FACTS AND FORMULAS

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Hariharan Thangarajah Saif A. Ghole

AL

Quick Reference

Cardiovascular
Cardiac output (CO)  SV  HR (3 to 7 liters/min)
Fick equation for CO  (O2 consumed)/(arterial O2  venous O2 content)
Cardiac index (CI)  CO/BSA (3.0 to 4.0 L/min/m2)
Ejection fraction  SV/EDV  100 (55% to 75%)
Mean arterial pressure (MAP)  CO  systemic vascular resistance
MAP  diastolic pressure  13 pulse pressure (70 to 105 mm Hg)
Pulse pressure  systolic pressure  diastolic pressure ( 40 mm Hg)
Systemic vascular resistance (SVR)  (MAP  right arterial pressure)/CO;
or (MAP  central venous pressure)/CO (700 to 1600 dynes/sec/cm2)
Normal Pressures
Systemic arterial pressure: (100-140)/(60-90) mm Hg
Left ventricle: (100-140)/(3-12) mm Hg
Pulmonary capillary wedge pressure (PCWP) Left atrial mean: 3 to
12 mm Hg
Pulmonary artery: (15-30)/(4-14) mm Hg
Right ventricle: (15-30)/(2-7) mm Hg
Central venous pressure (CVP): 0 to 8 mm Hg
Right atrium
Mean: 2 to 6 mm Hg
A-wave: 2 to 8 mm Hg
V-wave: 2 to 7 mm Hg
Pulmonary
A-a O2 gradient: PAO2  PaO2
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PR
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N

AL

Alveolar gas equation:

PAO2  FiO2 (Patm  PH2O)  PaCO2/RQ
Normal adult  0.21(760  47)  (40/0.8) 100
1. PaCO2  0.86(VCO2)/VAlv
2. O2 content (arterial)  1.34(Hb)SaO2  0.003(PaO2)
3. Minute ventilation: tidal volume  respiratory rate
4. Typical tidal volume: Weight (in kg)  10
5. Rapid shallow breathing index (RSBI)  Spontaneous respiration rate/tidal
volume (in liters); (desired value  100 to predict successful extubation)
6. Improve oxygenation: (1) increase FiO2; (2) increase PEEP; (3) adjust
inspiratory/expiratory ratio; (4) prone positioning (rarely done)
7. Improve ventilation: (1) increase rate; (2) increase tidal volume
Renal
Normal adult urine output  0.5 to 1 ml/kg/hr
Normal infant urine output 2 ml/kg/hr
Fractional excretion of sodium (FENa) 
(Urinary Na)(Plasma creatinine)
 100
Urinary creatinine)
(Plasma Na)(U

(in prerenal azotemia, FENa is 1%, ATN is 2%)

Creatinine clearance (for 24-hour urine collection)  (UCr  UVolume)/
(PCr  1440) (75 to 160 ml/min)
Estimated creatinine clearance 
(140 age)(weight in kg) ( 0.85 in females)
(serum creatinine)(722)

Average glomerular ltration rate 125 ml/min

Renal blood ow  1200 ml/min
Indications for dialysis:
Acidosis (severe, refractory to treatment)
Electrolyt abnormality (hyperkalemia)
Ingestions (overdose)
Overload (uid)
Uremia
Fluids, Electrolytes, Nutrition
Water balance:
Fluid in: 2500 ml/day (35 ml/kg/day baseline)
Fluid out: 1400 to 2300 ml/day
Total body water  Weight (in kg)  0.6 (male) or 0.5 (female)
Intracellular water  Weight (in kg)  0.4
Extracellular water  Weight (in kg)  0.2

 Plasma volume  Weight (in kg)  0.05

Desired TBW  (PNa  TBW)/Normal Na
Na decit  Desired TBW  TBW  (140  Plasma Na)  TBW
Serum Na 140
)
140
BUN
glucose
+
Serum osmolality  2(Na) 
(275 to 290 mosm/kg)
2.8
18

Water decit  TBW  (

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AL

Corrected Na  Measured Na  (glucose  100)  0.016

or for every 100 mEq/L increase in glucose (200), Na decreases by 1.6 mEq
Corrected Ca (for hypoalbuminemia)  Measured Ca  0.8 (4  measured
albumin) or if albumin 4.0, for every 1.0 mg/dL less than 4 mg/dL add
0.8 mg/dL to Ca
Anion gap  Na  (Cl  HCO3) (10 to 12)
Anion gap adjusted (for hypoalbuminemia)  Na  (Cl  HCO3) 
2.5(4  Alb)
Dilantin level adjusted for low albumin (4.5): (Dilantin measured)/[(0.2
 serum albumin)  0.1]
Miscellaneous
Parkland formula  4 ml/kg  % burn uid given over 24 hours:
Administer 12 of total in rst 8 hours
Administer 12 of total over next 16 hours
Volume of distribution  amount drug in body/plasma drug concentration
Weight conversion: lb  kg  2.2
Temperature conversion: C  (F  32)(5/9)
Epidemiology
Sensitivity, specicity
test 
test 

dz 
a
c

dz 
b
d

Sensitivity  a/(a  c) (Screening test)

Specicity  d/(b  d) (Conrming test)
Positive predictive value  a/(a  b) (Inuenced by prevalence)
Negative predictive value  d/(b  d) (Inuenced by prevalence)
Odds ratio, relative risk
dz 
dz 
exposure 
a
b
exposure 
c
d
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Odds ratio  [a/c]/[b/d]  ad/bc (Retrospect studies, rare diseases)

Relative risk  [a/(a  b)]/[c/(c  d)] (Prospective studies)
Attributable risk  [a/(a  b)]  [c/(c  d)]

COMMON DRIPS USED IN THE ICU

Bethany J. Slater

Indication

Comments/
Adverse Eects

1-20 g/kg/min Cardiogenic, septic

May cause tachyarshock; low dose can
rhythmias,
preserve renal blood
ischemic limb
ow and promote
necrosis
urinary output
10-200 g/min Hypotension
Pure alpha-agonist

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Vasopressors
Dopamine

Dose

AL

Medication

Phenylephrine
(Neo-Synephrine
[Bayer Corporation,
West Haven, CT])
Norepinephrine
1-20 g/min
(Levophed [Abbott
Laboratories,
Abbott Park, IL])

Potent alpha-agonist
(vasoconstrictor),
avoid in cardiogenic shock

Vasopressin

Septic shock with

hypotension refractory to dopa (low
systemic vascular
resistance and
adequately
resuscitated)
0.01-0.04 units/ Refractory vasodilamin
tory shock (late)
2-20 g/kg/min Severe systolic heart
failure
1-20 g/min or Second-line for
30-100 ng/
cardiogenic shock
kg/min

Avoid with CAD

0.5-5 g/kg/min Severe hypertension

(particularly with
low CO)

Potent vasodilator,
caution in renal
and hepatic
failure (cyanide/
thiocyanide
toxicity); do not
use alone in
dissection (reex
tachycardia); can
decrease PaO2
due to pulmonary
shunting

Dobutamine
Epinephrine

Inotrope and systemic vasodilator

Chronotrope,
inotrope, and
vasoconstrictor

Antihypertensives
Nitroprusside
(Nipride [Roche
Laboratories,
Nutley, NJ])

Nitroglycerin

10-400 g/min

Nicardipine

5-15 mg/hr

Diltiazem

5-15 mg/hr

Esmolol

50-300 g/kg/
min

Comments/
Adverse Eects

Indication

Decreased
Predominantly
BP/hypertensive
venodilator,
crisis; augment CO
mediated by NO;
(intermediate dose)
rapid onset;
angina (low dose,
headache;
typically 0.3-0.6 mg
increased ICP;
SL q5 min)
methemglobinemia; tachyphylaxis
Hypertension,
Potent calcium
decreased cerebral
channel blocker;
vasospasm
vasodilator; renal
clearance
Hypertension, atrial
Ca channel blocker,
brillation
monitor HR and
BP especially if
also on betablocker
Hypertension,
beta-1 blocker,
particularly with
short acting
aortic dissection,
supraventricular
tachycardia

AL

Dose

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Medication

Paralytics
Vecuronium

Cisatracurium

0.05-0.1 mg/
kg/hr

Paralysis

0.5-10 g/kg/
min

Paralysis with renal

or hepatic failure

Sedatives
Midazolam (Versed
1-10 mg/hr
[Roche Laboratories,
Nutley, NJ])

Sedation

Monitor muscular
twitch (2/4 trainof-four); nondepolarizing; onset
1-2 min; caution
with hepatic failure; caution with
steroids (including myopathy)
Nondepolarizing,
Homan
elimination

Potent, short acting

but can result in
accumulation

CAD, coronary artery disease.

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SURGICAL SUTURES

AL

Denitions
Tensile strength: Weight required to break a suture/cross-sectional area of
suture. Increased suture size (e.g., 4-0 or 2-0) translates to decreased crosssectional area, which effectively decreases the tensile strength.
Tissue reactivity: Natural bers (silk and gut) cause more inammation
than synthetic bers (PDS and Vicryl [Ethicon Inc., Somerville, NJ]).
Configuration: Twisted, braided, monolament.
Knot security: Braided and uncoated sutures hold the knot better.
Infection risk: Braided suture can harbor bacteria.

PR
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PL R
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N

Absorbable

Suture

Trade
Name

Conguration

Tensile
Strength

Tissue
Reaction

Common
Uses

Fast gut

Twisted

3-5



Plain gut

Twisted

5-7



Chromic gut

Twisted

10-14



Braided

14-21



GI tract,
vessel
ligation

Braided

14-21



Fascia,
viscera, GI
tract,
muscle,
vessel
ligation

Polyglecaprone 25

Polyglycolic
acid

Polygalactic
acid

Monocryl
(Ethicon,
Inc.,
Somer
ville, NJ)
Dexon
(Syneture,
Norwalk,
CT)
Vicryl
(Ethicon,
Inc.,
Somerville, NJ)

Monolament

Scalp and
facial
lacerations
in children
Vessel
ligation,
mucosa
Vessel
ligation,
mucosa,
GI tract,
viscera
Subcutaneous tissue,
skin,
GI tract

Polydioxanone

Polyglyconate

Trade
Name

Conguration

Tensile
Strength

PDS
Monolament
(Ethicon,
Inc.,
Somerville, NJ)
Maxon
Monolament
(Syneture,
Norwalk,
CT)

Tissue
Reaction

Common
Uses

28

28

Fascia,
cosmetic
closures,
GI tract,
muscle
GI tract,
cosmetic
closures,
muscle,
fascia

AL

Suture

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N

Nonabsorbable

Suture

Trade
Name

Silk

Nylon

Nylon

Polypropylene

Ethilon
(Ethicon,
Inc., Somerville, NJ),
Dermalon
(Syneture,
Norwalk,
CT)
Nurolon
(Ethicon,
Inc., Somerville, NJ),
Surgilon
(Syneture,
Norwalk,
CT)
Prolene
(Ethicon,
Inc., Somerville, NJ),
Surgilene
(Surgitech
Surgical
Sutures)

Conguration

Tensile
Strength

Tissue
Common
Reaction Uses

Braided

Good



Monolament

High

Braided

High



Monolament

Good

Vessel
ligation,
GI tract
Skin, drain
stitches,
fascia,
vasculature

Neurosurgery,
tendons

Cardiac
tissue,
vasculature,
fascia,
skin,
tendons,
neurosurgery

Continued on following page

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23

2 Quick Reference

Polyester

Ethibond
(Ethicon,
Inc., Somerville, NJ),
Tycron
(Tyco
Healthcare,
Manseld,
MA)
Novol
(Syneture,
Norwalk,
CT)
Ethisteel
(Ethicon,
Inc., Somerville, NJ),
Flexon
(Syneture,
Norwalk,
CT)

Conguration

Tensile
Strength

Tissue
Common
Reaction Uses

Braided

High



Monolament

High



Cardiac
tissue,
vascular,
fascia,
tendon

Fascia ligaments,
tendons

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Polybutester

Trade
Name

AL

Suture

Stainless
Steel

Monolament

24

High

Sternal
closure,
orthopedics,
drain
stitches,
fascia

REGULAR INSULIN (SQ) SLIDING SCALE

Finger Stick
Blood Glucose
60

60-150
151-200
201-250
251-300
301-350
351-400
400

Mild Scale

Moderate Scale

Aggressive Scale

1 amp (25 g) D50

or orange juice,
call MD
No insulin
No insulin
2 units
4 units
6 units
8 units
10 units, call MD

