: 3mL/kg/hour IV 1 hour prior to contrast administration. 1 ml/kg/hour IV during the procedure and 1 ml/kg/hour IV 6 hour post procedure. sodium bicarbonate IV drip (1 amp = 50mEq) 150 meq Page 2 of 26

3 DRUG AND TREATMENT Sodium Bicarbonate. 150 meq/ Sterile Water 1000 ml IV Set (IVS)* Sterile Water (admix) IV bag Rate: 2 ml/kg/hour Comments: 2 ml/kg/hour IV 1 hour prior to contrast administration. 1 ml/kg/hour IV during the procedure and 1 ml/kg/hour IV 6 hour post procedure sodium bicarbonate IV drip (1 amp = 50mEq) 150 meq Laboratory Prothrombin INR Pre-Op Priority, ONCE, If patient is on Coumadin and INR is GREATER than 1.5, STAT PT/INR Partial Thromboplast Time Complete Blood Count. Basic Metabolic Panel Lipid Profile If not done within 2 weeks of procedure(note)* Comprehensive Metabolic Panel Pre-Op Priority, ONCE Pre-Op Priority, ONCE Pre-Op Priority, ONCE Pre-Op Priority, ONCE Pre-Op Priority, ONCE Comments: Fasting Lipid Profile Perform Serum HCG for females of child bearing age and capacity(note)* Serum HCG Qual Pre-Op Priority, ONCE Radiology XR Chest *1 view AP Portable Pre Cardiac Catheterization, Pre-op, ONCE Cardiology If not done within one week prior(note)* ECG Standard Pre-op, ONCE SUB CARD Fast Track Non Categorized This plan is designed to be used as part of a larger plan not independently. Please do NOT order individually(note)* IV Solutions Infuse Sodium Bicarbonate Drip if creatinine greater than or equal to 1.6(NOTE)* Sodium Bicarbonate. 150 meq/ Sterile Water 1000 ml IV Set (IVS)* Sterile Water (admix) IV bag Rate: 3 ml/kg/hour Comments: 3mL/kg/hour IV 1 hour prior to contrast administration. 1 ml/kg/hour IV during the procedure and 1 ml/kg/hour IV 6 hour post procedure. sodium bicarbonate IV drip (1 amp = 50mEq) 150 meq Page 3 of 26

4 DRUG AND TREATMENT Sodium Bicarbonate. 150 meq/ Sterile Water 1000 ml IV Set (IVS)* Sterile Water (admix) IV bag Rate: 2 ml/kg/hour Comments: 2 ml/kg/hour IV 1 hour prior to contrast administration. 1 ml/kg/hour IV during the procedure and 1 ml/kg/hour IV 6 hour post procedure sodium bicarbonate IV drip (1 amp = 50mEq) 150 meq Laboratory Prothrombin INR STAT Priority, ONCE Partial Thromboplast Time STAT Priority, ONCE Complete Blood Count. STAT Priority, ONCE Basic Metabolic Panel STAT Priority, ONCE If not done within 2 weeks of procedure(note)* Comprehensive Metabolic Panel STAT Priority, ONCE Lipid Profile STAT Priority, ONCE Serum HCG Qual STAT Priority, ONCE Radiology XR Chest *1 view AP Portable Pre Cardiac Catheterization, Stat Cardiology If not done within one week prior(note)* ECG Standard Stat, ONCE Page 4 of 26

5 DRUG AND TREATMENT Intra-Procedue Vital Signs Vital Signs Q5MINS Int, and record Cardiac Monitor Continuous and record Q5MINS Pulse Oximetry (Continuous) Nursing Orders O2 Therapy. Nasal Cannula, 2, Liters (DEF)* Nasal Cannula, 3, Liters Nasal Cannula, 4, Liters ACT istat Routine, PERIOP_ONCE. For interventional procedures. Medications Communication Order Stop IV Heparin Drip on arrival to Cath Lab IV Drips Sodium Chloride 0.9% 500 ml 500 ml IV PERIOP_ONCE Comments: To be given during procedure Nitroglycerin 25 mg/d5w 250 ml 5 mcg/min IV PERIOP_ONCE Comments: Titrate as directed. Max dose is 50 mcg/min. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Sodium Bicarbonate 150 meq/d5w 1000 ml 3 ml/kg/hr IV PERIOP_ONCE Comments: Begin at 3 ml/kg/hr for 1 hour. NOT to exceed 330 ml/hr. After 1 hour decrease to 1 ml/kg/hr for 6 hours. Total dose administered document on the Local Anesthetic Agents Volume Medication Xylocaine 1% MDV inj soln 50 ml INFILTRATE PERIOP_ONCE Comments: To groin for analgesia. Total dose administered document on the Page 5 of 26

6 DRUG AND TREATMENT Volume Medication Nesacaine 2% MPF inj soln 20 ml INFILTRATE PERIOP_ONCE Comments: To groin for analgesia. Total dose administered document on the Sedatives Dilaudid 1 mg IV PUSH PERIOP_ONCE Comments: Administer Q2MINS PRN for sedation. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Fentanyl 25 mcg IV PUSH PERIOP_ONCE Comments: Administer Q2MINS PRN for sedation. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Morphine 2 mg IV PUSH PERIOP_ONCE Comments: Administer Q2MINS PRN for sedation. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Versed 2 mg IV PUSH PERIOP_ONCE Comments: Administer Q2MINS PRN for sedation. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Haldol 5 mg IV PUSH PERIOP_ONCE Anticoagulants/Antiplatelets Angiomax 0.75 mg/kg IVPB PERIOP_ONCE Comments: Draw bolus amount from drip and administer. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Page 6 of 26

7 DRUG AND TREATMENT Angiomax 250 mg/ns 50 ml 1.75 mg/kg/hr IV PERIOP_ONCE Comments: If patient weight is LESS than 98kg, dilute Angiomax 250 mg in NS 50 ml. Final concentration = 5 mg/ml. Document infusion begin and end times. Do not pull sheath for 2 hours after infusion discontinued. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Angiomax 500 mg/ns 100 ml 1.75 mg/kg/hr IV PERIOP_ONCE Comments: If patient weight is GREATER than or EQUAL to 98kg, dilute Angiomax 500 mg in NS 100 ml.final concentration = 5 mg/ml. Document infusion begin and end times. Do not pull sheath for 2 hours after infusion discontinued. Total dose administered will be documented on the emar. Please refer to Heparin 5000 unit IV PUSH PERIOP_ONCE Comments: Total dose administered will be documented on the emar. Please refer Integrilin 180 mcg/kg IV PUSH PERIOP_ONCE Comments: May repeat dose in 10 minutes times 1 dose. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Integrilin 75 mg/100 ml solution 2 mcg/kg/min IV PERIOP_ONCE (DEF)* Comments: Total dose administered will be documented on the emar. Please refer to Integrilin 75 mg/100 ml solution 1 mcg/kg/min IV PERIOP_ONCE Comments: For creatinine clearance LESS than 50 ml/min. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Reopro 0.25 mg/kg IV PUSH PERIOP_ONCE Comments: IV bolus. MAXIMUM bolus dose = 18.5 ml Reopro 9 mg/ns 250 ml IV Set mcg/kg IV PERIOP_ONCE Comments: Maximum 10 mcg/min. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Page 7 of 26

8 DRUG AND TREATMENT Contrast Media Volume Medication non-ionic contrast media (Optiray 350) 50 ml IATERIAL PERIOP_ONCE (DEF)* Comments: Administered intracoronary Volume Medication non-ionic contrast media (Visipaque 320) 50 ml IATERIAL PERIOP_ONCE Comments: Administered intracoronary Intra Coronary and Intra Arterial Agents Adenosine 90 mg ICARDIAC PERIOP_ONCE Comments: Administered intracoronary. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Heparin 2000 unit IATERIAL PERIOP_ONCE Comments: Total dose administered will be documented on the emar, Please refer to nitroprusside 50 mcg IATERIAL PERIOP_ONCE (DEF)* Comments: PRN vasospasms, given intracoronary. Titrate to effect. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual nitroprusside 100 mcg IATERIAL PERIOP_ONCE Comments: PRN vasospasms, given intracoronary. Titrate to effect. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Nitroglycerin 200 mcg IATERIAL PERIOP_ONCE Comments: Total dose administered will be documented on the emar. Please refer to Nitroglycerin 100 mcg IATERIAL PERIOP_ONCE Comments: Adminster Intracoronary. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Page 8 of 26

9 DRUG AND TREATMENT Integrelin 180 mcg/kg IATERIAL PERIOP_ONCE Comments: Administer Intracoronary. May repeat dose in 10 minutes times 1 dose. Total dose administered will be documented on the emar. Please refer to Reopro 0.25 mg/kg IATERIAL PERIOP_ONCE Comments: IV bolus. MAXIMUM bolus dose = 18.5 ml. Administer Intracoronary Verapamil 3 mg IATERIAL PERIOP_ONCE Comments: For radial arteries. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Verapamil 200 mcg ICARDIAC PERIOP_ONCE Comments: Total dose administered will be documented on the emar, Please refer to Pressure Wire Adenosine FFR 140 mcg/kg/min IV PERIOP_ONCE (DEF)* Comments: Dilute 90 mg in NS 90 ml, yields 1 mg/ml. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Adenosine FFR 180 mcg/kg/min IV PERIOP_ONCE Comments: Dilute 90 mg in NS 90 ml, yields 1 mg/ml. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Antiplatelets PO Aspirin 324 mg PO PERIOP_ONCE (DEF)* Comments: Administer 4-81 mg chew tabs. Aspirin 162 mg PO PERIOP_ONCE Comments: Administer 2-81 mg chew tabs. Aspirin 325 mg PO PERIOP_ONCE Effient 60 mg PO PERIOP_ONCE Comments: Loading dose. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses administered Page 9 of 26

10 DRUG AND TREATMENT Effient 10 mg PO PERIOP_ONCE Comments: Maintenance Dose. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses administered Plavix 75 mg PO PERIOP_ONCE (DEF)* Plavix 300 mg PO PERIOP_ONCE Plavix 600 mg PO PERIOP_ONCE Brilinta (ticagrelor) 90 mg PO PERIOP_ONCE (DEF)* Brilinta (ticagrelor) 180 mg PO PERIOP_ONCE Pletal 100 mg PO PERIOP_ONCE Allergy Agents Benadryl 25 mg IV PUSH PERIOP_ONCE (DEF)* Comments: ONCE, for anaphylactic reaction Benadryl 50 mg IV PUSH PERIOP_ONCE Comments: ONCE, for anaphylactic reaction Epinepherine 0.3 mg SUBCUT PERIOP_ONCE Comments: Administer for anaphylactic reaction. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Page 10 of 26

11 DRUG AND TREATMENT SoluMedrol 125 mg IV PUSH PERIOP_ONCE Zantac 50 mg IV PUSH PERIOP_ONCE Antiarrhythmics Adenosine 6 mg IV PUSH PERIOP_ONCE (DEF)* Comments: Total dose administered will be documented on the emar, Please refer to Adenosine 12 mg IV PUSH PERIOP_ONCE Comments: Adminiser Q5 MINS Int for SVT. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Amiodorone 150 mg IV PUSH PERIOP_ONCE (DEF)* Comments: Infuse over 10 minutes. Dilute in 100mL of Normal Saline. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Amiodorone 300 mg IV PUSH PERIOP_ONCE Comments: Total dose administered will be documented on the emar, Please refer to Amiodarone 450 mg/d5w 250 ml 1 mg/min IV PERIOP_ONCE Comments: Begin infusion at 1 mg/min for 6 hours, then decrease rate to 0.5 mg/min. Total dose administered will be documented on the emar, Please refer to Atropine 0.5 mg IV PUSH PERIOP_ONCE (DEF)* Comments: Adminsiter Q5MINS Int, bradycardia (heart rate LESS than 60 beats/min), maximum dose 3 mg. Total dose administered will be documented on the Page 11 of 26

12 DRUG AND TREATMENT Atropine 1 mg IV PUSH PERIOP_ONCE Comments: Adminsiter Q5MINS Int, bradycardia (heart rate LESS than 60 beats/min), maximum dose 3 mg. Total dose administered will be documented on the Cardizem 10 mg IV PUSH PERIOP_ONCE Comments: Guidelines: 0.25 mg/kg Bolus over 2 minutes. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Cardizem 100 mg/ns 100 ml 10 mg/hour IV PERIOP_ONCE Digoxon 0.5 mg IV PUSH PERIOP_ONCE Epinepherine 1 mg IV PUSH PERIOP_ONCE Comments: Administer Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses administered Lidocaine 1 mg/kg IV PUSH PERIOP_ONCE Comments: Administer Q5 MINS Int up to 3 mg/kg as needed for cardiac arrhythmias. Total dose administered will be documented on the emar. Please refer to Lidocaine 2g/D5W 500 ml 1 mg/min IV PERIOP_ONCE Comments: Maximum: 4 mg/min. Total dose administered will be documented on the Lopressor 2.5 mg IVPB PERIOP_ONCE Comments: Repeat Q5MINS Int for BP greater than and Heartrate Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Page 12 of 26

13 DRUG AND TREATMENT Vasopressor 40 unit IV PUSH PERIOP_ONCE Comments: Total dose administered will be documented on the emar. Please refer to Antihypertensives ORAL(NOTE)* Nitroglycerin 0.4 mg SUBLING PERIOP_ONCE, Duration: 3 dose Comments: May repeat Q5MINS Int x 3 doses. Total dose administered will be documented on the emar. Please refer to Cardiac Cath procedure documentation for individual Procardia 10 mg PO PERIOP_ONCE IV PUSH(NOTE)* Hydralazine 10 mg IV PUSH PERIOP_ONCE (DEF)* Hydralazine 20 mg IV PUSH PERIOP_ONCE Labetalol 5 mg IV PUSH PERIOP_ONCE (DEF)* Comments: Administered for blood pressure. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses Labetalol 10 mg IV PUSH PERIOP_ONCE Comments: Administered for blood pressure. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses Labetalol 20 mg IV PUSH PERIOP_ONCE Comments: Administered for blood pressure. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses Page 13 of 26

14 DRUG AND TREATMENT Vasotec 1.25 mg IV PUSH PERIOP_ONCE (DEF)* Vasotec 2.5 mg IV PUSH PERIOP_ONCE IV INFUSIONS(NOTE)* Cardene 40 mg/200 ml 5 mg/hr IV PERIOP_ONCE Comments: Start at 5 mg/hr, then increase by 2.5 mg/hr every 15 minutes up to 15 mg/hour. Total dose administered document on the emar. Please refer to Nipride 50 mg/d5w 250 ml IV Set 0.3 mcg/kg/min IV PERIOP_ONCE Vasopressors DOPamine 400 mg/dextrose (iso-osmotic) 250 ml 5 mcg/kg/min IV PERIOP_ONCE Comments: Total dose administered will be documented on the emar, Please refer to DOBUTamine 250 mg/d5w 250 ml 2 mcg/kg/min IV PERIOP_ONCE Comments: Titrate as directed. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses administered Levophed 8 mg/d5w 250 ml IV Set 2 mg/min IV PERIOP_ONCE Comments: Titrate as directed. MAXIMUM dose: 20 mg/min. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Epinephrine 8 mg/d5w 250 ml 2 mcg/min IV PERIOP_ONCE Comments: Total dose administered will be documented on the emar, Please refer to Page 14 of 26

15 DRUG AND TREATMENT phenylephrine 100 mg IV PUSH PERIOP_ONCE (DEF)* Comments: IV bolus. Mix 10 mg phenylephrine with 100 ml NS. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual phenylephrine 200 mg IV PUSH PERIOP_ONCE Comments: IV bolus. Mix 10 mg phenylephrine with 100 ml NS. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual phenylephrine 300 mg IV PUSH PERIOP_ONCE Comments: IV bolus. Mix 10 mg phenylephrine with 100 ml NS. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Neo-Synephrine 50 mg/ns 250 ml IV Set 100 mcg/min IV PERIOP_ONCE Comments: Titrate as directed. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses administered Vasopressin 40 unit IV PERIOP_ONCE Antibiotics Ancef 1 g IVPB PERIOP_ONCE Comments: Infuse over 30 minutes Total dose administered document on the Vancomycin 500 mg IVPB PERIOP_ONCE (DEF)* Comments: Infuse over 1 hour. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses administered Vancomycin 1000 mg IVPB PERIOP_ONCE Comments: Infuse over 1 hour. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual doses administered Page 15 of 26

16 DRUG AND TREATMENT Antiemetics Phenergan 12.5 mg IV PUSH PERIOP_ONCE Comments: Administer as needed for nausea/vomiting. If the patient has an IV running, the Phenergan should be mixed in 10 ml of saline and administered slowly over 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the Phenergan should be mixed in 50 ml 0.9% Normal Saline and administered over 15 minutes. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Reglan 10 mg IV PUSH PERIOP_ONCE Comments: Administer for nausea/vomitting. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Zofran 4 mg IV PUSH PERIOP_ONCE Comments: Administer as needed for nausea/vomiting. Total dose administered will be documented on the emar, Please refer to Cardiac Cath procedure documentation for individual Miscellaneous Intra-Op Medications Dextrose 50% ( 1 amp = 25grams) 12.5 g IV PUSH PERIOP_ONCE (DEF)* Dextrose 50% ( 1 amp = 25grams) 25 g IV PUSH PERIOP_ONCE Robinul 0.1 mg IV PUSH PERIOP_ONCE Comments: May repeat every 3 minutes Total dose administered document on the Anticoagulants Protamine sulfate 10 mg IV PUSH PERIOP_ONCE Comments: 1 mg for every Heparin 100 units OR 10 mg for Heparin 1000 units IV slowly. Total dose = 50 mg in 10 minutues. Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Page 16 of 26

17 DRUG AND TREATMENT REMINDER: To order High Intensity Heparin use separate form REMINDER: To order Low Intensity Heparin use separate form. Insulins Insulin regular human 5 unit IV PUSH PERIOP_ONCE Diuretics Bumex 0.5 mg IV PUSH PERIOP_ONCE (DEF)* Bumex 1 mg IV PUSH PERIOP_ONCE Lasix 20 mg IV PUSH PERIOP_ONCE (DEF)* Lasix 40 mg IV PUSH PERIOP_ONCE Lasix 80 mg IV PUSH PERIOP_ONCE Electrolyte Replacement Calcium chloride 500 mg IV PUSH PERIOP_ONCE (DEF)* Calcium chloride 1000 mg IV PUSH PERIOP_ONCE Page 17 of 26

18 DRUG AND TREATMENT Calcium gluconate 1 g IV PUSH PERIOP_ONCE Magnesium 2g / NS 50 ml 2 g IVPB PERIOP_ONCE Comments: Infuse over 30 minutes Potassium chloride 20 meq PO PERIOP_ONCE (DEF)* Potassium chloride 40 meq PO PERIOP_ONCE Potassium chloride 20 meq IV PERIOP_ONCE (DEF)* Comments: Administer over 2 hours. Total dose administered document on the Potassium chloride 40 meq IV PERIOP_ONCE Comments: Administer over 2 hours. Total dose administered document on the Intubation Propofol 1000mg/100 ml 5 mcg/kg/min IV PERIOP_ONCE Comments: Begin infusioin at 5 mcg/kg/min Total dose administered document on the emar. Please refer to Cardiac Cath procedure documentation for individual Ativan 1 mg IV PUSH PERIOP_ONCE (DEF)* Ativan 2 mg IV PUSH PERIOP_ONCE Page 18 of 26

