Unique Plan Description: NeuroSurg Endovascular with Intervention Post op EKM
Plan Selection Display: NeuroSurg Endovascular with Intervention Post op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-09-12 07:49:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-06-04 15:46:07
Available at all facilities: No

NeuroSurg Endovascular with Intervention Post op E
Admit/Discharge/Transfer
	Admit to Critical Care Inpatient Status (MH)
		T;N, Anticipated LOS 2 midnight or more, Consult Intensivist: Pulmonary Medicine Specialist
Vital Signs
	Vital Signs
		Routine: Post op
Activity
	Activity-As Tolerated
		T;N, After bedrest complete
	Elevate head of bed
		Elevate head of bed 30 degrees
			Comment: Continuously. May elevate head of bed maximum of 30 degrees
Diet
	Regular Diet
		T;N, Advance as Tolerated
Medications
	labetalol  injection
		10 mg 2 mL, Injection, IV Push, Q1H, PRN, systolic blood pressure > (see comment), Duration: 30 Dose(s)/Time(s)
			Comment: sbp > 140.  Hold for HR < 60. If sbp greater than 140, 15min after dose, initiate Cardene Protocol.  Notify provider if approaching 300mg max dose limit.
		10 mg 2 mL, Injection, IV Push, Q10MIN, PRN, see comment, Duration: 2 Dose(s)/Time(s)
			Comment: To Keep SBP <180/105.  Give over 2 minutes.  Notify MD if labetalol 10mg IV q10min PRN x2 doses is not effective
	aspirin
		325 mg, Tablet-Enteric-Coated, By Mouth, DAILY
	Plavix
		75 mg, Tab, By Mouth, DAILY, T+1;0900
Patient Care
	Resuscitation Status
		Full Code
		No Code
	VTE Advisor
		Medical
	Intake and Output
		Q1H
	Neurological Assessment-Focused
		T;N, Q1H
	Sequential Compression Device
		
	Notify MD
		T;N, if SBP persistent > 140 despite treatment. Urine output less than or equal
			Comment:  to 30ml/hr, hematoma formation, increased oxygen requirement, neurological deficit or loss of signals LE, bleeding or hematoma, loss of distal pulses or extremity ischemia, new neurologic deficit.
	Foley Catheter
		T;N, Foley Removal Protocol
Therapies
	Consult Physical Therapy, Evaluate and Treat
		Reason to See: Evaluate and Treat
	Consult Occupational Therapy, Evaluate and Treat
		Reason to See: Evaluate and Treat
Consults/Follow-up
	Consult Social Work
		Discharge Planning

nicardipine (Cardene) Protocol EKM
IV Solutions
	niCARdipine 25 mg/NS 250 mL
		25 mg, EVERY BAG, 5 mg/hr, T;N
		250 mL, IV, Routine, Start: T;N, Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy.  If hypotension or tachycardia occurs, discontinue the infusion and notify provider.  IV may be re-initiated after weaning within 12hours, re-initiate at the dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
	niCARdipine 20mg/NS 200mL
		200 mL, IV, STAT, Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy. Reduce by 2.5mg/hr every 15 minutes.   If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
		20 mg, EVERY BAG, 5 mg/hr, T;N
	nicardipine 20mg/NS 200mL premix
		200 mL, IV, STAT, Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy. Reduce by 2.5mg/hr every 15 minutes.   If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
		20 mg, EVERY BAG, 5 mg/hr
Patient Care
	IV-Restart
		T;N, Q12H
			Comment: if peripheral site is used while on nicardipine

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Peripheral Lock - Access
Medications