1 amp D50 or
orange juice,
call MD
No insulin
3 units
5 units
7 units
9 units
11 units
13 units, call MD

1 amp D50 or
orange juice,
call MD
No insulin
4 units
6 units
10 units
12 units
15 units
18 units, call MD

STEROID CONVERSION SCALE

Oscar J. Abilez
Relative Antiinammatory
Potency

Relative Mineralocorticoid
Potency

0.6-0.75
25
0.75
20
4
5
5
4

20-30
0.8
20-30
1
5
4
4
5

0
2
0
2
0
1
1
0

PR
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N

Betamethasone
Cortisone
Dexamethasone
Hydrocortisone
Methylprednisolone
Prednisolone
Prednisone
Triamcinolone

Approximate
Equivalent
Dose (mg)

Biologic
Half-Life
(hours)
36-54
8-12
36-54
8-12
18-36
18-36
18-36
18-36

AL

Corticosteroids

Data adapted from Green SM: Tarascon Pocket Pharmacopoeia, Tarascon Inc., 2006.

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Fentanyl
(Sublimaze
[Janssen-Cilag,
High Wycombe,
UK], Duragesic
[Ortho-McNeil
Pharmaceutical,
Raritan, NJ])

Potent Opioids
Morphine (Roxanol [Xanodyne
Pharmaceuticals,
Inc., Newport,
KY], MS Contin
[Purdue Pharmaceuticals, Stamford, CT])

Drug
IM, IV, SQ
2.5-20 mg every
2-6 hr infusion:
0.5-10 mg/hr
Oral prompt
release: 10-30
mg every 4 hr
Oral
extended release: 15-30
mg every
8-12 hr
Rectal suppository 5-10 mg
every 4-6 hr
IM, IV, SQ
50-100 g every
30-60 min
Transdermal
dose as g/hr

Dose Ranges in
Adults
Parenteral 
10 mg
Oral  30 mg

Parenteral 
100 g

Parenteral 
3-5 hr
Oral prompt
release  4 hr
Oral extended
release 
8-12 hr

Parenteral 
0.5-1 hr

Duration

Equianalgesic
Dose to
Morphine
10 mg IV

Wide range of
doses
Transdermal
system not for
acute pain
management

Basal 10 g/hr
PCA 10 g every
10 min
Range 10-50 g
every 10 min

AL

Potential
accumulation of
active metabolite
morphine-6glucoronid,
which is renally
excreted
Avoid doses
100 mg/hr
Histamine
release may
cause local
reaction

Comments

Basal 1-2 mg/hr

PCA 2 mg every
10 min
Range 0.5-3 mg
every 10-20 min

PatientControlled
Analgesia
Starting Doses

Equianalgesic dose refers to the amount of other opioid required to produce the same effect as 10 mg IV
morphine. To convert between opioids, determine the morphine equivalent of the rst drug. Convert the
morphine dose to the new drug using the following table.

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OPIOID DOSING TABLE

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Methadone
(Dolophine
{Roxane Laboratories Inc.,
Columbus, OH])

Merepidine
(Demerol
[Sano-Aventis,
Bridgewater, NJ])

Hydromorphone
(Dilaudid
[Abbott Laboratories, Abbott
Park, IL])

Drug

Equianalgesic
Dose to
Morphine
10 mg IV

Parenteral 
2 mg
Oral  4 mg

Parenteral 
75 mg
Oral  300 mg

Parenteral 
5-10 mg
Oral  5-10 mg

Duration

Parenteral 
3-4 hr
Oral  4-6 hr

Parenteral 
2-4 hr
Oral  3-6 hr

Parenteral 
4-8 hr
Oral  4-12 hr

PatientControlled
Analgesia
Starting Doses

IM, IV, PO
2.5-150 mg
every 6 hr

IM, IV, SQ
1-2 mg every
4-6 hr
Oral 2-4 mg
every 4-6 hr
Rectal suppository 6 mg every
4-6 hr
IM, IV
25-150 mg every
3-4 hr

Dose Ranges in
Adults
Comments

AL

Continued on following page

Oral route not

recommended
Active metabolite normeperidine accumulates
in renal impairment and may
cause seizures
Methadone has
variable half-life
Slow titration
advised

