THYMOGLOBULIN FOR KIDNEY TRANSPLANT REJECTION		version 3/30/2022		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☐	Referral to IV Infusion Room . Therapy Plan #1; Performing Department: HMH TRANSPLT INFUSION; Choose a treatment option: New Therapy Plan; Infusion Medication: Thymoglobulin; Urgency of Scheduling: STAT	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+7, Clinic Performed
	. Therapy Plan #1
	Performing Department: HMH TRANSPLT INFUSION
	Choose a treatment option: New Therapy Plan
	Infusion Medication: Thymoglobulin
	Urgency of Scheduling: STAT
	Patient must be scheduled in the morning (prior to 10am).		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Please continue to schedule subsequent infusion appointments manually as appropriate.		

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	Every visit	S	Until discont'd	
		Clinic Performed, Normal		
	☐	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	Every visit	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag., Starting when released, Until Discontinued		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	Heparin flush for Implanted Vascular Access Device Maintenance.		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Nursing communication	Every visit	S	Until discont'd	
		o	Review CBC prior to releasing Thymoglobulin orders.
	o	Call transplant pharmacist if WBC LESS than 3 or Platelets LESS than 75 (WBC 2 to 3 or Platelets 50 to 75 will require dose adjustment; WBC LESS than 2 or Platelets LESS than 50 require holding the dose for one day).		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Notify provider for any infusion reaction.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Basic metabolic panel	Every visit	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Magnesium level	Every visit	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Phosphorus level	Every visit	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	FK506 Tacrolimus level, random	Every visit	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	CD3 enumeration	Every visit	S	Until discont'd	
		Routine, Normal, Clinic Collect		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 500 mg	Once	S	1 treatment	
		500 mg, intravenous, Administer over: 5 Minutes, once, Starting when released
	Give 30 minutes prior to 1st thymoglobulin infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 250 mg	Once	S+7	1 treatment	
		250 mg, intravenous, Administer over: 5 Minutes, once, Starting when released
	Give 30 minutes prior to 2nd thymoglobulin infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 125 mg	Once	S+14	1 treatment	
		125 mg, intravenous, Administer over: 5 Minutes, Starting when released
	Give 30 minutes prior to 3rd thymoglobulin infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 80 mg	Once	S+21	1 treatment	
		80 mg, intravenous, Administer over: 5 Minutes, Starting when released
	Give 30 minutes prior to 4th thymoglobulin infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Once	S+28	1 treatment	
		40 mg, intravenous, Administer over: 5 Minutes, Starting when released
	Give 30 minutes prior to 5th thymoglobulin infusion.		
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Give 30 minutes prior to thymoglobulin 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 thymoglobulin infusion.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	antithymocyte globulin (rabbit) (THYMOGLOBULIN) 1.5 mg/kg, HEParin, porcine (PF) 500 Units, hydrocortisone sodium succinate (PF) (Solu-CORTEF) 12.5 mg in sodium chloride 0.9% 244.75 mL IVPB - for PERIPHERAL line	Every visit	S	Until discont'd	
		1.5 mg/kg, intravenous, Administer over: 6 Hours, daily, Starting S As Scheduled, Until Discontinued
	Administer via 0.2 micron low protein binding filter into a PERIPHERAL vein		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 6 hours PRN, fever, Temperature > 100F, Starting when released, for 1 dose
	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	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, chills, Starting when released, Until Discontinued