PLACE LABEL HERE

ELECTROPHYSIOLOGY LAB

POST-PROCEDURE

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

  1. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission?

Yes, admit as inpatient, proceed to # 2No, place in observationNo, outpatient, DC home in ____hrs

  1. If admitted as inpatient, Inpatient Physician Certification:

Diagnosis ______or Same as pre-procedure ______(initial)

Level of Care:  Critical  Intermediate  Acute Care Specialty Unit Preference:______

  1. Telemetry: If patient Medical/Surgical, must complete form # 36084
  2. Isolation  Contact Airborne Droplet For: ______
  3. Consults:______
  4. Diagnostics:

EKG 12 lead STATReason: status post EP procedure Group to read:______

EKG 12 lead in AM Reason: follow up post EP procedure Group to read: ______

ECHO Reason:______Group to read: ______

Bedside glucose monitoring ac & hs (Call physician for BG >180 mg/dL x2 consecutively)

 AM Labs: CBC, Chem 7, PT/INR

  1. Initiate Sleep Apnea Standing Orders (form # 21266) if OSA screen is positive for suspected or reported sleep apnea
  2. Diet:NPOFull liquid, advance to Cardiac after sheath removed

RegularCardiac Diabetic ______calories Renal

  1. Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)

POST PROCEDURE MONITORING:

  1. Vital signs:
  • Sheath in place: vitals, procedure site, and neurovascular checks q 15 min until sheath removal
  • After Sheath Removal & Hemostasis Achieved: vitals, procedure site, and neurovascular checks q 15 min x 2, then q 30 min x 4, then q hr x 4, then per unit routine or until discharge
  1. O2 per Oxygen for Adults Initiation and WeaningProtocol (form # 34431)
  2. Notify physician of the following:
  • Bleeding/hematoma
  • Temp > 38.4C (101° F),
  • HR < 50 or > 130; Arrhythmias or angina
  • Symptomatic hypotension > 40 mmHg drop in systolic baseline and/or systolic pressure < 90
  • Systolic BP > 160 mmHg; Diastolic BP > 100 mmHg
  • Unrelieved chest, back, or leg pain, itching, rash or flushing
  • Peripheral vascular changes in affected extremity: Numbness, tingling, decreased or absent pulses, and/or temperature change (if changed from the initial presentation)
  1. If applicable: Bilateral groin suture removal once bedrest is completed.
  2. SHEATH REMOVAL ORDERS:
  • Remove sheath per Sheath Removal Policy (# 6670-23). Notify physician before arterialsheath removal, if BP >165/90. If femoral puncture site, do not elevate HOB > 30° while on bedrest.
  • HOB ≤ 30° while on bedrest.
  • Bedrest x ______hours
  • Right femoral sheath:  Arterial  Venous

Immobilize right leg x _____ hours, then may move extremity until bedrest complete

  • Left femoral sheath:  Arterial  Venous

Immobilize left leg x _____ hours, then may move extremity until bedrest complete

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

SHEATH REMOVAL ACT GUIDELINES

ACT: Remove Sheath when ACT less than 180seconds or within 20 sec of baselinee.
If ACT is: / Recheck in:
≥ 180 but < 220 seconds
≥ 220 but < 250 seconds
≥ 250 but < 300 seconds
Greater than 300 seconds / 45 minutes
1 hour
2 hours
3 hours

SCHEDULED MEDICATIONS:

  1. Intravenous fluids:

 D/C IVF now in ____ hrs after current bag has infused When patient tolerating po fluids

IVF______at ____ml/hr

  1. Anti-Platelet/Anticoagulant:

Aspirin  81 mg or  325 mg po daily. Give first dose at______

Eliquis (apixaban) _____mg po bid. Give first dose at ______

Xarelto (rivaroxaban) _____mg po daily. Give first dose at ______

Pradaxa (dabigatran) _____mg po bid. Give first dose at ______

Coumadin (warfarin)_____mg po dailyGive first dose at ______

Plavix (clopidogrel) 300 mg or 600 mg loading dose NOW, then 75 mg po daily

OR Plavix (clopidogrel) 75 mg po daily

Brilinta (ticagrelor)  180 mg loading dose NOW, then 90 mg po BID

OR Brilinta (ticagrelor) 90 mg po BID (use with aspirin 81 mg max daily maintenance dose)

Effient (prasugrel)  60 mg loading dose NOW, then 10 mg po daily (avoid if > 75 y/o unless diabetic or hx of MI, < 60 kg, hx of TIA/Stroke; or likely to undergo CABG surgery):

OR Effient (prasugrel) 10 mg po daily (avoid if > 75 y/o unless diabetic or hx of MI, < 60 kg, hx of TIA/Stroke; or likely to undergo CABG surgery):

  1. Colchicine 0.6 mg po bid begin evening of procedure
  2. Solucortef (hydrocortisone) ______mg (2 mg/kg) x 1 dose upon completion of procedure
  3. Prednisone 20 mg po daily begin AM following ablation
  4. Protonix (pantoprazole) 40 mg po daily

PRN MEDICATIONS See policy 520-06 for range orders and pain intensity guidelines.

  1. Mild Pain, Temp100.5F, HA:Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
  2. Moderate Pain:

Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.

or If patient can not take tablet, Hycet elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po q 4 hrs prn intead of Norco. DC if Percocet ordered.

or Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.

and/or  Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if CrCl 31-50, > 65 y/o old or <50 kg) or 10 mg po q 6 hrs prn (max combined duration of IV and po ketorolac is 5 days). DC if CrCl < 30.

  1. Severe Pain (Begin when Epidural or PCA has been discontinued)

Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered.

or  Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered.

  1. Nausea/Vomiting: Zofran (ondansetron) 4 mg IV or po q 6 hrs prn

If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)

  1. Cardioversion patch site redness:  Hydrocortosone 1% cream q 4 hr prn

______

DateTimePhysician SignaturePID Number

Copy to pharmacy

FORM 3-32772 REV. 02/2018 Page 2 of 2