Why you do what you do? Nikki Dotson-Lorello RN, BSN, CCRN, CPTC Organ Recovery Coordinator LifeShare Of The Carolina s

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 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 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??