Unique Plan Description: Apheresis
Plan Selection Display: Apheresis
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2024-07-09 14:33:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-07-31 09:45:48
Available at all facilities: Yes

Pre Procedure
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Ionized Calcium
		T;N, Stat, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
	ADAMTS 13 Activity
		T;N, Stat, spec type = Blood
	LDH
		T;N, Stat, spec type = Blood
	Albumin
		T;N, Stat, spec type = Blood
	Triglycerides
		T;N, Stat, spec type = Blood
	Total Protein
		T;N, Stat, spec type = Blood
IV Solutions
	HEParin 1000 units/mL injectable solution (MH/WH)
		1000 - 2000 units, Injection, Catheter, Once
			Comment: Per lumen size
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV Push, Q5MIN, PRN IV line flush
	Cathflo Activase (alteplase)
		2 mg, Injection, Clotted Catheter, Once, PRN poor venous access
			Comment: Instill into occluded Central Venous Catheter and allow to sit for 30 minutes, then assess catheter function by aspirating.  If not restored, allow 90 additional minutes of dwell time and reassess.  If still unsuccessful then repeat dose one time only.
Patient Care
	Obtain Consent/Permit for:
		T;N, Verify MHS informed consent has been obtained for blood/blood components
		T;N, Verify MHS informed consent has been obtained for treatment utilizing apheresis.
	Discontinue Central Line
		T;N
			Comment: Double lumen dialysis catheter, prior to discharge
	Dressing Care
		Change
			Comment: per central line policy
	Notify
		T;N, ARC of procedure.  To be done:______________
			Comment: 8a-4:30p 402-271-2598. If this is an afterhours request, your call will be forwarded to the on call nurse
	Order Lab
		T;N, Ok to place order for Ionized Calcium and H&H PRN during therapeutic apheresis at American Red Cross discretion.
Consults/Follow-up
	Consult Social Work
		Home Health Care
			Comment: For Home Health referral, patient to be discharged with catheter in place
	Consult Vascular Surgeon
		Reason for Referral: Vascular Access, Refer to/Consult with: Vascular Surgeon on call
	Consult Interventional Radiologist
		Reason for Referral: Vascular Access, Refer to/Consult with: Interventional Radiologist on call

Procedure
Laboratory
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	PTT - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	Ionized Calcium
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	Fibrinogen Level - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	LDH
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	Albumin
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	Triglycerides
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	Total Protein
		T+1;0400, Routine, spec type = Blood
			Comment: while receiving therapeutic apheresis
	INR - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
	Hemoglobin and Hematocrit
		T+1;0400, Routine, Q24H, spec type = Blood
			Comment: while receiving therapeutic apheresis
Plasma
	Plasma Pheresis (FFP mLs)
		
	Administer blood products
		T;N, Plasma-fresh frozen
			Comment: Plasma-fresh frozen, Replacement volume products for apheresis procedure only, to be used by American Red Cross Only. Do not infuse prior.  Notify Blood Bank 2 hours prior to apheresis procedure so that plasma is prepared and available for apheresis procedure
	Notify
		T;N, Blood Bank 2 hours prior to apheresis procedure so that plasma is prepared and available for apheresis procedure
Cryopreciptate
	Cryoprecipitate
		Stat, 10 units, No Requirements, To be Transfused
			Comment: Replacement volume products for apheresis procedure only, to be used by American Red Cross Only. Do not infuse prior.
	Administer blood products
		T;N, Cryoprecipitate, 10 units
			Comment: Replacement volume products for apheresis procedure only, to be used by American Red Cross Only. Do not infuse prior.
Erythrocytapheresis (Red Cell Exchange)
	Type and Crossmatch (Product Available)
		T;N, Routine
	Hemoglobin and Hematocrit
		T;N, Routine, spec type = Blood
			Comment: to be drawn post apheresis
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
Blood Prime
	Crossmatch Red Blood Cells
		
	Administer blood products
		T;N, Packed cells
IV Solutions

	albumin human 5% intravenous solution
		gm, Solution-Injection, IVPB, Once, 300 ml/hr
			Comment: Replacement volume products for apheresis procedure only, to be used by American Red Cross Only. Do not infuse prior.
	Sodium Chloride 0.9% Intravenous Solution (Bolus)
		500 mL, IV, 1 hr, Bolus, Total Volume = 500
Medications
	calcium gluconate
		2 gm, Injection-Premix, IVPB, Q1H, PRN for see comment, infuse over 2 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
		1 gm, Injection-Premix, IVPB, Q1H, PRN for see comment, infuse over 1 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
		3 gm, INT, IVPB, Q1H, PRN for see comment, infuse over 3 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
		4 gm, INT, IVPB, Q1H, PRN for see comment, infuse over 3 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
		5 gm, INT, IVPB, Q1H, PRN for see comment, infuse over 3 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
		6 gm, INT, IVPB, Q1H, PRN for see comment, infuse over 3 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
		7 gm, INT, IVPB, Q1H, PRN for see comment, infuse over 3 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
		8 gm, INT, IVPB, Q1H, PRN for see comment, infuse over 3 hr, duration: 2 Dose(s)/Time(s)
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction. To be given PRN during plasma exchange.
Emergency Medications
	Tylenol
		650 mg, Tab, By Mouth, Once, T;N
	Benadryl
		25 mg, Injection, IV Push, Once, PRN see comment
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction.
		25 mg, Capsule, By Mouth, Once, PRN see comment
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction.
		50 mg, Capsule, By Mouth, Once, PRN see comment
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction.
	calcium carbonate
		500 mg, Tablet-Chew, By Mouth, Q15MIN, PRN see comment, duration: 4 Dose(s)/Time(s)
			Comment: For citrate reaction symptoms such as tingling, or muscle cramps. For apheresis procedure. Do not use this med at any other time. To be given under ARC direction
	EPINEPHrine 0.1 mg/mL injectable solution
		0.5 mg, Injection, IM-Intramuscular, Q5MIN, PRN anaphylaxis
			Comment: May repeat dose every 5 to 15 minutes if patient does not adequately respond
	SOLU-Medrol
		40 mg, Injection, IV Push, Once, PRN see comment
			Comment: For apheresis procedure. Do not use this med at any other time. To be given under ARC direction
Patient Care

	Notify
		T;N, Blood Bank one hour prior to apheresis procedure so that plasma is prepared and available for apheresis procedure

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase