CAGT- INTRAVENOUS FLUID (IV)		version 11/17/2023		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		
	☑	Nursing communication	Every visit	S	Until discont'd	
		Please continue to schedule subsequent infusion appointments manually as appropriate.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Magnesium level	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	LDH	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Type and screen	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		

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, Until Discontinued		
	☐	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		
	☐	Discharge patient after completion of therapy, if stable	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Verify patient/caregiver received prescriptions and/or instruction as needed	Every visit	S	Until discont'd	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	ondansetron (ZOFRAN) IV 8 mg	Every visit	S	Until discont'd	
		8 mg, intravenous, once, Starting when released
	May cause QTc prolongation.		
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	S	Until discont'd	
		650 mg, oral, PRN, mild pain (score 1-3), 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).		

IV Fluids 	

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

Supportive Care 	

	
	Interval	Defer Until	Duration	
	☐	ondansetron (ZOFRAN) IV 8 mg	Every visit	S	Until discont'd	
		8 mg, intravenous, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once, Starting when released