Transcript 7. Donor Management – Lorello-Hasskamp

Why you do
what you do?
Nikki Dotson-Lorello RN, BSN, CCRN, CPTC
Organ Recovery Coordinator
LifeShare Of The Carolinas
Why is my
dead patient
so busy???
Demanding Organ
Recovery Coordinator
• We expect a lot in the first few hours so
optimal staffing is one on one!
• Keep your daggers in your pocket please!!
• Usually after the first few hours things will
slow down.
How many lines do you
really need?
• You will be grateful for the central line when
you see the amount of labs tubes we need.
And no they will not need a blood
transfusion
• Ton of medications, most likely blood pressure
support in the early stages, so that central line
is again very handy!
• Respiratory Therapy will love me for the
arterial line I will have to have! If we pursue
lungs, TONS of ABG’s!
LifeShare Orders
• Admit and readmit
• Labs for baseline references
• Chest Xrays, possible implementation of
lung protocol, possibly CT scan
• EKG, possibly ECHO and Cath Lab
• Tons of medications and fluid changes
They were
stable before
death, what
happened?
Physiologically
speaking!
• No Hypothalamus, therefore no thyroid
hormones
• No ADH
• No temperature control
• No blood sugar control
• No parasympathetic response systems,
causing cardiovascular dilation
• Little to no BP and HR control
No Hypothalamus,
NEED Thyroid Fix
• Levothyroxine=T4; Bolus then start
a drip
• D50 amp
• 20 units Regular Insulin
• 2 Grams Solumedrol
ALL MUST BE GIVEN CLOSE
TOGETHER!!!!
DIABETES
INSIPIDUS
No Hypothalamus + No
ADH = Loss of free
water and sodium
increase
Diabetes Insipidus
Fix
• Hourly I&O
• If UOP exceeds 800ml/hr, need
ADH-Vasopressin, Goal UOP 150300 ml/hr
• Urine Replacement ml:ml hourly
• Low Sodium fluids
• Replace electrolytes
• Monitor CVP, BP and HR
No more sugar for
me please!
• Blood sugar check q2hr
• Bolus insulin or even start a drip
• Look out for increased UOP, may
indicate an elevated blood
sugar!!
It’s getting hot in
here!
Goal temp 96.8-99.5
Cold = warm blankets to body and head, warm
circuit to ventilator, warm fluids and/or bair
hugger, turn up the thermostat!
Hot = remove blankets, cooling blanket, ice
packs and turn down thermostat!
Just gets you ready for menopause
Who turned the lytes
out?
•
•
•
•
Prior to brain death medical
management can lead to challenges
Mannitol/diuretics to reduce swelling
IVF fluid restriction to avoid pulmonary
edema or CHF
DI
Excessive blood due to trauma or
coagulopathy
Please fix the Lytes!
•
•
•
•
•
Replace K+
Replace Phos if <2.5
Reduce Na, monitor IVF for Na
If NA <130, consider 3%
CaCl or Ca Gluconate for cardiac
function
• Monitor q4hr and check q1hr after
any replacements
Complication: DIC
• Common with head trauma-GSW, Open
head injuries, closed head trauma’s
• Concern with organ donor-clotting of
vascular system causes necrosis or
organs
PTT< 38
PT< 15
Platelets >65,000
Fibrinogen >100,000
How do you fix it?
• Observe for any bleeding
• Monitor coags
• Use PRBC’s, FFP,
cryoprecipitate
• Treatment will not cure but will
slow process
BP, it’s up, it’s down!
No parasympathetic or sympathetic
responses
It’s UP
• Treat with Labetalol or Nipride
It’s Down
• Treat with Dopamine, Levothyroxine,
Neosynephrine, Levophed, Albumin 5%, IVF
boluses dependent on lytes and CVP
Now for the CVP of SVV!!
• Monitor Hydration
• Consider albumin of Na up
• Tricky if placing lungs, need
hydration for kidneys, dry for
lungs!
If that was not enough,
what about the pH?
• No respiratory drive, need to know if metabolic
acidosis or alkalosis
• Keep pH and pCO2 normal
• Acidosis most common, collaborate with RT,
may need NaHCO3
• Monitor TV and FiO2
• ABG’s q2-4, hours
• HOB up
• Rotate and percuss
• Suction
Two Sides to the Story
• Primary goal is to return the organ
function back to baseline to
optimize for placement
• Ideally this will make the
transplant as easy as possible for
the recipient
Mathematically
Speaking…..
Collaboration
Nurse + MD + LifeShare ORC = Organ Recovery
Organ Recovery + Transplant = Recipient
GO TEAM!
Questions??