INFLIXIMAB MAINTENANCE INFUSION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 8 weeks	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Sedimentation rate	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	C-reactive protein	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Zinc level, serum	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Ferritin level	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Iron level	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Total iron binding capacity	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Vitamin D 25 hydroxy level	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Vitamin B12 level	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Vitamin A level, plasma or serum	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Folate level	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	TB GOLD Quantiferon	PRN	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Nursing communication: Observe patient for 30 minutes	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Nursing communication: Monitor patient for any signs of MINOR INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for any signs of infusion reaction.  For MINOR INFUSION REACTIONS (fever, chills, pruritis, uticaria, chest pain, mild hypotension, hypertension, or mild dyspnea) stop or slow infusion rate by 50%. If symptoms do not resolve within 5-10 minutes give Benadryl as ordered. Notify MD if symptoms do not resolve within 5-10 minutes. With MD approval, give Solu-medrol as ordered. When symptoms resolve, restart medication at 25% of the original rate. After 15-30 minutes gently increase rate and monitor patient closely until completion.		
	☐	Nursing communication: Monitor patient for signs of SEVERE INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for signs of SEVERE INFUSION REACTION: severe dyspnea, wheezing, stridor, angioedema, or marked hypotension. For severe infusion reaction take the following steps; STOP Infusion and start Normal Saline solution, Notify physician and administer Benadryl as ordered, Monitor vital signs, Administer  Epinephrine as ordered. Consult MD for further orders.		
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once, Starting when released
	ONLY IF PATIENT HAS PORTACATH: Flush portacath before removing needle from portacath.		
	☐	sodium chloride 0.9% infusion 250 mL	Every visit	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 500 mg	PRN	S	Until discont'd	
		500 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	famotidine (PEPCID) tablet 40 mg	PRN	S	Until discont'd	
		40 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	fexofenadine (ALLEGRA) tablet 180 mg	PRN	S	Until discont'd	
		180 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 125 mg	PRN	S	Until discont'd	
		125 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	INFLIXIMAB IV ORDERABLE IV 5 mg/kg	Every 8 weeks	S	Until discont'd	
		5 mg/kg, intravenous, once, Starting when released
	This is Infliximab IV for Regular infusion Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less. Total infusion time is 2 hours plus 15 minutes for the flush.
	
	Infuse at 40 mL/hour x 15 minutes, then if tolerated, increase
	infusion to 80 mL/hour x 30 minutes, then if tolerated, increase
	Infusion to 160 mL/hour for the duration of infusion.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		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	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for mild to moderate infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	PRN	S	Until discont'd	
		40 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	ondansetron (ZOFRAN) IV 4 mg	PRN	S	Until discont'd	
		4 mg, intravenous, once PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued