Unique Plan Description: ONC Aldesleukin Protocol
Plan Selection Display: ONC Aldesleukin Protocol
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-18 15:59:08
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-07-13 00:11:11
Available at all facilities: Yes

ONC Aldesleukin Protocol
Vital Signs
	Vital Signs
		Q4H
			Comment: Before each dose of Aldesleukin.
Activity
	Activity-As Tolerated
		
Diet
	Regular Diet
		
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
	Magnesium Level
		T+1;0400, Routine, Q24H, spec type = Blood
	Phosphorus
		T+1;0400, Routine, Q24H, spec type = Blood
	INR - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
	PTT - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
	LD
		T+1;0400, Routine, Q24H, spec type = Blood
	Uric Acid
		T+1;0400, Routine, Q24H, spec type = Blood
	CK
		T+1;0400, Routine, Q24H, spec type = Blood
IV Solutions

	Dextrose 5% in Water IVPB
		50 mL, IVPB, Q8H, 14 Dose(s)/Time(s), 200 ml/hr
			Comment: Infuse at a rate of 200ml/hr. Give prior to Proleukin
		100 mL, IVPB, Q8H, 14 Dose(s)/Time(s), 400 ml/hr
			Comment: Infuse at a rate of 400ml/hr. Give after Proleukin
Medications
	Pepcid
		20 mg, Tab, BY MOUTH, Q12H
	Tylenol
		650 mg, Tab, By Mouth, Q8H
			Comment: Give one hour before Proleukin dose
		650 mg, Tab, By Mouth, Q4H, T;N+240
			Comment: for fever or chills
	meperidine
		50 mg, Syringe, IV PUSH, Q6H, PRN, see comment
			Comment: for chills and rigors
	cephalexin
		500 mg, Capsule, BY MOUTH, Q6H, Other- type in, prophylaxis
	Proleukin
		600,000 IU/kg, INT, IVPB, Q8H, 14 Dose(s)/Time(s)
			Comment: _____kg=____intl units in 50ml D5W. Use maximum of 90kg for dose calculation.Infuse over 15 minutes every 8 hours to a maximum of 14 doses. Notify MD prior to each dose. Do not make up missed doses.Flush tubing with 50ml D5W before and 100ml  D5W after each dose.
	Benadryl
		25 mg, Capsule, By Mouth, Q6H, PRN, itching
		25 mg, Injection, IV PUSH, Q6H, PRN, itching
	Ativan
		1 mg, Tab, BY MOUTH, Q2H, PRN, anxiety
		1 mg, Tab, SUBLINGUAL, Q2H, PRN, anxiety
	Ativan Injectable
		1 mg, Injection, IV Push, Q2H, PRN, anxiety
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: Do not give when platelets less than 50,000. Pharmacy to adjust dosing for CrCl < 30mL/min.
	ondansetron
		8 mg, Injection, IV PUSH, Q8H, PRN for nausea
	Imodium
		2 mg, Capsule, By Mouth, Q4H, PRN, loose stools
			Comment: Give 2 after each loose stool PRN (no more than 8 per day)
		4 mg, Capsule, By Mouth, Q4H, PRN, loose stools
			Comment: Give 2 after each loose stool PRN (no more than 8 per day)
	prochlorperazine
		10 mg, Tab, BY MOUTH, Q6H, PRN, nausea and/or vomiting
	Eucerin topical cream
		1 appl, Cream, TOPICAL, Q4H, PRN, dry skin
	Roxicodone
		5 mg, Tab, BY MOUTH, Q2H, PRN, pain-severe
	Indocin
		25 mg, Capsule, By Mouth, Q8H
			Comment: Until 12 hours after last IL2 dose.
Patient Care
	Resuscitation Status
		Full Code
		No Code
	No Steroids
		
	VTE Advisor
		Medical
	Do not give medication
		No Steroids to be administered at all (includes intravenous, subcutaneous, inhaled, topical, and/oral)
	Cardiac Telemetry Monitoring
		Telemetry Indications: Other
	Discontinue PICC Line
		Prior to discharge
	Notify MD
		if urine output less than 30ml/hr, temp > or equal to 38.5 C, HR >120bpm, SBP <90mmHg, or SAO2 <92%.
		Dr. Hauke one hour before IL2 dose to confirm administration of dose. Use cell: 402-981-5978. OK to leave voicemail.
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
Consults/Follow-up
	Pharmacy Consult
		Change enoxaparin time to 12:00. Discontinue enoxaparin when platelets less than 50,000. Resume when platelets recover to >50,000.

Peripheral Lock - Access
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

PICC line Access
Diagnostic Tests
	IV Team US Guidance
		T;N, PICC Line Insertion
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV Push, BID
		10 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
		20 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
		30 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
	lidocaine 1% injectable solution (MH/WH/FH)
		5 mL, SUBCUTANEOUS, Q1H, PRN, see comment
			Comment: For PICC line insert
	sodium chloride bacteriostatic 0.9% injectable soln
		5 mL, Injection, SUBCUTANEOUS, Q1H, PRN, see comment
			Comment: For PICC line insert, use if patient has lidocaine allergy.
Patient Care
	PICC Line Insert (MH/WH)
		T;N
	PICC Line Insert (JE)
		T;N
	PICC line insert (FH)
		T;N

*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