Unique Plan Description: Vasc Surg Bypass, Pre op
Plan Selection Display: Vasc Surg Bypass, Pre op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2016-09-06 07:17:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-12-13 10:01:07
Available at all facilities: Yes

Vasc Surg Bypass, Pre op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
Diet
	NPO
		NPO Except for: Medications
Laboratory
	Type and Screen (No Product on hold)
		Stat, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
	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
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	PTT - 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 1 View
		Stat
			Comment: Vascular Surgery, Pre Op
	ECG
		Routine, Indication: Pre-op Release
		Routine, Indication: Abnormal Stress Test | Pre-op Release
Medications
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: 80-120kg
		1,000 mg, INT, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: <80kg
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: >120kg
	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, Once, Surgical prophylaxis
			Comment: For patients weighing < 80kg. To run over 60 minutes. Give with penicillin allergy unless history of anaphylactic reaction
		1,500 mg, INT, IVPB, Once, 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, INT, IVPB, Once, Surgical prophylaxis
			Comment: For patients weighing > 120kg. To run over 90 minutes.  Give with penicillin allergy unless history of anaphylactic reaction.
Patient Care
	Obtain Consent/Permit for:
		
	Notify MD
		If dialysis patient, notify Nephrologist and caremanager preoperatively of date and time of surgery
	Pre-op bath/shower
		T;2000
			Comment:  Patient to shower with chlorhexadine gluconate evening before surgery
		T+1;0500
			Comment: Patient to shower with chlorhexadine gluconate morning of surgery
	No ACE (angiotensin converting enzyme) inhibitors
		
	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

*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