Unique Plan Description: Vasc Surg Post Catheter Directed Thrombolysis, Pre op
Plan Selection Display: Vasc Surg Post Catheter Directed Thrombolysis, Pre op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-11-05 09:08:47
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 12:35:35
Available at all facilities: Yes

Vasc Surg Post Catheter Directed Thrombolysis, Pre
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Diet
	NPO
		After Midnight, NPO Except for: Medications
Laboratory
	CBC with Diff
		Stat, spec type = Blood
			Comment: if not ordered by anesthesia
	Basic Metabolic Panel
		Stat, spec type = Blood
			Comment: if not ordered by anesthesia
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
			Comment: if not ordered by anesthesia
	INR - MH/WH/JE
		Stat, spec type = Blood
			Comment: if not ordered by anesthesia
	Fibrinogen Level - MH/WH/JE
		Stat, spec type = Blood
	Urinalysis
		Nurse Collect, Stat, Stat, spec type = Urine, when foley inserted
			Comment: if not ordered by anesthesia
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine, when foley inserted
Diagnostic Tests
	Chest 2 View
		Stat
	ECG
		Stat, Indication: Pre-op Release
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 50 ml/hr
			Comment: Start if no current IV order.  Continue current IV if present.
		1,000 mL, IV, 75 ml/hr
			Comment: Start if no current IV order.  Continue current IV if present.
		1,000 mL, IV, 100 ml/hr
			Comment: Start if no current IV order.  Continue current IV if present.
		1,000 mL, IV, 125 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.
Medications
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
		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.
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
		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
	No ACE (angiotensin converting enzyme) inhibitors
		stop nephrotoxic medications.
	No ARB (angiotensin receptor blocker)
		stop nephrotoxic medications.
	No NSAIDS (non steroidal anti-inflamatory)
		stop nephrotoxic medications.
	Foley Catheter
		Obtain UA for C&S at time of insertion

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

Vasc Surg Arterial Thrombolysis
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		25,000 units, EVERY BAG, 500 units/hr
		250 mL, IV, Routine, T;N
		EKOs:(NOTE)*
	alteplase 5 mg/NS 500 mL
		500 mL, Catheter, STAT, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: conc: 0.01mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
	alteplase 5 mg/NS 250 mL
		250 mL, Catheter, STAT, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.02mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
	alteplase 10 mg/ NS 250 mL
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.04mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		10 mg, EVERY BAG, 0.5 mg/hr, T;N
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
	alteplase 20mg/NS 250mL
		250 mL, Catheter, STAT, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.08mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		20 mg, EVERY BAG, 1 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
		Catheter:(NOTE)*
	alteplase 5 mg/NS 500 mL
		500 mL, Catheter, STAT, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: conc: 0.01mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	alteplase 5 mg/NS 250 mL
		250 mL, Catheter, STAT, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.02mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	alteplase 10 mg/ NS 250 mL
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.04mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		10 mg, EVERY BAG, 0.5 mg/hr
	alteplase 20mg/NS 250mL
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.08mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		20 mg, EVERY BAG, 1 mg/hr
Consults/Follow-up
	Pharmacy Consult
		pharmacy to review tpa orders STAT. Please deliver to pt room within 30 minutes

Vasc Surg Venous Thrombolysis
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		25,000 units, EVERY BAG, 500 units/hr
		250 mL, IV
		EKOs:(NOTE)*
	alteplase 5 mg/NS 500 mL
		500 mL, Catheter, STAT, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: conc: 0.01mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
	alteplase 5 mg/NS 250 mL
		250 mL, Catheter, STAT, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.02mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
	alteplase 10 mg/ NS 250 mL
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.04mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		10 mg, EVERY BAG, 0.5 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
	alteplase 20mg/NS 250mL
		250 mL, Catheter, STAT, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.08mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		20 mg, EVERY BAG, 1 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 35 ml/hr
			Comment: via coolant port
		1,000 mL, IV, 30 ml/hr
			Comment: via sheath
		Catheter:(NOTE)*
	alteplase 5 mg/NS 500 mL
		500 mL, Catheter, STAT, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: conc: 0.01mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	alteplase 5 mg/NS 250 mL
		250 mL, Catheter, STAT, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.02mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		5 mg, EVERY BAG, 0.25 mg/hr
	alteplase 10 mg/ NS 250 mL
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.04mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		10 mg, EVERY BAG, 0.5 mg/hr, T;N
	alteplase 20mg/NS 250mL
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 12.5 ml/hr
			Comment: conc: 0.08mg/mLInfuse via infusion catheter.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
		20 mg, EVERY BAG, 1 mg/hr
Consults/Follow-up
	Pharmacy Consult
		pharmacy to review tpa orders STAT. Please deliver to pt room within 30 minutes

Vasc Surg PE Thrombolysis
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV, 12 hr
		25,000 units, EVERY BAG, 500 units/hr
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.9600.20512(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.9600.20512(NOTE)*
	Alteplase 12mg/NS 250mL
		12 mg, EVERY BAG
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 21 ml/hr
			Comment: Infusion rate: 21ml/hr (1mg/hr) Infuse via LEFT pulm artery infusion catheter, Total IV fluids at 125ml/hr while tpa infusing. Begin enoxaparin 1mg/kg SC q12h once tpa infusion is complete.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
	Sodium Chloride 0.9%
		1,000 mL, IV, 12 hr, 35 ml/hr
			Comment: via LEFT coolant port
		1,000 mL, IV, 12 hr, 30 ml/hr
			Comment: via LEFT coolant sheath
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.9600.20512(NOTE)*
	Alteplase 12mg/NS 250mL
		12 mg, EVERY BAG
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 21 ml/hr
			Comment: Infusion rate: 21ml/hr (1mg/hr)  Infuse via RIGHT pulm artery infusion catheter, Total IV fluids at 125ml/hr while tpa infusing.  Begin enoxaparin 1mg/kg SC q12h once tpa infusion is complete.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
	Sodium Chloride 0.9%
		1,000 mL, IV, 12 hr, 35 ml/hr
			Comment: via RIGHT coolant port
		1,000 mL, IV, 12 hr, 30 ml/hr
			Comment: via RIGHT coolant sheath
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.9600.20512(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.9600.20512(NOTE)*
	Alteplase 12mg/NS 250mL
		12 mg, EVERY BAG
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 21 ml/hr
			Comment: Infusion rate: 21ml/hr (1mg/hr) Infuse via LEFT pulm artery infusion catheter, Total IV fluids at 125ml/hr while tpa infusing. Begin enoxaparin 1mg/kg SC q12h once tpa infusion is complete.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
	Sodium Chloride 0.9%
		1,000 mL, IV, 12 hr, 30 ml/hr
			Comment: via LEFT pulmonary artery sheath
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.9600.20512(NOTE)*
	Alteplase 12mg/NS 250mL
		12 mg, EVERY BAG
		250 mL, Catheter, STAT, T;N, 1 Dose(s)/Time(s), 21 ml/hr
			Comment: Infusion rate: 21ml/hr (1mg/hr) Infuse via RIGHT pulm artery infusion catheter, Total IV fluids at 125ml/hr while tpa infusing. Begin enoxaparin 1mg/kg SC q12h once tpa infusion is complete.Pharmacy to inquire on procedure start time with Main OR to ensure proper tpa start time.
	Sodium Chloride 0.9%
		1,000 mL, IV, 12 hr, 30 ml/hr
			Comment: via RIGHT pulmonary artery sheath
Consults/Follow-up
	Pharmacy Consult
		pharmacy to review tpa orders STAT. Please deliver to pt room within 30 minutes of OR start time
		Follow up to insure enoxaparin 1mg/kg SC q12h is started once TPA finished

*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