Unique Plan Description: Cards IABP Post op
Plan Selection Display: Cards IABP Post op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2022-11-02 10:40:54
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-06-25 09:33:52
Available at all facilities: Yes

Cards IABP Post op
Vital Signs
	Vital Signs
		T;N, Q15min x 4, then Q30min x 2, then hourly
	Notify MD
		
		Perfusionist on call for IABP console concerns/trouble shooting
Activity
	Bedrest
		T;N
			Comment: with head of bed elevated less than 30 degrees if groin insertion site is stable. Log roll to turn. Keep leg of pump insertion site straight.
		T;N
			Comment: post IAB removal x 8 hours
	Immobilizer, Knee - Apply
		T;N, May use knee immobilizer as needed to prevent leg flexion on side of the device insertion.
Laboratory
STAT Lab
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Plasma Hemoglobin (HGB)
		T;N, Stat, spec type = Blood
	Ionized Calcium
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Phosphorus
		T;N, Stat, spec type = Blood
	Glucose POC - RN
		T;N, Q2H-Sch
			Comment: Q2H if diabetic, ok to modify order to Q4H if no history of diabetes. Notify MD if blood sugar >200 x 2 consecutive, and initiate CT Surg Regular Insulin Drip.
Tomorrow's Lab
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
	CBC with Diff
		T+1;0400, Routine, Q24H, spec type = Blood
	PTT - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
	hs Troponin T
		T+1;0400, Routine, Q24H, spec type = Blood
	Plasma Hemoglobin (HGB)
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	Chest 1 View
		T;N, Stat, Post Op F/U
			Comment: IABP Placement, on arrival to CVICU
		T+1;0400, Routine, Post Op F/U, DAILY, Caregiver's Arms (A)
			Comment: IABP Placement
	Echo Limited
		T;N, Stat, Indication: Congestive heart failure
			Comment: Post op Followup
	ECG
		T+1;0600, Stat, Indication: Post Cardiac Procedure, DAILY
			Comment: in the am
IV Solutions
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Vital Signs/Hemodynamic Monitoring
		Via swan ganz with each vital signs
		Monitor minimally invasive hemodynamics via Acumen/Arterial line with each vital signs
	Arterial Line Monitoring
		T;N, with each vital signs
	Foley Catheter
		T;N, Insert, Accurate output hemodynamically unstable, with urometer
	Vascular Assessment-Focused
		T;N
			Comment: Assess IABP insertion site and doppler distal pulses with each vital signs
	IABP Monitoring and Care
		T;N
			Comment: Assess IABP timing every hour and with HR & rhythm changes
		T;N
			Comment: Emergency CPR: Use ECG or Arterial Pressure triggering during CPR. No change is needed for defibrillation
		T;N
			Comment: Ensure IAB catheter secure; use securement device if needed
		T;N
			Comment: Emergency CPR: Use ECG or Arterial
	IABP Dressing
		T;N
			Comment: as per central line protocol
	IABP Settings
		T;N
			Comment: IABP Frequency: 1:1 or as directed
	IABP Weaning
		T;N
			Comment: as per MD
	IABP Removal
		T;N
			Comment: Only an IABP trained physician may remove IABP Catheter. Physician is responsible for manual hold of pressure to IABP insertion site (typically about 45 min, or about 20 min followed by application of FemStop) to achieve hemostasis. Discontinue anticoagulation as directed prior to IAB removal.
	Notify MD
		T;N, If bleeding or hematoma at insertion site
		T;N, If signs of limb ischemia to include: change in limb color, change in limb temperature, change in or loss of distal pulses
		T;N, If significant change in VS, EKG or hemodynamics
	Intake and Output
		Q1H
			Comment: Notify MD if urine output < 30ml/hr x 2.
	Discontinue Medication
		Discontinue any previous heparin orders
Consults/Follow-up
	Pharmacy Consult
		Discontinue any previous heparin orders

Heparin Non DVT/PE (Low dose) Xa Monitoring
Admit/Discharge/Transfer
		This plan is to be used for patients with the following diagnoses: atrial fibrillation, chest pain, stroke, MI(NOTE)*
		MH/WH/JE only: Consider using PTT monitoring if enoxaparin/apixaban/rivaroxaban received in previous 48hr.(NOTE)*
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T+2;0400, Timed, Q48H, spec type = Blood
	Heparin Anti-Xa Heparin
		Stat, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV
			Comment: conc: 100 units/mL. Titrate according to Low Dose Weight Based Heparin Protocol.  Maximum weight for dosing 110kg.  MAXIMUM INITIAL rate is 1000unit/hr.1)  Anti-factor Xa UFH <than 0.2 units/mL, bolus 60 units/kg & increase rate by 4 units/kg/hr.2)  Anti-factor Xa UFH = 0.2-0.29 units/mL, bolus 30 units/kg & increase rate by 2 units/kg/hr.3)  Anti-factor Xa UFH = 0.3-0.7 units/mL, (therapeutic range) Do not give bolus & do not change rate.4)  Anti-factor Xa UFH = 0.71-0.95 units/mL, do not bolus. Decrease rate by 2 units/kg/hr.5)  Anti-factor Xa UFH = 0.96 units/mL or more, do not give bolus. Stop infusion for 60 mins & decrease rate by 3 units/kg/hr.Upper hard limits for weight based and non-weight based infusions are as follows: 40 units/kg/hour and 3000 units/hour, respectively; if patient needs require exceeding these limits, contact pharmacy and prescriber.MH/WH/JE only: Consider using PTT monitoring if enoxaparin/apixaban/rivaroxaban received in previous 48hr.
		25,000 units, EVERY BAG, 12 unit/kg/hr
Medications
		No IM injections while on anticoagulants(NOTE)*
	HEParin 1000 units/mL injectable soln
		60 units/kg, Injection, IV Push, Once, STAT
			Comment: Dose = 60 units/kg Bolus.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose. Begin heparin bolus and infusion immediately after initial stat labs are drawn.  (MAXIMUM INITIAL bolus = 4000 units)
		60 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 60 units/kg Bolus.  Anti-factor Xa UFH level < 0.2 units/mL, Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose. (MAXIMUM bolus = 6600 units)
		30 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 30 units/kg Bolus.  Anti-factor Xa UFH level between 0.2-0.29 units/mL.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose.  (MAXIMUM bolus = 3300 units)
Patient Care
	Notify MD
		T;N, For surgical patients, contact surgeon for approval to start heparin protocol if ordered post surgery
		T;N, if 2 consecutive 60 unit/kg boluses of heparin given and the resulting anti-factor-Xa UFH is not in therapeutic range within 12 hours
		T;N, if 2 consecutive anti-factor-Xa UFHs are greater or equal to 0.96 units/ml
		T;N, if initial stat anti-factor-Xa UFH comes back elevated.
		T;N, If baseline PTT is >42 seconds (5 seconds above upper normal limit of 22-37 seconds).
		T;N, if critical PTT >135.
		T;N, MH/WH/JE only: If patient has received enoxaparin/apixaban/rivaroxaban in previous 48hr and/or has an elevated baseline UFH antiXa level, please contact prescriber/pharmacy to consider switching to PTT monitoring protocol.
	Order Lab
		T;N, Enter orders for anti-factor-Xa UFH Q6Hr timed after initiation of therapy or any dosage change until 2 consecutive anti-factor-Xa UFH in therapeutic range, then q24h in am.
	Avoid IM Injections if possible while on anticoagulants

*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