SILTUXIMAB (SYLVANT) INFUSION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 3 weeks	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Every 3 weeks	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Every 3 weeks	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Sedimentation rate	Every 3 weeks	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	C-reactive protein	Every 3 weeks	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every 3 weeks	S	Until discont'd	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every 3 weeks	S	Until discont'd	
		No details available for preview		
	☐	Treatment conditions	Every 3 weeks	S	Until discont'd	
		HOLD and notify provider if 
	o ANC LESS than 1000; 
	o Platelets LESS than 50,000; 
	o Hemoglobin GREATER than 17 g/dL.		
	☐	Nursing communication: Monitor patient for any signs of MINOR INFUSION REACTION	Every 3 weeks	S	Until discont'd	
		Monitor patient for signs of minor infusion reaction; fever, chills, pruritis, uticaria, chest pain, mild hypotension, hypertension, or mild dyspnea. For *MINOR INFUSION REACTION* take the following steps: stop infusion and restart 20 minutes later after administration of Benadryl 25 mg IV once, Tylenol 650 mg PO once, and Hydrocortisone 25 mg IV once.		
	☐	Nursing communication: Monitor patient for signs of SEVERE INFUSION REACTION	Every 3 weeks	S	Until discont'd	
		Monitor patient for signs of moderate/severe or anaphylaxis infusion reaction: stop infusion and call MD.		
	☐	sodium chloride 0.9% flush 10 mL	Every 3 weeks	S	Until discont'd	
		10 mL, intravenous, PRN, line care, catheter care, Starting when released, for 10 doses		
	☐	sodium chloride 0.9% infusion 250 mL	Every 3 weeks	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	Every 3 weeks	S	Until discont'd	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every 3 weeks	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Administer 30 minutes before siltuximab infusion.
	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	Every 3 weeks	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Administer 30 minutes before siltuximab infusion.		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Every 3 weeks	S	Until discont'd	
		100 mg, intravenous, once, Starting when released
	Administer 30 minutes before siltuximab infusion.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	siltuximab 11 mg/kg in dextrose 5% 250 mL chemo IVPB	Every 3 weeks	S	Until discont'd	
		11 mg/kg, intravenous, Administer over: 1 Hours, once, Starting when released
	Administer using administration sets lined with polyvinyl chloride (PVC), or polyurethane (PU), or polyethylene (PE), which contain a 0.2 micron inline polyethersulfone (PES) filter.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours PRN, headaches, fever, myalgia, Starting when released, Until Discontinued
	Give 325-650 mg for headache, fever, myalgia
	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, for allergic reaction symptoms, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for anaphylactic reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 1 mg	PRN	S	Until discont'd	
		1 mg, intravenous, once PRN, anaphylaxis, for anaphylactic reaction, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for anaphylactic reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 50 mg	PRN	S	Until discont'd	
		50 mg, oral, every 4 hours PRN, nausea, vomiting, Starting when released, Until Discontinued
	Give 25-50 mg every 4-6 hours for nausea/vomiting		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued