Unique Plan Description: ONC Rituximab-pvvr (Ruxience)
Plan Selection Display: ONC Rituximab-pvvr (Ruxience)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-11-01 09:48:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-04-08 11:02:35
Available at all facilities: Yes

ONC Rituximab-pvvr (Ruxience)
Vital Signs
	Vital Signs
		T;N
			Comment: Prior to beginning rituximab infusion, then with each rate change and PRN
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Hepatitis B Surface Antigen
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
IV Solutions
Chemotherapy Agent
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	riTUXimab-pvvr/NS 500 mL IV
		500 mL, IV, Routine, T;N+60, 1 Dose(s)/Time(s)
			Comment: Initial infusion: Start an infusion rate of 50 mg/hour; if there is no infusion-related reaction, increase the rate by 50 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.
		375 mg/m2, EVERY BAG, 50 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, Routine, T;N+30, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: Use as flush or carrier fluid for rituximab
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	riTUXimab-pvvr/NS 500 mL IV
		500 mL, IV, Routine, T;N+60, 1 Dose(s)/Time(s)
			Comment: Standard infusion rate: If patient tolerated initial infusion, start at 100 mg/hour; if there is no infusion-related reaction, increase the rate by 100 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.
		375 mg/m2, EVERY BAG, 50 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, Routine, T;N+30, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: Use as flush or carrier fluid for rituximab
Medications

Premeds
	acetaminophen
		1,000 mg, Tab, By Mouth, Once, T;N+30
			Comment: give 30 minutes prior to rituximab
		650 mg, Tab, By Mouth, Once
			Comment: give 30 minutes prior to rituximab
	diphenhydrAMINE
		50 mg, Injection, IV Push, Once, T;N+30
			Comment: give 30 minutes prior to rituximab
		25 mg, Injection, IV Push, Once, T;N+30
			Comment: give 30 minutes prior to rituximab
Patient Care

	Obtain Consent/Permit for:
		T;N, Obtain or verify consent for chemotherapy
	IV-Maintain
		T;N
			Comment: insure 2 vascular access devices
	Notify MD
		T;N, Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
		T;N, Contact Provider for further orders if allergic reaction protocol initiated.
	Initiate MD Plan for:
		T;N, Allergy Reaction protocol if patient experiences reaction to treatment.

CHEMO Reaction Protocol
Vital Signs
	Vital Signs
		Assess vital signs every 2 to 5 minutes until the patient is stable. Place patient into a recumbent position with elevation of the lower extremities if hypotensive
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		Reassess vital signs every 15 minutes x 2, then q30min x 2, or more frequently as needed, I&O, etc until stable
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in Trendelenburg.
IV Solutions
	Sodium Chloride 0.9% IVPB
		500 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give 1-2 minutes after diphenhydramine if no improvement or if symptoms worsen to include: hypotension, shortness of breath, facial/lip/tongue swelling, and/or any other signs /symptoms of a severe allergic reaction.
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give if dexamethasone unavailable or ineffective and additional steroids are needed, per provider.
	EPINEPHrine
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
	meperidine
		25 mg, Syringe, IV Push, Once, PRN for see comment
			Comment: For chills and rigors
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, PRN for see comment
			Comment: For chills and rigors
Patient Care
	Notify MD
		T;N, Contact the oncologist if any of the reaction protocol medications are administered to the patient.

*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