19 DRUG AND TREATMENT Etomidate 20 mg IV PUSH PERIOP_ONCE Succinylcholine 0.3 mg IV PUSH PERIOP_ONCE (DEF)* Succinylcholine 0.6 mg IV PUSH PERIOP_ONCE Succinylcholine 1.1 mg IV PUSH PERIOP_ONCE Sodium Bicarbonate 25 meq IV PUSH PERIOP_ONCE (DEF)* Sodium Bicarbonate 50 meq IV PUSH PERIOP_ONCE Norcuron 0.08 mg/kg IV PUSH PERIOP_ONCE Norcuron 100 mg / NS 100 ml IV Set 0.8 mcg/kg/min IV PERIOP_ONCE Comments: Titrate as directed to maximum 1.7 mcg/kg/min. Maintenance. Rocuronium 0.6 mg/kg IV PUSH PERIOP_ONCE Page 19 of 26

20 DRUG AND TREATMENT Reversal Agents Narcan 0.1 mg IV PUSH PERIOP_ONCE (DEF)* Comments: For sedation reversal Total dose administered document on the Narcan 0.2 mg IV PUSH PERIOP_ONCE Comments: For sedation reversal Total dose administered document on the Narcan 0.3 mg IV PUSH PERIOP_ONCE Comments: For sedation reversal Total dose administered document on the Narcan 0.4 mg IV PUSH PERIOP_ONCE Comments: For sedation reversal Total dose administered document on the Volume Medication Romazicon 0.1 mg IV PUSH PERIOP_ONCE (DEF)* Comments: For sedation reversal Total dose administered document on the Volume Medication Romazicon 0.2 mg IV PUSH PERIOP_ONCE Comments: For sedation reversal Total dose administered document on the Volume Medication Romazicon 0.3 mg IV PUSH PERIOP_ONCE Comments: For sedation reversal Total dose administered document on the Page 20 of 26

21 DRUG AND TREATMENT Volume Medication Romazicon 0.4 mg IV PUSH PERIOP_ONCE Comments: For sedation reversal Total dose administered document on the Volume Medication Romazicon 0.5 mg IV PUSH PERIOP_ONCE Comments: For sedation reversal Total dose administered document on the Respiratory ABG/VBG Notification Page 21 of 26

22 DRUG AND TREATMENT Post-Procedure Condition/Status Communication Order: The following Vascular Closure Device was used: Stare Close (DEF)* Communication Order: The following Vascular Closure Device was used: Angioseal Communication Order: The following Vascular Closure Device was used: Mynx Communication Order: The following Vascular Closure Device was used: Discharge Patient Plan for discharge after hemostasis obtained and no complications with groin in: 3 Hours (with arterial device) (DEF)* Plan for discharge after hemostasis obtained and no complications with groin in: 4 Hours Plan for discharge after hemostasis obtained and no complications with groin in: 6 Hours Vital Signs Cardiac Monitor Continuous Vital Signs ASDIR, Q15MINS Int x 4, then Q30MINS Int x 2, then Q1H Int x 4, then resume previous vital signs Neurovascular Check Monitoring Q15MINS Int, 4, times, Assess for bleeding and document pulses distal to cath site +1 Hours Neurovascular Check Monitoring Q30MINS Int, 2, times, Assess for bleeding and document pulses distal to cath site +2 Hours Neurovascular Check Monitoring Q1H Int, 4, times, Assess for bleeding and document pulses distal to cath site +6 Hours Neurovascular Check Monitoring ASDIR, Resume previous vital signs Neurovascular Checks Q15MINS Int, 4, times, Assess for bleeding and document pulses distal to cath site +1 Hours Neurovascular Checks Q30MINS Int, 2, times, Assess for bleeding and document pulses distal to cath site +2 Hours Neurovascular Checks Q1H Int, 4, times, Assess for bleeding and document pulses distal to cath site +6 Hours Neurovascular Checks ASDIR, Resume previous vital signs Hemostasis Technique SUB Hemostasis with Manual Pressure(SUB)* SUB Hemostasis with Femostop Device(SUB)* SUB Hemostasis with Arterial Closure Device(SUB)* Page 22 of 26

