CYTOMEGALOVIRUS IMMUNE GLOBULIN 100-150 MG/KG FOR PANCREAS TRANSPLANT		version 6/12/2024		

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.		

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).		

2 Weeks after Transplant 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 150 mg/kg	Once	S	1 treatment	
		150 mg/kg, intravenous, once, Starting when released
	The initial infusion rate should be 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, increase dose to 30 mg/kg/hour. If no adverse reactions occur after 30 more minutes, increase dose to 60 mg/kg/hour. Total volume should not exceed 75 mL/hour.		

4 Weeks after Transplant 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 150 mg/kg	Once	S	1 treatment	
		150 mg/kg, intravenous, once, Starting when released
	The initial infusion rate should be 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, increase dose to 30 mg/kg/hour. If no adverse reactions occur after 30 more minutes, increase dose to 60 mg/kg/hour. Total volume should not exceed 75 mL/hour.		

6 Weeks after Transplant 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 150 mg/kg	Once	S	1 treatment	
		150 mg/kg, intravenous, once, Starting when released
	The initial infusion rate should be 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, increase dose to 30 mg/kg/hour. If no adverse reactions occur after 30 more minutes, increase dose to 60 mg/kg/hour. Total volume should not exceed 75 mL/hour.		

8 Weeks after Transplant 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 150 mg/kg	Once	S	1 treatment	
		150 mg/kg, intravenous, once, Starting when released
	The initial infusion rate should be 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, increase dose to 30 mg/kg/hour. If no adverse reactions occur after 30 more minutes, increase dose to 60 mg/kg/hour. Total volume should not exceed 75 mL/hour.		

12 Weeks after Transplant 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 100 mg/kg	Once	S	1 treatment	
		100 mg/kg, intravenous, once, Starting when released
	The initial infusion rate should be 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, increase dose to 30 mg/kg/hour. If no adverse reactions occur after 30 more minutes, increase dose to 60 mg/kg/hour. Total volume should not exceed 75 mL/hour.		

16 Weeks after Transplant 	

	
	Interval	Defer Until	Duration	
	☐	cytomegalovirus immune globulin (CYTOGAM) IVPB 100 mg/kg	Once	S	1 treatment	
		100 mg/kg, intravenous, once, Starting when released
	The initial infusion rate should be 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, increase dose to 30 mg/kg/hour. If no adverse reactions occur after 30 more minutes, increase dose to 60 mg/kg/hour. Total volume should not exceed 75 mL/hour.		

Discharge Nursing Orders 	

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

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours 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).		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	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	PRN	S	Until discont'd	
		0.5 mg, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	0.9%  NaCl solution	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, for hydration, Starting when released, Until Discontinued