INTRAVENOUS FLUID (IV) INFUSION		version 12/14/2021		

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		
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	LDH	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Magnesium level	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Type and screen	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		

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		

Hydration 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9 % bolus	Every visit	S	Until discont'd	
		intravenous, once, Starting when released		
	☐	sodium chloride 0.45 % infusion	Every visit	S	Until discont'd	
		intravenous, once, Starting when released		
	☐	dextrose 5% infusion	Every visit	S	Until discont'd	
		intravenous, once, Starting when released		
	☐	dextrose 5%-0.9% sodium chloride infusion	Every visit	S	Until discont'd	
		intravenous, once, Starting when released		
	☐	dextrose 5%-0.45% sodium chloride infusion	Every visit	S	Until discont'd	
		intravenous, once, Starting when released		
	☐	custom IV infusion builder	Every visit	S	Until discont'd	
		intravenous, once, Starting when released		

Electrolyte Replacement 	

	
	Interval	Defer Until	Duration	
	☐	magnesium sulfate IV 4 g	Every visit	S	Until discont'd	
		4 g, intravenous, once, Starting when released		
	☐	potassium chloride IVPB 10 mEq	Every visit	S	Until discont'd	
		10 mEq, intravenous, Administer over: 60 Minutes, once, Starting when released
	http://www.tmh.tmc.edu/dept/pharmacy/physorders/rx230.pdf
	Rate of administration should be adjusted according to patient tolerance.		
	☐	potassium chloride IVPB 20 mEq	Every visit	S	Until discont'd	
		20 mEq, intravenous, Administer over: 60 Minutes, once, Starting when released
	http://www.tmh.tmc.edu/dept/pharmacy/physorders/rx230.pdf