CAGT- PALIFERMIN (KEPIVANCE) INJECTION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 1 day	S	3 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 1 day	S	3 treatments	
		No details available for preview		
	☐	sodium chloride 0.9% flush 10 mL	Every 1 day	S	3 treatments	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	sodium chloride 0.9% infusion 250 mL	Every 1 day	S	3 treatments	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	palifermin (KEPIVANCE) injection 60 mcg/kg	Every 1 day	S	3 treatments	
		60 mcg/kg, intravenous, once, Starting when released
	Do not administer palifermin during or within 24 hours before or after chemotherapy.
	HAZARDOUS

	Handle with care		

Discharge Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Discontinue IV	Every 1 day	S	3 treatments	
		No details available for preview