Unique Plan Description: Vasc Surg Angiogram, Pre op
Plan Selection Display: Vasc Surg Angiogram, Pre op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-11-04 21:35:03
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 12:33:23
Available at all facilities: Yes

Vasc Surg Angiogram, Pre op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 1 midnight or less
	Admit to Observation Status
		T;N
Diet
	NPO
		After Midnight
			Comment: Including tube feedings
		NPO Except for: Medications | Sips of Water
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	BUN
		Stat, spec type = Blood
	Creatinine
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
IV Solutions
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, 75 ml/hr
			Comment: start at least one hour before start of interventional radiology procedure if patient has no IV order and patient is not diabetic
	Sodium Chloride 0.9%
		1,000 mL, IV, 75 ml/hr
			Comment: start at least one hour before start of interventional radiology procedure if patient has no IV order, if patient diabetic
Medications
	Versed 5 mg/5 mL vial
		5 mg, Injection, IV Push, Q5MIN, PRN, sedation, 4 Dose(s)/Time(s)
			Comment: titrate 1-5mg to affect per MD
	Versed (FH)
		5 mg, Injection, IV Push, Q5MIN, PRN for sedation, duration: 4 Dose(s)/Time(s)
			Comment: titrate 1-5mg to affect per MD
	fentaNYL
		25 mcg, Injection, IV Push, Q5MIN, PRN, sedation, T;N, 4 Dose(s)/Time(s)
			Comment: titrate 25-50 mcg to affect per MD
Patient Care
	Obtain Consent/Permit for:
		T;N
	Notify MD
		T;N, Nephrologist prior to any procedure for all patients who receive dialysis
	Glucose POC - RN
		T;N, Once, Now
	Do not give medication
		T;N, Hold oral hypoglycemics except actos and avadia prior to IR procedures.
	Notify MD
		Interventional radiologist if patient diabetic

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 IV Pre Med orders
Medications
		It is recommended to wait 4-5 hours prior to administering IV Contrast. If the exam is urgent, the wait time can be waived at the discretion of a physician after 1 hour of administering both of the pre-medications.(NOTE)*
	Decadron injectable
		7.5 mg, Injection, IV PUSH, Once
			Comment: 4-5 hours prior to exam.
	Benadryl
		50 mg, Injection, IV Push, Once
			Comment: 1 hour prior to exam.   IV contrast can be administered after 1 hour of premedication.
	SOLU-Medrol
		40 mg, Injection, IV PUSH, Once
			Comment: Alternative to Decadron.  4-5 hours prior to exam.
Patient Care
	Fall Precautions
		T;N
			Comment: Use fall precaution protocol for 6 hours after Diphenhydramine given

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