Lifeshare of the Carolinas

LifeShare Of The Carolinas

Routine Deceased Donor Orders

LifeShare Coordinator:____________________________________ Blackberry #:_____________________

· DO NOT initiate these orders until patient is declared brain dead and consent obtained for donation

· Discontinue all previous orders except those continued below

· Discharge patient and readmit as “Organ Donor” prior to entering new orders

o Attending Physician/Responsible Party: LifeShare Of The Carolinas

Procedures:

______Arterial Line

______Triple or Quad Lumen Central Venous Catheter

______Bronchoscopy - If available, video record/photograph bronchoscopy

· REASON: Therapeutic and to assess for anatomical abnormalities

______Initiate Non Invasive Cardiac Monitoring

Cardiology:

______Stat 12 lead EKG - NO Physician Interpretation

______Stat Echo

· STAT dictated read and electronic copy of study on disc required

· REASON: Evaluation of cardiac function

Radiology:

_____ AP Portable CXR with lung measurements to include:

· length of left lung, length of right lung, aortic knob width, diaphragm width and distance RCPA to LCPA

· If central access is pending, hold order until access is obtained

Laboratory: STAT

_____ ABG _____ HgBA1C

_____ CBC with Differential _____ Amylase/Lipase

_____ CMP _____ Troponin I

_____ PT/INR _____ Fibrinogen

_____ PTT _____ Magnesium

_____ UA with Micro _____ Phosphorus

_____ Direct Bili _____ Lactate

_____ ABO Type and crossmatch for 2 units PRBC’s, maintaining 2 units available at all times

· Subgroup A blood types

_____CMV Negative, if available

_____Blood cultures x 2 with sensitivity

· May obtain from Arterial and/or Central Venous Line if both/either are < 12 hrs post insertion

_____Urine culture and sensitivity

_____Bronchial washing x 2 for gram stain

· Obtain during bronchoscopy

· BAL sample from Right Lung and Left Lung

· Perform bacterial culture only if initial gram stain is positive

Pharmacy: STAT and all meds should be mixed in NS when possible

Fluids:

_____ Maintenance IVF of______________________, infused at _________ ml/hr, add ____________ mEq KCl

_____ Start urine replacement of _________________, infuse at __________ml:ml/hr

· May titrate fluids at direction of LifeShare Coordinator

Vasopressors:

_____Dopamine infusion titrating dose from 1-20 mcg/kg/min

_____Phenylephrine infusion titrating dose from 1 - 200 mcg/min

_____Continue current vasopressor as follows:

______________________________________________________________________________________

______________________________________________________________________________________

Antibiotics:

_____Piperacillin/Tazobactam (Zosyn) 4.5 gms IV and repeat every 6 hrs

_____Ceftriaxone (Rocephin) 1 gm IV every 12 hrs x 2 doses, then 1 gm every 24 hrs

_____Continue previous antibiotic coverage as follows: ______________________________________________________________________________________

______________________________________________________________________________________

Hormone Replacement Protocol: (Steroid, Insulin, Dextrose and Levothyroxine should be given in rapid succession)

______Methylprednisolone (SoluMedrol) mix in NS

_____ 2 gm IV Bolus over 30 minutes

_____ Repeat dose of 1 gm every 6 hrs after initial dose

_____ Repeat dose of 1 gm every 12 hrs after initial dose

______Regular Insulin - 20 units IV push x 1

______D50 – 25grams/1amp IV push x 1

______Levothyroxine: mix 200 mcg in 100 ml NS

_____Initial bolus: IVP from infusion bag 10mls = 20 mcgs

_____Immediately after bolus: start an infusion at 5 ml/hr = 10 mcg/hr

_____Immediately after bolus: start an infusion at 10 ml/hr = 20 mcg/hr

_____Immediately after bolus: start and infusion at 25 ml/hr = 50 mcg/hr

Various Pharmacy Orders:

______Vasopressin: Mix 40 units in 250 ml NS

· Start infusion at 15 ml/hour = 0.04 units/min

· May titrate at LifeShare direction to obtain hourly UOP goal

______Mannitol

_____Bolus 12.5 gms IV push

_____Bolus 25 gms IV push

_____6 gm/hr IV infusion

______Phytonadione (Vitamin K) – 20 mg IV x 1

______Calcium Gluconate – 1 gram/1 amp IV push x 1

______Naloxone (Narcan) - 8 mg IV push x 1

______Artificial Tears or Normal Saline - 2 drops per eye every 2 hrs and tape lids closed

Respiratory:

______Perform ABG’s, O2 Challenges and ventilator changes at the direction of the LifeShare Coordinator

______Chest PT and Rotation

· Keep HOB at 30 degrees

· Auscultate lung fields every hour

· Module or manual rotation every 15 minutes

· Percussion for 15 minutes every 2 hours, suctioning each time

· If hemodynamically tolerated, place in trendelenburg for percussion then suction and return HOB to 30degrees

______Rotation, PT, auscultation of lung fields prn to maintain O2 saturation of 96% or better

Nursing:

Obtain current - Weight:____________ kg Height:_______________ in

_____ Check Blood Glucose every 2 hrs

· Notify LifeShare Coordinator if > 200

_____ NG/OG tube to low intermittent wall suction prn

_____ Free water for elevated Sodium

_____Push 100 mls of tap water down NG/OG, clamp, suction after 1 hour, repeat

_____Push 100 mls of tap water down NG/OG, clamp, suction every 2 hours, repeat

_____ Record VS every 15 minutes and CVP hourly

· Notify LifeShare Coordinator if:

· O2 saturation < 96 %

· Heart Rate < 50 or > 120 beats/min

· Systolic BP < 90or > 160 mmHg

· CVP < 4 or > 8 mmHg

· Urine output < 150 or > 300 ml/hr

_____ Maintain temperature 96.0 – 101.0 degrees Fahrenheit

· Use warming blanket and/or Baer Hugger as needed

· Record temperature hourly

_____ If NonInvasive Cardiac Monitoring Device initiated record:

· CO, SVI and SVV hourly

Page 2 of 3– Orders

Signature:_____________________________________________ per LifeShare Standing Orders/Protocol

LifeShare Organ Recovery Coordinator

Date:___________________ Time:__________________ UNOS: ___________________

Revised 2/28/2012