RITUXAN-PVVR (RUXIENCE) - SMITH 1101		version 1/23/2025		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
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	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		At start of infusion: obtain vital signs every 15 minutes x 4, then every 30 minutes.		
	☐	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 reaction (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 (PF) injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	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	
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Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	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).		
	☐	acetaminophen (TYLENOL) tablet 1,000 mg	Every visit	S	Until discont'd	
		1,000 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	Every visit	S	Until discont'd	
		25 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every visit	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Every visit	S	Until discont'd	
		40 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 80 mg	Every visit	S	Until discont'd	
		80 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 125 mg	Every visit	S	Until discont'd	
		125 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	rituximab-pvvr (PF) (RUXIENCE) 375 mg/m2 in sodium chloride 0.9% IVPB	1 time a week	S	4 treatments	
		375 mg/m2, intravenous, once, Starting when released
	Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mmHG of baseline, PULSE between 60 and 120 and TEMP less than 38 degrees C, and no symptoms), then increase infusion rate by 50 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.
	Infusion of Ruxience should be completed within 8 hours from removal from the refrigerator.		
	☐	rituximab-pvvr (PF) (RUXIENCE) 1,000 mg in sodium chloride 0.9% 250 mL (4 mg/mL) IVPB	Every 2 weeks	S	6 treatments	
		1,000 mg, intravenous, once, Starting when released
	Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mmHG of baseline, PULSE between 60 and 120 and TEMP less than 38 degrees C, and no symptoms), then increase infusion rate by 50 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.
	Infusion of Ruxience should be completed within 8 hours from removal from the refrigerator.		
	☐	rituximab-pvvr (PF) (RUXIENCE) 500 mg in sodium chloride 0.9% 250 mL (2 mg/mL) IVPB	Every 2 weeks	S	6 treatments	
		500 mg, intravenous, once, Starting when released
	Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mmHG of baseline, PULSE between 60 and 120 and TEMP less than 38 degrees C, and no symptoms), then increase infusion rate by 50 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.
	Infusion of Ruxience should be completed within 8 hours from removal from the refrigerator.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 500 mg	Every visit	S	Until discont'd	
		500 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).		
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	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	Every visit	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	Every visit	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.5 mg	Every visit	S	Until discont'd	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	famotidine (PEPCID) injection 20 mg	Every visit	S	Until discont'd	
		20 mg, intravenous, once PRN, for mild to moderate infusion reaction, Starting when released, Until Discontinued		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Every visit	S	Until discont'd	
		40 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	ondansetron (ZOFRAN) injection 4 mg	Every visit	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	Every visit	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	Every visit	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued