ETESEVIMAB-BAMLANIVIMAB INFUSION		version 10/18/2021		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☑	Nasal Cannula- Oxygen Therapy	Once	S	1 treatment	
		Hospital Performed, Normal
	Device: Nasal Cannula
	Titrate to keep O2 Sat Above: 92%
	Indications for O2 therapy: Hypoxemia
	Continuous or PRN Oxygen: PRN		
	☑	Vital signs - T/P/R/BP	Once	S	1 treatment	
		Clinic Performed, Normal
	Pre-infusion		
	☑	Vital signs - T/P/R/BP	Once	S	1 treatment	
		Clinic Performed, Normal
	Post-Infusion:  At the end of infusion, obtain vital signs and every 30 minutes x 2.		
	☑	Insert Peripheral IV or Access Portacath	Once	S	1 treatment	
		No details available for preview		
	☑	Discontinue IV	Once	S	1 treatment	
		Post-infusion order: Prior to sending patient home		
	☑	Nursing communication	Once	S	1 treatment	
		Monitor patient for 1-hour POST-infusion for signs of INFUSION REACTIONS.		
	☐	Pulse oximetry, spot	Once	S	1 treatment	
		Clinic Performed, Normal
	O2 must be GREATER than 93% on Room Air prior to infusion		
	☐	Nursing communication	Once	S	1 treatment	
		Prior to infusion, assess patient to ensure still meets emergency use authorization (EUA) criteria.  Provide patient with a copy of the "Fact Sheet for Patients, Parents and Caregivers.		

Hypersensitivity Infusion Reaction Standing Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☑	Nursing communication	Once	S	1 treatment	
		Grade 1 - MILD infusion reaction symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
	1.  Stop the infusion
	2.  Place the patient on continuous monitoring
	3.  Obtain vital signs
	4.  Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing
	5.  If symptoms do not resolve within 5- 10 minutes, administer Diphenhydramine 25 mg intravenously once
	6.  Notify the treating physician
	7.  If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe)
	8.  Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
	9. If improvement of symptoms, may restart the infusion and slow infusion rate by 50%.		
	☑	Nursing communication	Once	S	1 treatment	
		Grade 2 - MODERATE infusion reaction symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
	1.  Stop the infusion
	2.  Notify the CERT team and treating physician immediately
	3.  Place the patient on continuous monitoring
	4.  Obtain vital signs
	5.  Administer Oxygen at 2 L per minute via nasal cannula.  Titrate to maintain O2 saturation of GREATER than or EQUAL to 92%
	6.  Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing
	7.  Administer Hydrocortisone 100 mg intravenous once (if patient has allergy to Hydrocortisone, administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg IV once  
	8.  If no improvement after 15 minutes, advance level of care to Grade 3 (Severe)
	9.  Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician		
	☑	Nursing communication	Once	S	1 treatment	
		Grade 3 - SEVERE infusion reaction symptoms (hypoxia, hypotension, or neurologic compromise - cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure LESS than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
	1.  Stop the infusion
	2.  Notify the CERT team and treating physician immediately
	3.  Place the patient on continuous monitoring
	4.  Obtain vital signs
	5.  If heart rate is LESS than 50 or GREATER than 120, or blood pressure is LESS than 90/50 mmHg, place patient in reclined or flattened position
	6.  Administer Oxygen at 2 L per minute via nasal cannula.  Titrate to maintain O2 saturation of greater than or equal to 92%
	7.  Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing
	8.  Administer Hydrocortisone 100 mg intravenous once (if patient has allergy to Hydrocortisone, administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once
	9.  If MD/ CERT team approves, administer Epinephrine (1:1000) 0.3 mg intramuscular once
	10.  Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician		

Medications 	

	
	Interval	Defer Until	Duration	
	☑	etesevimab-bamlanivimab infusion IVPB	Once	S	1 treatment	
		intravenous, Administer over: 30 Minutes, once, Starting when released
	Use PVC infusion set containing a 0.2 - 0.22 micron in-line polyethersulfone filter. Administer solution via pump over at least 30 minutes. Once infusion is complete, flush the infusion line to ensure delivery of the required dose. Monitor patients for at least 1 hour after infusion is complete.
	Use PVC infusion set containing a 0.2 - 0.22 micron in-line polyethersulfone filter. Do not infuse concomitantly with other agents.  Stable: 24 hours refrigerated or 7 hours at room temp		
	☑	sodium chloride 0.9 % infusion	Once	S	1 treatment	
		25 mL, intravenous, continuous, Starting when released, Until Discontinued
	Flush line with 25 mL NS POST Etesevimab-Bamlanivimab infusion.		

Line Care 	

	
	Interval	Defer Until	Duration	
	☑	sodium chloride 0.9% flush 10 mL	Once	S	1 treatment	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☑	HEParin, porcine injection 500 Units	Once	S	1 treatment	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	Heparin flush for Implanted Vascular Access Device Maintenance.  Flush port-a-cath before removing needle from port-a-cath.		
	☑	sodium chloride 0.9% infusion 250 mL	Once	S	1 treatment	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☑	acetaminophen (TYLENOL) tablet 650 mg	Once	S	1 treatment	
		650 mg, oral, every 6 hours PRN, mild pain (score 1-3), headaches, fever, Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☑	diphenhydrAMINE (BENADRYL) injection 25 mg	Once	S	1 treatment	
		25 mg, intravenous, once PRN, for MILD infusion reaction, Starting when released, Until Discontinued
	If symptoms do NOT resolve within 5-10 minutes, administer diphenhydramine 25 mg intravenously once for MILD infusion reaction.		
	☑	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Once	S	1 treatment	
		100 mg, intravenous, once PRN, for MODERATE to SEVERE infusion reaction, Starting when released, Until Discontinued
	If Patient has allergy to hydrocortisone (SOLU-CORTEF), administer dexamethasone (DECADRON) 4 mg IV Once for MODERATE to SEVERE infusion reaction.		
	☐	dexamethasone (DECADRON) IV 4 mg	Once	S	1 treatment	
		4 mg, intravenous, once PRN, for MODERATE to SEVERE infusion reaction, Starting when released, Until Discontinued
	Administer dexamethasone If patient is allergic to hydrocortisone for MODERATE to SEVERE infusion reaction.		
	☑	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Once	S	1 treatment	
		0.3 mg, intramuscular, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☑	famotidine (PEPCID) injection 20 mg	Once	S	1 treatment	
		20 mg, intravenous, once PRN, for MODERATE to SEVERE infusion reaction, Starting when released, Until Discontinued		
	☑	fexofenadine (ALLEGRA) tablet 180 mg	Once	S	1 treatment	
		180 mg, oral, once PRN, allergies, for MODERATE infusion reaction, Starting when released, Until Discontinued		
	☑	ondansetron (ZOFRAN) IV 4 mg	Once	S	1 treatment	
		4 mg, intravenous, once PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☑	promethazine (PHENERGAN) tablet 25 mg	Once	S	1 treatment	
		25 mg, oral, once PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☑	sodium chloride 0.9 % infusion	Once	S	1 treatment	
		50 mL/hr, intravenous, once PRN, for MILD infusion reaction, Starting when released, Until Discontinued		
	☑	sodium chloride 0.9 % infusion	Once	S	1 treatment	
		150 mL/hr, intravenous, once PRN, for MODERATE infusion reaction, Starting when released, Until Discontinued		
	☑	sodium chloride 0.9 % bolus 1,000 mL	Once	S	1 treatment	
		1,000 mL, intravenous, Administer over: 60 Minutes, once PRN, for SEVERE infusion reaction, Starting when released, Until Discontinued