INTRAVENOUS ANTIBIOTICS THERAPY PLAN		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 1 day	S	7 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

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		
	☐	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		
	☐	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		
	☐	HEParin, porcine injection 100 Units	Every visit	S	Until discont'd	
		100 Units, intra-catheter, once, Starting when released		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, PRN, line care, Starting when released, Until Discontinued		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		

PICC Line or Implanted Port 	

	
	Interval	Defer Until	Duration	
	☐	Change dressing: PICC	1 time a week	S	Until discont'd	
		No details available for preview		
	☐	Change dressing: Port-a-cath	1 time a week	S	Until discont'd	
		Port-a-cath dressing is changed ONLY when non-coring needle is changed and as needed		
	☐	Replace StatLock	1 time a week	S	Until discont'd	
		No details available for preview		
	☐	Notify Physician if arm swelling, drainage, or other complications arise concerning the central line	1 time a week	S	Until discont'd	
		No details available for preview		

Centrally Inserted Catheter or Temporary Dialysis Catheter 	

	
	Interval	Defer Until	Duration	
	☐	Change dressing	1 time a week	S	Until discont'd	
		No details available for preview		
	☐	Notify Physician if arm swelling, drainage, or other complications arise concerning the central line	1 time a week	S	Until discont'd	
		No details available for preview		

Hydration 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9 % bolus 250 mL	Every visit	S	Until discont'd	
		250 mL, intravenous, once, Starting when released		
	☐	sodium chloride 0.9 % bolus 500 mL	Every visit	S	Until discont'd	
		500 mL, intravenous, once, Starting when released		
	☐	sodium chloride 0.9 % bolus 1,000 mL	Every visit	S	Until discont'd	
		1,000 mL, intravenous, once, Starting when released		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	cefTRIAxone (ROCEPHIN) IV 1 g	Every 1 day	S	7 treatments	
		1 g, intravenous, Administer over: 30 Minutes, once, Starting when released		
	☐	cefTRIAxone (ROCEPHIN) IV 2 g	Every 1 day	S	7 treatments	
		2 g, intravenous, Administer over: 30 Minutes, once, Starting when released		
	☐	ertapenem (INVanz) IV 1 g	Every 1 day	S	7 treatments	
		1 g, intravenous, once, Starting when released
	ERTApenem must not be mixed or Y-sited into any Dextrose-containing solutions. Flush IV line with Normal Saline before and after administration.		
	☐	ceFEPime (MAXIPIME) IV 1 g	Every 1 day	S	7 treatments	
		1 g, intravenous, once		
	☐	ceFEPime (MAXIPIME) IV 2 g	Every 1 day	S	7 treatments	
		2 g, intravenous, once, Starting when released		
	☐	meropenem (MERREM) IV 1 g	Every 1 day	S	7 treatments	
		1 g, intravenous, once, Starting when released		
	☐	meropenem (MERREM) IV 2 g	Every 1 day	S	7 treatments	
		2 g, intravenous, once, Starting when released		
	☐	DAPTOmycin (PF) (CUBICIN) 500 mg in sodium chloride 0.9% IVPB (RESTRICTED)	Every 1 day	S	7 treatments	
		500 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Use ADJUSTED body weight if BMI is 30 or greater.		
	☐	DAPTOmycin (PF) (CUBICIN) 1,000 mg in sodium chloride 0.9% IVPB (RESTRICTED)	Every 1 day	S	7 treatments	
		1,000 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Use ADJUSTED body weight if BMI is 30 or greater.		
	☐	ceFAZolin (ANCEF) in sodium chloride 0.9% 100 mL IVPB	Every 1 day	S	7 treatments	
		intravenous, Administer over: 30 Minutes, once, Starting when released		
	☐	gentamicin (GARAMYCIN) IVPB	Every 1 day	S	7 treatments	
		intravenous, Administer over: 30 Minutes, Starting when released		
	☐	tobramycin (TOBREX) IV	Every 1 day	S	7 treatments	
		intravenous, Administer over: 60 Minutes, Starting when released		
	☐	amikacin (AMIKIN)	Every 1 day	S	7 treatments	
		intravenous, Administer over: 30 Minutes, Starting when released		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor 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		
	☐	ondansetron (ZOFRAN) injection 8 mg	PRN	S	Until discont'd	
		8 mg, intramuscular, every 8 hours PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☐	ondansetron (ZOFRAN) tablet 4 mg	PRN	S	Until discont'd	
		4 mg, oral, every 8 hours PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	1 time a week	S	Until discont'd	
		Please select the appropriate resulting agency for all labs prior to their release.		
	☐	CBC hemogram	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Basic metabolic panel	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Sedimentation rate	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Creatine kinase, total (CPK)	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	C-reactive protein	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Blood culture, aerobic & anaerobic	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Blood culture, fungus	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect, Blood		
	☐	Urinalysis, automated with microscopy	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Urine culture	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect, Urine		
	☐	Hemoglobin A1c	1 time a week	S	Until discont'd	
		Routine, Normal, Clinic Collect