Unique Plan Description: Warfarin Reversal - Vitamin K (Phytonadione)/FFP/Kcentra
Plan Selection Display: Warfarin Reversal - Vitamin K (Phytonadione)/FFP/Kcentra
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-01-15 11:27:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-10 18:38:49
Available at all facilities: No

Warfarin Reversal - Vitamin K (Phytonadione)/FFP/K
Laboratory
	INR - MH/WH/JE
		T;0400, Routine, Q24H, spec type = Blood
	Prothrombin Time (PT) - FH
		T;0400, Q24H, Routine, spec type = Diagnostic Blood
		T;0400, Q24H, Routine, spec type = Therapeutic Blood
		Frozen Plasma dosing recommendations: 10-15ml/kg for reversal for surgery; 10-20ml/kg for serious bleed(NOTE)*
Medications
		<!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 background-color: rgb(255,255,0);margin:0; P margin:0 </STYLE><META name=GENERATOR(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 10.00.9200.17609(NOTE)*
	Vitamin K IVPB
		1 mg, INT, IVPB, Once, NOW
		2.5 mg, INT, IVPB, Once, NOW
		<!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 10.00.9200.17609(NOTE)*
	Vitamin K
		2.5 mg, Solution, By Mouth, Once, NOW
		5 mg, Solution, By Mouth, Once, NOW
		<!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 background-color: rgb(255,255,0);margin:0; P margin:0 </STYLE><META name=GENERATOR(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 11.00.9600.19377(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 11.00.9600.19377(NOTE)*
		2.5 mg, Solution, By Mouth, Once, NOW
		1 mg, Solution, By Mouth, Once, NOW
		<!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 background-color: rgb(255,255,0);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
		2.5 mg, Solution, By Mouth, Once, NOW
		5 mg, Solution, By Mouth, Once, NOW
		<!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 background-color: rgb(255,255,0);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
		Vitamin K may be repeated in 12 hours(NOTE)*
	Vitamin K IVPB
		5 mg, INT, IVPB, Once, NOW
		10 mg, INT, IVPB, Once, NOW
		<!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 background-color: rgb(255,255,0);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
		Vitamin K may be repeated in 12 hours(NOTE)*
		5 mg, INT, IVPB, Once, NOW
		10 mg, INT, IVPB, Once, NOW
		<!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 background-color: rgb(0,128,255);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
	Kcentra
		1,000 units, Injection, IVPB, Once, NOW
			Comment: Rate = 0.12 mL/kg/min DOSING BASED ON FACTOR IX UNITS. Max infusion rate = 210 units/min (approx 8.4ml/min). Contraindicated in patients with Heparin Induced Thrombocytopenia (HIT) or Disseminated Intravascular Coagulopathy (DIC).  Dose may be repeated x1 if INR level 30min post infusion is >2 or there are signs/symptoms of active bleeding.
		<!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 background-color: rgb(0,128,255);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
		1,500 units, Injection, IVPB, Once, NOW
			Comment: Rate = 0.12 mL/kg/min DOSING BASED ON FACTOR IX UNITS. Max infusion rate = 210 units/min (approx 8.4ml/min). Contraindicated in patients with Heparin Induced Thrombocytopenia (HIT) or Disseminated Intravascular Coagulopathy (DIC).  Dose may be repeated x1 if INR level 30min post infusion is >2 or there are signs/symptoms of active bleeding.
		<!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 background-color: rgb(255,255,0);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
		Vitamin K may be repeated in 12 hours; do not repeat Kcentra.(NOTE)*
	Vitamin K IVPB
		5 mg, INT, IVPB, Once, NOW
		10 mg, INT, IVPB, Once, NOW
		<!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 background-color: rgb(0,128,255);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
	Kcentra
		25 units/kg, Injection, IVPB, Once
			Comment: Rate = 0.12 mL/kg/minDOSING BASED ON FACTOR IX UNITS. Max dose for this drug/indication = 2500 units (Max dosing weight = 100 kg). Max infusion rate = 210 units/min (approx 8.4ml/min). Contraindicated in patients with Heparin Induced Thrombocytopenia (HIT) or Disseminated Intravascular Coagulopathy (DIC)
		<!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 background-color: rgb(0,128,255);margin:0; P margin:0 </STYLE><META name=GENERATOR(NOTE)*
		35 units/kg, Injection, IVPB, Once, NOW
			Comment: Rate = 0.12 mL/kg/minDOSING BASED ON FACTOR IX UNITS. Max dose for this drug/indication = 3500 units (Max dosing weight = 100 kg). Max infusion rate = 210 units/min (approx 8.4ml/min). Contraindicated in patients with Heparin Induced Thrombocytopenia (HIT) or Disseminated Intravascular Coagulopathy (DIC)
Patient Care
	Order Lab
		T;N
			Comment: RN to enter INR level to be drawn 30min after the completion of any Kcentra or FFP infusion and contact provider with results.
Consults/Follow-up
	Pharmacy Consult
		T;N, Discontinue warfarin orders

Transfuse (Administer) Blood Products EKM
Vital Signs
		Refer to Transfusion Guidelines for Blood Components(NOTE)*
	Vital Signs
		T;N
			Comment: VS within 30 minutes before starting the transfusion, within 5-15 minutes after starting infusion, whenever a suspected adverse reaction occurs, and within 30 minutes of when transfusion complete
Laboratory
Packed Cells
	Crossmatch Red Blood Cells
		T;N, Routine
		T;N, Stat
	Administer blood products
		T;N, Packed cells
Plasma
	Frozen Plasma
		T;N, Routine
	Administer blood products
		T;N, Plasma-fresh frozen
Platelet Pheresis
	Platelet Pheresis
		T;N, Routine
	Administer blood products
		T;N, Platelet
Cryopreciptate
	Cryoprecipitate
		T;N, Routine
	Administer blood products
		T;N, Cryoprecipitate
IV Solutions

	Sodium Chloride 0.9%
		500 mL, IV, 1 Dose(s)/Time(s), 20 ml/hr
Medications
	Tylenol
		650 mg, Tab, By Mouth, Once, T;N
Patient Care
	Obtain Consent/Permit for:
		T;N, blood product transfusion
	Patient Education
		T;N, Review education leaflet "When you need a blood transfusion" prior to administering blood.
	Notify MD
		T;N, Temperature >100.0 F prior to transfusion

*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