Basal 0.2 mg/hr

Avoid doses
Patient-controlled
40 mg/hr
analgesia 0.2 mg Choice over
every 10 min
morphine in
Range 0.1-0.5
hepatic
mg every 10-15
impairment
min

PR
SA O
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PL R
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C O
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N E
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T V
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O R
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FI
N

Hydrocodone
(Vicodin
[Abbott Laboratories, Abbott
Park, IL], Lortab
[UCB Pharmaceuticals Inc.,
Atlanta, GA)

Weak Opioids
Codeine
(Tylenol #3
[Ortho-McNeil
Pharmaceutical,
Raritan, NJ])

Oxycodone
(Percocet [Endo
Pharmaceuticals,
Chadds Ford,
PA], Tylox
[Ortho-McNeil
Pharmaceutical,
Raritan, NJ],
Oxycontin
[Purdue Pharmaceuticals,
Stamford, CT])

Drug

Equianalgesic
Dose to
Morphine
10 mg IV

PatientControlled
Analgesia
Starting Doses

Duration

PO
5-10 mg every
4-6 hr

IM, PO
15-60 mg every
4-6 h
max 360 mg/
24 hr

Parenteral 
120 mg
Oral  200 mg

Oral  40 mg

Oral  4-5 hr

Oral 
15-30 mg

Parenteral 
4-6 hr
Oral  4-6 hr

Oral prompt
Oral  4-5 hr
release 5-10 mg
every 3-4 hr
Oral extended
release 10 mg
every 12 hr

Dose Ranges in
Adults

AL

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PL R
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C O
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N E
TE L
N SE
T V
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O R
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FI
N

Note cumulative
acetaminophen
dosage
Adjust
acetaminophen
dose for liver
impairment
2 g/24 hr
Note cumulative
acetaminophen
dosage
Adjust
acetaminophen
dose for liver
impairment
2 g/24 hr

Note cumulative
acetaminophen
dosage
Adjust
acetaminophen
dose for liver
impairment
2 g/24 hr

Comments

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Dose Ranges in
Adults

PO
50-100 mg every
4-6 hr
max 400 mg/
24 hr

Oral  4 6 hr

Oral  4-6 hr

Duration

Oral  300 mg

260 mg as HCL
400 mg as
napsylate

PatientControlled
Analgesia
Starting Doses

Seizure risk
400 mg/24 hr
Reduce dose in
elderly,
cirrhosis50 mg
every 12 hr

Potential for
hepatoxicity
Note cumulative
acetaminophen
dosage
Adjust
acetaminophen
dose for liver
impairment
2 gs/24 hr

Comments

AL

Data from Stanford University Hospital and Clinics Departments of Pharmacy and Nursing, approved 1998.

Miscellaneous
Tramadol
(Ultram [OrthoMcNeil Pharmaceutical, Raritan,
NJ])

Ultra-Weak Opioid
Propoxyphene
PO
(Darvon,
HCL 65 mg every
Darvocet N
4 hr max 390
100 [Xanodyne
mg/24 hr
Pharmaceuticals, Napsylate 100
Inc., Newport,
mg every 4 hr,
KY])
max 600
mg/24 hr

Drug

Equianalgesic
Dose to
Morphine
10 mg IV

PR
SA O
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PL R
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C O
O F
N E
TE L
N SE
T V
- N IE
O R
T
FI
N

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PR
SA O
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PL R
E TY
C O
O F
N E
TE L
N SE
T V
- N IE
O R
T
FI
N

AL

Adverse Side Eect Management

Nausea/Vomiting
Metoclopramide (Reglan [Schwartz Pharma, Inc., Mequon, WI]): 10 to
20 mg IV/PO every 3 to 6 hr
Promethazine (Phenergan [Wyeth-Ayerst Laboratories, Philadelphia, PA]):
12.5 to 25 mg IV/PO/PR every 4 to 6 hr
Droperidol: 0.625 mg IV every 4 to 6 hr
Ondansetron (Zofran [Cerenex, Research Triangle Park, NC]): 4 to 8 mg
IV every 4 hr
Pruritis (commonly resolves in 1 to 2 days)
Diphenhydramine (Benadryl [Pzer, Inc., New York, NY]): 10 to 25 mg
IV/PO every 4 to 6 hr
Hydroxyzine (Atarax, Vistaril [Pzer, Inc., New York, NY]): 25 mg PO/IM
every 6 hr
Nalbuphine (Nubain [Endo Pharmaceuticals Chadds Ford, PA]): 2.5 to 5 mg
IV every 2 to 4 hr
Constipation
Dicosate sodium: 250 mg PO twice daily
Milk of magnesia: 30 ml PO twice daily
Lactulose: 30 ml PO twice daily
Senokot: 1 to 4 tabs PO daily
Bisacodyl (Dulcolax [Boehringer Ingelheim Pharmaceuticals, Inc., Ridgeeld, CT]): 5 to 10 mg PO or 10 mg PR daily
Fleets enema as needed
Magnesium citrate: 300 ml PO as needed
Sedation
Decrease dose.
Add adjuvant.
Change routes to minimize dose (IV to epidural).
Change opiates.
Adjust dosing schedule to normalize sleep/wake cycle.
Avoid drugs with sedating effects.
Key Concepts
Administer on scheduled basis.
Provide PRNs (as needed) for breakthrough pain.
Consider adjuvants (nonsteroidal antiinammatory drugs [NSAIDs],
antidepressant sleep agents, anesthetics).

 Individualize doses.
Consider long-acting preparations when dose is stabilized (fentanyl
transdermal, methadone).
Provide bowel regimen with opiates.

HEPARIN SLIDING SCALE

Oscar J. Abilez

AL

Indication: Pulmonary embolism and/or DVT

Initial bolus: 80 U/kg IV
Initial rate: 18 U/kg/hr IV
Obtain baseline platelet count, then platelet count at least every other day
while patient is receiving heparin to watch for heparin-induced thrombocytopenia with thrombosis

PR
SA O
M PE
PL R
E TY
C O
O F
N E
TE L
N SE
T V
- N IE
O R
T
FI
N

PTT

Re-bolus (U)

Stop (min)

Change (U/hr)

Repeat PTT (hrs)

50
50-59
60-80
81-120
120

5000
-

30
60

 200
100
100
200

6
6
next AM
6
6

*PTT, Partial thromboplastin time

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SURGICAL CARE IMPROVEMENT PROJECT

RECOMMENDATIONS
Tom C. Nguyen

AL

Denition
Surgical Care Improvement Project (SCIP) is a national quality partnership
committed to improving patient safety by driving down postoperative complications by 25% by 2010. By implementing SCIP quality measures, hospitals could prevent an estimated 13,000 patient deaths and 271,000 surgical
complications each year.

PR
SA O
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PL R
E TY
C O
O F
N E
TE L
N SE
T V
- N IE
O R
T
FI
N

The SCIP Measures

Antibiotic prophylaxis: (1) Antibiotic received within 1 hour prior to
surgical incision, (2) antibiotic selection for surgical patients, and
(3) antibiotics discontinued within 24 hours after surgery time, 48 hours
for CABG and other cardiac surgery.

Type of Surgery

Antimicrobial Recommendations

Cardiac or vascular

Preferred: Cefazolin 1-2 gm IV.

If -lactam allergy: Clindamycin
600-900 mg IV or vancomycin 1 g IV.
If known history of MRSA:
Vancomycin 1 g IV
Preferred: Cefoxitin 1-2 g IV.
If -lactam allergy: Metronidazole
500 mg IV and ciprooxacin 400 mg IV
Preferred: Cefoxitin 1-2 g IV.
If -lactam allergy: Metronidazole
500 mg IV and ciprooxacin 400 mg IV
Preferred: Cefazolin 1-2 g IV.
If -lactam allergy: Clindamycin
600-900 mg IV or vancomycin 1 g IV.
If known history of MRSA:
Vancomycin 1 g IV
Preferred: Cefoxitin 1-2 g IV.
If v-lactam allergy: Metronidazole
500 mg IV and ciprooxacin 400 mg IV
Preferred: Cefazolin 1-2 g IV.
If -lactam allergy: Clindamycin
600-900 mg IV or vancomycin 1 g IV.
If known history of MwRSA:
Vancomycin 1 g IV

Colon

General surgery (hepatobiliary,

gastroduodenal)

Other general surgical procedures

(e.g. hernia repair, breast)

Gynecological procedures
(e.g., hysterectomy, C-section)
Neurosurgery

Type of Surgery

Antimicrobial Recommendations

Orthopedic: hip/knee arthroplasty

(infuse completely before tourniquet
ination)

Preferred: Cefazolin 1-2 g IV.

