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IP CAGT AUTOLOGOUS SCT IV BEAM	

Types:      ONCOLOGY TREATMENT
Synonyms:  BEAM, CARMUSTINE, BICNU, CYTARABINE, ARAC, VP16, ETOPOSIDE, MELPHALAN, ALKERAN, BMT, CAGT, AUTOLOGOUS, SCT

Transplant	Repeat 1 time	Cycle length: 90 days	Day -6 through -1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 64	Interval: Once	Occurrences: --	Comments:	Verify Hep B panel status prior to cycle. Date *** of panel. Result positive/negative/pending/unknown:22867

The required components for the hepatitis B panel includes: Hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B antibody (anti-HBs).
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	OLANZapine (ZYPREXA) tablet 10 mg	Dose: 10 mg	Route: oral	daily for 9 doses	Start: S			Instructions:	Day -6 through Day +2		  	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Day -6 prior to Carmustine		  	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	daily for 6 doses	Start: S			Instructions:	Day -6 through Day -1		  	ondansetron (ZOFRAN) tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours for 24 doses	Start: S+1			Instructions:	Day -5 through Day +2			Antiemetics
  	promethazine (PHENERGAN) injection 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 4 hours PRN	Start: S					Supportive Care
  	acyclovir (ZOVIRAX) tablet 800 mg	Dose: 800 mg	Route: oral	daily	Start: S				  	fluconazole (DIFLUCAN) tablet 200 mg	Dose: 200 mg	Route: oral	daily	Start: S				  	levoFLOXacin (LEVAQUIN) tablet 500 mg	Dose: 500 mg	Route: oral	daily at 0600 (TIME CRITICAL)	Start: S+9			Instructions:	Start Day +3			Chemotherapy
☑	carmustine (BiCNU) 300 mg/m2 in dextrose (NON-PVC) 5% 500 mL chemo IVPB	Dose: 300 mg/m2	Route: intravenous	once over 2 Hours for 1 dose	Start: S	End: S  8:30 AM		Instructions:	Day -6

Protect from light	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CARMUSTINE 100 MG INTRAVENOUS SOLUTION	Medications	300 mg/m2	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) IV SOLP (EXCEL; NON-PVC)	QS Base	500 mL	Yes	Yes			☑	cytarabine PF (CYSTOSAR) 200 mg/m2 in dextrose 5% 100 mL chemo IVPB	Dose: 200 mg/m2	Route: intravenous	every 12 hours over 30 Minutes for 8 doses	Start: S+1			Instructions:	Day -5, -4, -3, -2	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION	Medications	200 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	100 mL	No	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	100 mL	Yes	Yes				Additional Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --	Comments:	During Etoposide infusion:
-Every 15 minutes for 1 hour, THEN
-Hourly until completion, THEN
-May return to routine VS at completion of infusion
-If SBP is less than 90 or greater than 160, call MD and slow infusion rate to HALF PREVIOUS RATE for completion of infusion.
			Chemotherapy
☑	etoposide (TOPOSAR) 200 mg/m2 in sodium chloride (NON-PVC) 0.9 % 1,000 mL chemo IVPB	Dose: 200 mg/m2	Route: intravenous	every 12 hours over 3 Hours for 8 doses	Start: S+1			Instructions:	Day -5, -4, -3, -2.  Administer through a 0.22 micron filter and non-PVC tubing set.
During Etoposide infusion:
-Every 15 minutes for 1 hour, THEN
-Hourly until completion, THEN 
-May return to routine VS at completion of infusion
-If SBP is less than 90 or greater than 160, call MD and slow infusion rate to HALF PREVIOUS RATE for completion of infusion.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION	Medications	200 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % IV SOLP (EXCEL;NON-PVC)	QS Base	1,000 mL	Yes	Yes			☑	etoposide phosphate (ETOPOPHOS) 200 mg/m2 in sodium chloride 0.9% 500 mL chemo IVPB	Dose: 200 mg/m2	Route: intravenous	every 24 hours over 3.5 Hours for 4 doses	Start: S+1			Instructions:	Day -5, -4, -3, -2.  Administer in place of Etoposide.
During Etoposide infusion:
-Every 15 minutes for 1 hour, THEN
-Hourly until completion, THEN
-May return to routine VS at completion of infusion
-If SBP is less than 90 or greater than 160, call MD and slow infusion rate to HALF PREVIOUS RATE for completion of infusion.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION	Medications	200 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	500 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	ONC NURSING COMMUNICATION 47	Interval: Once	Occurrences: --	Comments:	Begin Melphalan infusion NO later than 10:00 am.
			Additional Orders
☑	ONC NURSING COMMUNICATION 25	Interval: Once	Occurrences: --	Comments:	Provide ice chips and / or popsicles to patient 30 minutes prior, during and for 30 minutes following Melphalan infusion.
			Chemotherapy
☑	melphalan HCL (ALKERAN) 140 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 140 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S+5  9:00 AM			Instructions:	Day -1.

Infuse within 60 minutes from vial reconstitution.

DO NOT begin infusion after 10AM.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION	Medications	140 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Medications
☑	prednisoLONE acetate (PRED FORTE) 1 % ophthalmic suspension 2 drop	Dose: 2 drop	Route: Both Eyes	4 times daily	Start: S+1			Instructions:	Days -5, -4, -3, -2, -1, 0.			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN							Day 0	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once for 1 dose				Instructions:	Premed for TRANSPLANT			Transplant Orders
  	ONC NURSING COMMUNICATION 55	Interval: Once	Occurrences: --	Comments:	-Oxygen at bedside during transplantation
-Anaphylaxis precautions at bedside during transplant:
		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses				Instructions:	Administer every 15 minutes x 3 doses PRN for each episode of rigors (if rigors persist, call MD).		  	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	once PRN	Start: S	End: S+2			  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once PRN	Start: S	End: S+2			  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once PRN							Day 1	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron ODT (ZOFRAN-ODT) disintegrating tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours PRN	Start: S+2