THERAPEUTIC PHLEBOTOMY		version 12/6/2021		

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		
	☐	Ferritin level	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Peripheral smear	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	
		Before phlebotomy.		
	☐	Therapeutic Phlebotomy	Every visit	S	Until discont'd	
		Normal
	Number of units: 1		
	☐	Orthostatic vital signs	Every visit	S	Until discont'd	
		After phlebotomy.		
	☐	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		

IV Fluids 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, PRN, Fluid repletion, Starting when released, Until Discontinued
	Replete with NS 250 mL.		

Discharge Nursing Orders 	

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