Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

ICD/Permanent Pacemaker Pre-Implantation Orders by 67qd0Aqf

VIEWS: 8 PAGES: 1

									                                                                                               PLACE LABEL HERE
ICD / PERMANENT PACEMAKER
PRE-IMPLANTATION
ORDERS
     The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
              Initial all handwritten order modification and the bottom of each page indicated (multipage).

1.     Diagnosis     Admit as Inpatient _______________________________________(reason for admission)
       & Status:     Place in Outpatient ______________________________________(diagnosis)

2.     Unit:  ICU       IMCU/PCU  Telemetry Floor           Any Floor Telemetry  Any Floor (No Telemetry)

3.     Patient scheduled for ICD / Permanent Pacemaker: Date: ________________ Time: ______________

5.     Labs within 72 hrs of procedure: Chem 7, CBC, PT/INR, PTT

6.     EKG on chart (performed within 72 hrs of procedure)

7.     IV access in both arms (with at least 20 gauge)

8.     Clip chest from neck to nipple line – bed line to bed line

9.     Patient to shower using an antibacterial soap the night before and the morning of the procedure

10.  NPO after midnight except medications                OR         NPO after clear liquid breakfast

11. Patient to void on call to cath lab

12. Pre-procedure antibiotic
     Ancef (cefazolin) 1 gm IV over 20 min x 1 dose
     Vancomycin 1 gm IV over 60 min x 1 dose (use for allergy with high risk of anaphylaxis)


ADDITIONAL ORDERS:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________


______________             __________               ______________________________                   ___________
Date                       Time                     Physician Signature                              PID Number



Send copy to pharmacy


*1-8211*                       FORM 1-8211 REV. 07/2012                                                 Page 1 of 1

								
To top