	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

Pain Constipation Nausea Protocol </= to 65 EKM
Medications
		Select only one medication in each category(NOTE)*
Mild Pain
	acetaminophen
		650 mg, Tab, By Mouth, Q4H, PRN for see comment
			Comment: Discomfort and/or pain-mild (pain rating 1-3) in opiate intolerant patient
		650 mg, Suppository, RECTALLY, Q6H, PRN for see comment
			Comment: Discomfort and/or pain-mild (pain rating 1-3) in opiate intolerant patient
	ibuprofen
		600 mg, Tab, By Mouth, Q6H, PRN for pain-mild
			Comment: pain rating 1-3
		800 mg, Tab, By Mouth, Q8H, PRN for pain-mild
			Comment: pain rating 1-3
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-mild
			Comment: pain rating 1-3
	oxyCODONE-acetaminophen 5/325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-mild
			Comment: Pain rating 1-3
	HYDROmorphone Injectable
		0.2 mg, Injection, IV Push, Q2H, PRN for pain-mild
			Comment: For pain rating 1-3 and if NPO
	morphine  IV
		2 mg, Syringe, IV Push, Q2H, PRN for pain-mild
			Comment: for pain rating 1-3 and if NPO
Moderate Pain
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	acetaminophen-hydrocodone 325 mg-7.5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	acetaminophen-hydrocodone 325 mg-10 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	oxyCODONE-acetaminophen 5/325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	oxyCODONE-acetaminophen 7.5/325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	oxyCODONE-acetaminophen 10/325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	oxyCODONE
		5 mg, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	morphine  oral immediate release
		15 mg, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: Pain rating 4-6
	HYDROmorphone Injectable
		0.2 mg, Injection, IV PUSH, Q2H, PRN for pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
		0.4 mg, Injection, IV PUSH, Q2H, PRN for pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
	morphine  IV
		2 mg, Syringe, IV Push, Q2H, PRN for pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
		4 mg, Syringe, IV Push, Q2H, PRN for pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
	ketorolac injectable
		15 mg, Injection, IV Push, Q6H, PRN for pain-moderate, duration: 48 hr
			Comment: For pain rating 4-6.
Severe Pain
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: Pain rating 7-10
	acetaminophen-hydrocodone 325 mg-7.5 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: Pain rating 7-10
	oxyCODONE-acetaminophen 5/325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: Pain rating 7-10
	oxyCODONE-acetaminophen 7.5/325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: Pain rating 7-10
	oxyCODONE-acetaminophen 10/325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: Pain rating 7-10
	oxyCODONE
		10 mg, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: Pain rating 7-10
	morphine  oral immediate release
		30 mg, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: Pain rating 7-10
	HYDROmorphone Injectable
		0.4 mg, Injection, IV PUSH, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics. Use 0.4mg if over age 70.
		0.5 mg, Injection, IV PUSH, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics. Use 0.4mg if over age 70.
		0.6 mg, Injection, IV PUSH, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO
		0.8 mg, Injection, IV PUSH, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO
		1 mg, Injection, IV PUSH, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO
	morphine  IV
		4 mg, Syringe, IV Push, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10; may give if NPO or for breakthrough pain if on oral analgesics.
		6 mg, Syringe, IV Push, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10; may give if NPO or for breakthrough pain if on oral analgesics.
		Opiate Reversal(NOTE)*
	Narcan
		0.2 mg, Injection, IV Push, Q2MIN, PRN for see comment
			Comment: if patient has received opiate agents in the past 24 hours and/or if patient becomes somnolent with minimal or no response to stimuli or respiratory rate is 10 or less per minute.  RN may administer naloxone prior to contacting MD.  Notify MD immediately upon administration of naloxone.  May give 0.2mg every 2 min up to 1mg total dose.
Constipation
	docusate
		100 mg, Capsule, By Mouth, DAILY
			Comment: Hold for diarrhea
	Senokot S 50 mg-8.6 mg oral tablet
		2 TAB, Tab, By Mouth, QHS
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, Q12H, PRN, constipation
			Comment: Mix in 6 oz juice or water
		17 gm, Packet, By Mouth, DAILY, PRN, constipation
			Comment: Mix in 6 oz juice or water
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, By Mouth, DAILY, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
		30 mL, Suspension, By Mouth, Q12H, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
	Dulcolax
		10 mg, Suppository, RECTALLY, DAILY, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
		10 mg, Suppository, RECTALLY, Q12H, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
	Fleet Enema 19 gm-7 gm rectal enema
		1 EA, Enema, RECTALLY, Q12H, PRN, constipation
			Comment: If bisacodyl ineffective
	Enema-Administer
		Tap water, Q1H, constipation
			Comment: if suppository ineffective
Nausea Vomiting
	ondansetron
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		Select either promethazine or prochlorperazine orders(NOTE)*
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available.
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		6.25 mg, Injection, IM-Intramuscular, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (FH)
		12.5 mg, INT, IVPB, Once, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, INT, IVPB, Once, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	metoclopramide
		10 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective; avoid in patients > 65 y/o.
		10 mg, Injection, IM-Intramuscular, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective; avoid in patients > 65 y/o.
Patient Care

	Notify MD
		If patient develops itching
		if no results from enema.

Pain Constipation Nausea Protocol > 65 Geriatric E
Medications
		Select only one medication in each category(NOTE)*
Mild Pain
	acetaminophen
		1,000 mg, Tab, By Mouth, Q8H-Sch, T;N
			Comment: For pain rating 1-3; Consider IV Acetaminophen (Ofirmev) if NPO.
		1,000 mg, Tab, By Mouth, Q8H, PRN for pain-mild
			Comment: For pain rating 1-3; Consider IV Acetaminophen (Ofirmev) if NPO.
		1,000 mg, Tab, By Mouth, Q8H-Sch, T+1;N
			Comment: For pain rating 1-3; Consider IV Acetaminophen (Ofirmev) if NPO.
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Q8H, T;N, duration: 3 Dose(s)/Time(s)
			Comment: For pain rating 1-3.
Moderate Pain
	oxyCODONE
		2.5 mg, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6
	traMADol
		25 mg, Tab, By Mouth, Q6H, PRN for pain-moderate
			Comment: For pain rating 4-6; Screen for drug interactions (e.g.SSRI), and adjust dose for CrCl<30ml/min; avoid use if history of seizures.
	HYDROmorphone Injectable
		0.2 mg, Injection, IV PUSH, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics.
Severe Pain
	oxyCODONE
		5 mg, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: For pain rating 7-10.
	traMADol
		50 mg, Tab, By Mouth, Q6H, PRN for pain-severe
			Comment: For pain rating 7-10; screen for drug interactions (e.g.SSRI), and adjust dose for CrCl<30ml/min; avoid use if history of seizures.
	HYDROmorphone Injectable
		0.4 mg, Injection, IV PUSH, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics.
		Opiate Reversal(NOTE)*
	Narcan
		0.2 mg, Injection, IV Push, Q2MIN, PRN for see comment
			Comment: If patient has received opiate agents in the past 24 hours and/or if patient becomes somnolent with minimal or no response to stimuli or respiratory rate is 10 or less per minute.  RN may administer naloxone prior to contacting MD.  Notify MD immediately upon administration of naloxone.  May give 0.2mg every 2 min up to 1mg total dose.
PRN Discomfort
	trolamine salicylate 10% topical cream
		1 appl, Cream, TOPICAL, TID, PRN for discomfort
			Comment: Apply to affected area.
	menthol-methyl salicylate topical
		1 appl, Cream, TOPICAL, TID, PRN for discomfort
			Comment: Apply to affected area.
	lidocaine 4% topical patch
		1 patch, Patch, TransDERMAL, DAILY
	lidocaine Patch Removal
		Patch Removal, Patch, TransDERMAL, QHS
	Medication patch site check
		T;N+720, Q12H
Constipation
	Senokot S 50 mg-8.6 mg oral tablet
		1 TAB, Tab, By Mouth, BID, PRN for constipation
			Comment: Hold for loose stools
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, BID
			Comment: Hold for loose stools.  Mix in 6oz juice or water.
	Dulcolax
		10 mg, Suppository, RECTALLY, Q12H, PRN for constipation
			Comment: If other agents ineffective or if patient NPO.
	Fleet Enema 19 gm-7 gm rectal enema
		1 EA, Enema, RECTALLY, Q12H, PRN for constipation
			Comment: If suppository ineffective.
	Enema-Administer
		Tap water, Q1H, see comment
			Comment: If suppository ineffective.
Nausea Vomiting
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
		4 mg, Injection, IV Push, Q6H, PRN for nausea and/or vomiting
			Comment: If unable to take by mouth.

NeuroSurg Neuro Endovasc Catheter Directed Thrombo
Laboratory

	PTT - MH/WH/JE
		Timed, Q6H, 24, hr, spec type = Blood
	Hemoglobin and Hematocrit
		Timed, Q6H, 24, hr, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		Timed, Q6H, 24, hr, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	INR - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
IV Solutions
	Sodium Chloride 0.45% w/ KCl 20mEq
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
	Dextrose 5% in Lactated Ringers
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
		1,000 mL, IV, 300 ml/hr
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV Push, Once, PRN IV line flush
			Comment: lysis catheter coolant line occlusion; call provider if additional doses are needed and/or attempt unsuccessful.
		10 mL, Syringe, IV Push, Once, PRN IV line flush
			Comment: lysis catheter tpa line occlusion; call provider if additional doses are needed and/or attempt unsuccessful.
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV, Routine, T;N
			Comment: Via Sheath
		25,000 units, EVERY BAG, 500 units/hr
Patient Care
	Incision/Drain Assessment-Focused
		T;N, Q1H
			Comment: monitor for excessive bleeding, and catheter placement
	Dressing Care
		Reinforce | Do not remove
	Discontinue
		Heparin protocol, no lab monitoring while lysis catheter in place
	Vascular Assessment-Focused
		T;N, Q1H
			Comment: While catheter in place
	No Venipunctures
		Avoid any unnecessary peripheral venous punctures for 24 hours post tpa infusion.
	Do Not
		No insertion of any IV, NG, central lines or arterial lines during tpa infusion and for 24 hours post tpa infusion
	Cardiac Telemetry Monitoring
		Telemetry Indications: Other

NeuroSurg Neuro Endovasc Radial Approach
Activity
	Bedrest
		T;N, 6, hr
			Comment: 6 hours post radial device removal
	Activity-Restrictions
		T;N, Do not lift more than 10 pounds for 5 days after radial device removal. No push or pulling with affected arm for 24 hours.
	Limb Alert
		Immobilize affected limb while on bedrest
Patient Care
	Vascular Assessment-Focused
		T;N
			Comment:  Every 15 minutes x 4, every 30 minutes x 2, 1 hour x 4, then per unit standard. Assess for CMS, circulation (including Doppler pulses) movement, sensation of bilateral extremities
	Incision/Drain Assessment-Focused
		T;N
			Comment: Every 15 minutes x 4, every 30 minutes x 2, 1 hour x 4, then per unit standard. If bleeding or hematoma occurs at the femoral site, apply manual pressure, restart bedrest and notify provider
	Notify MD
		bleeding or hematoma, loss of distal pulses or extremity ischemia
	Incision/Dressing Care
		T;N
			Comment: Okay to remove transparent dressing (from access site) in 24 hours.
	No Venipunctures
		NO venipuncture or blood pressure on affected limb for 24 hours post procedure
	Hemostatic Compression Device
		T;N
			Comment: Start deflation of radial band 2 hours after radial band applied. Remove 3ml of air every 10 minutes until air is removed. If bleeding occurs when 2ml is remove, re-inflate with 2 ml of air. Wait 20 minutes then restart deflation. If site is free of complications after 1 hour, remove radial again and apply sterile dressing. Keep compression device at bedside in case of bleeding complications

NeuroSurg Neuro Endovasc Femoral Approach
Activity
	Bedrest
		T;N, 6, hr
			Comment: 6 hours post sheath removal
	Activity-Restrictions
		T;N, No lifting > 10 pounds for 48 hours
	Limb Alert
		Immobilize affected limb while on bedrest
Patient Care
	Vascular Assessment-Focused
		T;N
			Comment: Every 15 minutes x 4, every 30 minutes x 2, 1 hour x 4, then per unit standard. Assess for CMS, circulation (including Doppler pulses) movement, sensation of bilateral extremities
	Incision/Drain Assessment-Focused
		T;N
			Comment: Every 15 minutes x 4, every 30 minutes x 2, 1 hour x 4, then per unit standard. If bleeding or hematoma occurs at the femoral site, apply manual pressure, restart bedrest and notify provider
	Notify MD
		bleeding or hematoma, loss of distal pulses or extremity ischemia
	Incision/Dressing Care
		T;N
			Comment: Okay to remove transparent dressing (from access site) in 24 hours.

*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