If -lactam allergy: Clindamyin
600-900 mg IV or vancomycin 1 g IV.
If known history of MRSA:
Vancomycin 1 g IV

MRSA, Methicillin resistant staphylococcus aureus.

PR
SA O
M PE
PL R
E TY
C O
O F
N E
TE L
N SE
T V
- N IE
O R
T
FI
N

AL

Glucose: Cardiac surgery patients with controlled 6 am postoperative

serum glucose ( 200 mg/dl) on postoperative days 1 and 2.
Hair removal: Surgery patients with appropriate hair removal. No hair
removal or removal with clippers or depilatory is considered appropriate.
Normothermia: Colorectal surgery patients with immediate normothermia
(
96.8 F) within the rst hour after leaving OR.
B-block: Surgery patients on beta-blocker therapy prior to admission who
received a beta-blocker during the perioperative period.
VTE: Venous thromboembolism prophylaxis: (1) Surgery patients with recommended VTE prophylaxis ordered, (2) surgery patients who receive appropriate
VTE prophylaxis within 24 hours prior to surgery to 24 hours after surgery.

Surgery and Level of Risk

VTE Prophylaxis

General surgery, moderate to high

risk. Open surgical procedure
30 min requiring in-hospital stay
24 hr postoperative.

Any of the following:

Low-dose unfractionated heparin (LDUH)
5000 units twice or three times daily
Low molecular weight heparin (LMWH)
LDUH or LMWH combined with
intermittent pneumatic compression
(IPC) or graduated compression
stockings (GCS)
Any of the following:
GCS
IPC

General surgery with high risk for

bleeding (based on physician
documentation of bleeding risk). Open
surgical procedure 30 min requiring
hospital stay 24 hr postoperative.
Urologic surgery. Open surgical
procedure 30 min requiring hospital
stay 24 hr postoperative.

Any of the following:

LDUH 5000 units twice or three times
daily
LMWH
IPC
GCS
LDUH or LMWH combined with IPC or
GCS
Continued on following page
2 Quick Reference

33

2 Quick Reference

VTE Prophylaxis

Elective total hip replacement. Open

surgical procedure 30 min requiring
hospital stay 24 hr postoperative.

Any of the following started within

24 hr of surgery:
LMWH
Fondaparinux 2.5 mg
Adjusted-dose warfarin (INR target
2.5, range 2.0-3.0)
Any of the following:
LMWH
IPC
Fondaparinux 2.5 mg
Adjusted-dose warfarin (INR target
2.5, range 2.0-3.0)
Any of the following:
LMWH
LDUH
Fondaparinux 2.5 mg
Adjusted-dose warfarin (INR target
2.5, range 2.0-3.0)
Any of the following:
GCS
IPC

Elective total knee replacement.

Open surgical procedure 30 min
requiring hospital stay 24 hr
postoperative.

PR
SA O
M PE
PL R
E TY
C O
O F
N E
TE L
N SE
T V
- N IE
O R
T
FI
N

Hip fracture surgery. Open surgical

procedure 30 min requiring hospital
stay 24 hr postoperative.

AL

Surgery and Level of Risk

34

Hip fracture surgery or elective

total hip replacement with high
risk for bleeding (based on
physician documentation of bleeding
risk). Open surgical procedure
30 min requiring hospital stay
24 hr postoperative.

Elective spinal surgery (with additional risk factors such as advanced

age, known malignancy, presence of a
neurologic decit, previous VTE, or an
anterior surgical approach). Open surgical procedure 30 min requiring
hospital stay 24 hr postoperative.
Intracranial neurosurgery. Open surgical procedure 30 min requiring
hospital stay 24 hr postoperative.

Any of the following:

LDUH
IPC
LMWH
GCS
IPC combined with GCS
LDUH or LMWH combined with IPC or
GCS
Any of the following:
LMWH
IPC with or without GCS
LDUH
LDUH or LMWH combined with IPC or
GCS

REFERENCE
Brendle TA: Surgical Care Improvement Project and the perioperative nurses role.
AORN J 86(1):94-101, 2007.

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