CYTOMEGALOVIRUS IMMUNE GLOBULIN (CYTOGAM) INFUSION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room Appointment request for loading doses.	Every 2 weeks	S	4 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment request for loading doses.		
	☑	Referral to IV Infusion Room Appointment request for maintenance doses.	Every 4 weeks	S+76	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment request for maintenance doses.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Basic metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Hepatic function panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		Vital Signs PRE & POST Infusion.		
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Nursing communication: Maintain IV access	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		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	Every visit	S	Until discont'd	
		25 mg, oral, once, Starting when released
	Administer 30 minutes before infusion.		
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Administer 30 minutes before infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) 250 mg in sodium chloride 0.9% 100 mL IVPB	Every visit	S	Until discont'd	
		250 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Administer 30 minutes before infusion.		

Loading Dose 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 250 mg/kg	Every 2 weeks	S	4 treatments	
		250 mg/kg, intravenous, once, Starting when released
	Per manufacturer's guidelines, according to patient tolerance.		

Maintenance Dose 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 250 mg/kg	Every 4 weeks	S+76	Until discont'd	
		250 mg/kg, intravenous, once, Starting when released
	Per manufacturer's guidelines, according to patient tolerance.		

Discharge Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview