Unique Plan Description: Vasc Surg Angiogram Intervention, Pre op
Plan Selection Display: Vasc Surg Angiogram Intervention, Pre op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2016-09-07 11:19:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-12-13 09:58:06
Available at all facilities: No

Vasc Surg Angiogram Intervention, Pre op
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Diet
	NPO
		After Midnight
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Urinalysis
		Stat, Stat, spec type = Urine, when foley inserted
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine, when foley inserted
Diagnostic Tests
	Chest 2 View
		Pre Op Release, Stat
	ECG
		Stat, Indication: Abnormal Electrolytes | Pre-op Release
		Stat, Indication: Abnormal Stress Test | Pre-op Release
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 20 ml/hr
			Comment: Start if no current IV order. Continue current IV if present.
		1,000 mL, IV, 300 ml/hr
			Comment: Start if no current IV order. Continue current IV if present.
	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, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
Medications
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: 80-120kg.  Give 1 hr preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery.
		1,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: < 80kg.  Give 1 hr preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery.
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment:  > 120kg.  give 1 hr Preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery.
		If allergic to cephalosporin enter vancomycin order(NOTE)*
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing < 80kg. To run over 60 minutes. Give with penicillin allergy unless history of anaphylactic reaction.
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  80kg-120kg. To run over 90 minutes.  Give with penicillin allergy unless history of anaphylactic reaction.
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing > 120kg. To run over 90 minutes.  Give with penicillin allergy unless history of anaphylactic reaction.
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients <80kg; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients 80-120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
		2,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
	No Antibiotic Prophylaxis Indicated
		
	Benadryl
		50 mg, Injection, IV PUSH, PREOP
			Comment: Sedation
	morphine  IV
		4 mg, Syringe, IV PUSH, PREOP
		6 mg, Syringe, IV PUSH, PREOP
		8 mg, Syringe, IV PUSH, PREOP
Patient Care
	Surgical Prep
		Shave prep
			Comment: Shave right and left groin
	Obtain Consent/Permit for:
		
	Patient Education
		Patient may take AM medications with sip of water
		If patient IDDM, administer 1/2 usual dose of Insulin
		If patient on glucophage (metformin), DO NOT give the morning of surgery
	Notify MD
		PCP of admission
	No ACE (angiotensin converting enzyme) inhibitors
		stop nephrotoxic medications.
			Comment: stop nephrotoxic medications.
	No ARB (angiotensin receptor blocker)
		
	No NSAIDS (non steroidal anti-inflamatory)
		
	Patient Education
		Stop Coumadin 5 days before surgery
		Stop Xarelto 3 days before surgery
		Stop Eliquis 2 days before surgery
		Stop Pradaxa 3 days before surgery
		Do Not stop Plavix or Aspirin unless instructed to do so by your physician
	Foley Catheter
		Obtain UA for C&S at time of insertion, Strict Immobilization for trauma/surgery

VTE Prophylaxis Pre Op
Medications
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, PREOP, T;N
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
		30 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
Patient Care
	Sequential Compression Device Pre Procedure
		T;N, Apply, Once
			Comment: knee high
	Anti Embolism Stockings Pre Procedure
		T;N, Apply, Once
			Comment: knee high

Rad Contrast Reaction Oral Pre Med orders
Medications
	predniSONE
		50 mg, Tab, By Mouth, Once
			Comment: 13 hours before contrast
		50 mg, Tab, By Mouth, Once
			Comment: 7 hours before contrast
		50 mg, Tab, By Mouth, Once
			Comment: 1 hour before contrast
		For JE patients, preferred medication is Benadryl:(NOTE)*
	Benadryl
		50 mg, Capsule, BY MOUTH, Once
			Comment: 1 hour before contrast.
		For FH/MH/WH patients, preferred medication is Claritin:(NOTE)*
	Claritin
		10 mg, Tab, By Mouth, Once
			Comment: 1 hour before contrast
	Medrol
		32 mg, Tab, BY MOUTH, Once
			Comment: 12 hours before contrast administration
		32 mg, Tab, BY MOUTH, Once
			Comment: 2 hours before contrast administration
	predniSONE 50 mg oral tablet
		See instructions, Take 1 tab by mouth 13 hours, 7 hours and 1 hour before radiology exam with contrast., # 3 TAB, 0 Refill(s)
	Claritin 10 mg oral tablet
		See instructions, Take 1 tab, BY MOUTH 1 hour before radiology exam with contrast., # 1 TAB, 0 Refill(s)
	methylPREDNISolone 32 mg oral tablet
		See instructions, Take 1 tab by mouth 12 hours and 2 hours before radiology exam with contrast., # 2 TAB, 0 Refill(s)

*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