23 DRUG AND TREATMENT Activity Elevate Head of Bed 30 Degrees, May elevate Head of Bed 30 Degrees once Hemostasis achieved (DEF)* 45 Degrees, May elevate Head of Bed 45 Degrees once Angioseal achieved Activity Ambulate in Hall, 30 minutes prior to discharge Communication Order Keep affected extremity straight until patient assisted up in recliner 1 hour prior to discharge, for 30 min Plan for discharge after hemostasis obtained and no complications with groin in: 3hrs (DEF)* Plan for discharge after hemostasis obtained and no complications with groin in: 4hrs Plan for discharge after hemostasis obtained and no complications with groin in: 6hrs Activity Ambulate in Hall, 30 minutes prior to discharge Diet Diet Order Low Cholesterol (DEF)* Comments: No added Salt Diabetic/ADA: calories Diet Order Clear Liquid, Advance as Tolerated to Regular--adult menu Comments: Encourage Fluids 1000 to 1500 ml PO during Recovery Diet Message Encourage 1000 ml to 1500 ml PO fluid during recovery for 2 hours unless restricted Nursing Orders Apply Direct Pressure If bleeding or hematoma occurs at cath site, apply manual pressure until hemostasis achieved then apply femostop and notify provider Notify Provider Routine, If bleeding or hematoma occurs at cath site Notify Provider Routine, If any neurologic changes occur in affected extremity Patient Education Review discharge instructions with patient and family member. Provide written instructions and brochure on closure device if used Heart Cath/EP Lab Diabetes Post-Procedure See order comments Comments: Heart Cath POST Procedure-Continue oral diabetes medications after the procedure and when the patient is able to eat-hold Metformin containing medications (GLUCOPHAGE, GLUCOVANCE,METAGLIP, and AVANDAMET) for 48 hours post procedure Page 23 of 26

24 DRUG AND TREATMENT Medications REMINDER: To order High Intensity Heparin(SUB)* use separate form REMINDER: To order MED Low Intensity Heparin(SUB)* use separate form Analgesics DO NOT ADMINISTER OVER TOTAL OF 4g/DAY OF ACETAMINOPHEN(NOTE)* Tylenol 500 mg cap PO Q4H, PRN Pain Mild (1-3) Comments: 2 tabs. Norco 325 mg-5 mg oral tablet 1 tab PO tab Q4H, PRN Pain Moderate (4-7)/Severe (8-10) Comments: Pain moderate (4-7) to severe (8-10) once tolerating oral route. If ineffective in 30 minutes, may give an additional tablet. If a second dose is required in 30 minutes, may begin next scheduled dose at 2 tablets. Not to exceed 2 tablets in a four hour period Antianginal Agents Imdur 30 mg tab CR PO DAILY (DEF)* Imdur 60 mg tab CR PO DAILY Imdur 90 mg tab CR PO DAILY Ranexa 500 mg tab ER PO BID (DEF)* Ranexa 1,000 mg tab ER PO BID Antiemetics Zofran 4 mg inj IV PUSH Q8H, PRN Nausea/Vomiting Comments: Slow push over 2 to 5 minutes every 8 hours. If Zofran ineffective in 30 minutes may give promethazine (Phenergan) Phenergan 12.5 mg inj IV PUSH Q6H, PRN Nausea/Vomiting Comments: If Zofran is ineffective then give promethazine (PHENERGAN). Give additional 12.5 mg if no effect by 30 minutes. If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 20 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) should be mixed in 50 ml bag of saline and administered over 15 minutes IV Solutions Sodium Chloride 0.9% IV bag Rate: 100 ml/hour Sodium Chloride 0.45% IV bag Rate: 100 ml/hour Consults Patient to follow up with :(NOTE)* Physician Consult Endocrinology, For diabetic management Physician Consult Cardiothoracic and Vascular Surgical Associates, Cardiothoracic Page 24 of 26

25 DRUG AND TREATMENT Surgery Physician Consult Cardiology Physician Consult Nephrology Physician Consult Pulmonary Physician Consult Internal Medicine Discharge Phase Page 25 of 26

26 DRUG AND TREATMENT Non Categorized SUB Interventional Cath Discharge(SUB)* SUB CARD Diagnostic Cath Discharge(SUB)* Page 26 of 26