Why you do what you do?

Nikki Dotson-Lorello RN, BSN, CCRN, CPTCOrgan Recovery CoordinatorLifeShare 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 150-300 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 96.8-99.5Cold = 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< 38PT< 15Platelets >65,000Fibrinogen >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 responsesIt’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??