Appendix 2 – Cytarabine CRI hospital chart( author’ s own) – Page 1 of 2
Date: Patient name: Client name: ID no.: Species: Breed: Age: Weight:
Vet: RVN:
IVC checklist |
Vein used: |
IVC checked: |
Attempt: |
|
am |
pm |
Clean stick: |
|
am |
pm |
Checked by: |
|
am |
pm |
Cannula size: |
G |
am |
pm |
Patient history and diagnosis: ……………………………….. ……………………………….. ……………………………….. ……………………………….. ……………………………….. ………………………………... ……………………………….. ……………………………….. ………………………………… ………………………………… Discharge Meds needed:…………. ……………………………….. Meds dispensed Time and date of discharge:………………… with …………………………
Bloodwork Haematology
Results:……………………. ………………………………… Vet seen
Other tests: ………………………………… ………………………………… Vet seen
Cytarabine dose Weight: BSA in m 2: Dose: / m 2
Total mg:
Calculated by:…………………. Checked 1:………………………… Checked 2:………………………… Checked 3:…………………………
Cytarabine CRI 4hrs / 6hrs / 8hrs / 24hrs
CRI rate: ml / hr / hrs
Vet checked Checked 1:……………………….. Checked 2:……………………….. Checked 3:………………………..
Estimate end date and time of CRI:………………………………
In-patient notes: ………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………