Unique Plan Description: Neuromuscular Blockade Protocol
Plan Selection Display: Neuromuscular Blockade Protocol
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-05-27 10:13:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-10-20 11:20:31
Available at all facilities: Yes

Neuromuscular Blockade Protocol
Laboratory
	CBC with Diff
		T+3;0400, Routine, Q48H, spec type = Blood
IV Solutions
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	cisatracurium 100mg/NS 50 mL
		100 mg, EVERY BAG, 1 mcg/kg/min, T;N
		50 mL, IV, Routine, TOF Goal: 2, Incremental Increase: 1 mcg/kg/min, Incremental Decrease: 1 mcg/kg/min, Incremental Freq: 30 min(s), Max Dose: 10 mcg/kg/min
			Comment: Conc: 2 mg/mL.  Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving.  Begin continuous infusion after bolus dose.  Use cisatracrium if patient has hepatic dysfunction or creatinine clearance <50 mL/min (do not give bolus)MAX: 10 mcg/kg/minNotify provider if maximum dose ordered is not sufficient to reach goal TOF.                                    Retest TOF 30 minutes after a bolus dose or when continuous infusion of NMB is given/initiated/changed. Retest every 2 hours after a clinically stable and satisfactory level of blockade is achieved
	cisatracurium 200mg/NS 100 mL
		100 mL, IV, Routine, TOF Goal: 2, Incremental Increase: 1 mcg/kg/min, Incremental Decrease: 1 mcg/kg/min, Incremental Freq: 30 min(s), Max Dose: 10 mcg/kg/min
			Comment: Conc: 2 mg/mL.  Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving.  Begin continuous infusion after bolus dose.  Use cisatracrium if patient has hepatic dysfunction or creatinine clearance <50 mL/min (do not give bolus)MAX: 10 mcg/kg/min)Notify provider if maximum dose ordered is not sufficient to reach goal TOF.                                        Retest TOF 30 minutes after a bolus dose or when continuous infusion of NMB is given/initiated/changed. Retest every 2 hour after a clinically stable and satisfactory level of blockade is achieved
		200 mg, EVERY BAG, 1 mcg/kg/min
	rocuronium 250 mg/25 mL
		250 mg, EVERY BAG, 4 mcg/kg/min
		25 mL, IV, Routine, TOF Goal: 2, Incremental Increase: 1 mcg/kg/min, Incremental Decrease: 1 mcg/kg/min, Incremental Freq: 30 min(s), Max Dose: 12 mcg/kg/min
			Comment: Conc: 2.5 mg/mL.  Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving.  MAX: 12 mcg/kg/minNotify provider if maximum dose ordered is not sufficient to reach goal TOF.                Retest TOF 30 minutes after a bolus dose or when continuous infusion of NMBD is given/initiated/changed. Retest every 2 hours after a clinically stable and satisfactory level of blockade is achieved
	rocuronium 250mg/NS 100mL
		250 mg, EVERY BAG, 4 mcg/kg/min
		100 mL, IV, Routine, TOF Goal: 2, Incremental Increase: 1 mcg/kg/min, Incremental Decrease: 1 mcg/kg/min, Incremental Freq: 30 min(s), Max Dose: 12 mcg/kg/min
			Comment: Conc: 2.5 mg/mL.  Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving.  MAX: 12 mcg/kg/minNotify provider if maximum dose ordered is not sufficient to reach goal TOF.                Retest TOF 30 minutes after a bolus dose or when continuous infusion of NMBD is given/initiated/changed. Retest every 2 hours after a clinically stable and satisfactory level of blockade is achieved
	vecuronium 50mg/NS 50 mL
		50 mg, EVERY BAG, 0.8 mcg/kg/min
		50 mL, IV, TOF Goal: 2, Incremental Increase: 0.2 mcg/kg/min, Incremental Decrease: 0.2 mcg/kg/min, Incremental Freq: 30 min(s), Max Dose: 1.6 mcg/kg/min
			Comment: Conc: 1 mg/mL.  Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving.  Do not give if patient has hepatic dysfunction or creatinine clearance <50 mL/min.  Begin continuous infusion after bolus dose. MAX: 1.6 mcg/kg/minNotify provider if maximum dose ordered is not sufficient to reach goal TOF. Retest TOF 30 minutes after a bolus dose or when continuous infusion of NMBD is given/initiated/changed. Retest every 2 hours after a clinically stable and satisfactory level of blockade is achieved
Medications
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	cisatracurium
		0.2 mg/kg, Injection, IV Push, Once, STAT
			Comment: Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving cisatracurium, begin continuous infusion after bolus dose.  Use cisatracrium if patient has hepatic dysfunction or creatinine clearance <50 mL/min (do not give bolus).
	rocuronium
		1 mg/kg, Injection, IV Push, Once, STAT
			Comment: Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving rocuronium.
	vecuronium
		0.1 mg/kg, Injection, IV PUSH, Once, STAT
			Comment: Use ideal body weight for dosing.  Determine supramaximal TOF setting before giving vecuronium. Dilute with 10mL sterile water for injection. Concentration = 1 mg/mL
	LacriLube ophthalmic ointment
		1 appl, Ointment, EYE, BOTH, Q8H
			Comment: Discontinue when NMB Protocol discontinued.
		1 appl, Ointment, EYE, BOTH, Q1H, PRN, dry eyes
			Comment: Discontinue when NMB Protocol discontinued.
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	VTE Advisor
		Medical

*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