Preparations for Liver Transplant (Donor)
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Peripheral line |
14/16G x 1 (Hartmann's with blood set, 6-inch extension tubing and 3-way stopcock) |
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Arterial line |
20G (with 6-inch extension tubing and 3-way stopcock) |
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Triple lumen |
16/18/18G x 16-20 cm |
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Distal port (16G) for Hartmann's with blood set |
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Middle port for CVP |
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Proximal port for relaxant and fentanyl |
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Anchored at 15 cm |
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Urinary catheter |
With urimeter |
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N/G |
14/16FG |
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Warming blanket |
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Temp. probe |
Nasopharyngeal |
NB: The atracurium and fentanyl go through the proximal port of the triple lumen catheter
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Cis-atracurium |
Bolus |
0.20 mg/kg |
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Infusion |
0.18 -> 0.12 -> 0.06 mg/(kg.h) |
x 20 ml |
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Fentanyl |
Bolus |
0.200-0.250 mg |
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Infusion |
0.005 mg/(kg.h) |
x 20 ml |
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O2/Air/Isoflurane |
FIO2 0.50 initially |
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For TFGF of 6 |
Flow(O2) = 7.595 x FIO2 -1.595 |
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or approx |
Flow(O2) = FIO2 x 30 / 4 -1.5 |
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FIO2 |
25 |
30 |
35 |
40 |
45 |
50 |
60 |
70 |
80 |
90 |
|
FlowO2 |
0.30 |
0.68 |
1.06 |
1.44 |
1.82 |
2.20 |
2.96 |
3.72 |
4.48 |
5.24 |
|
FlowAir |
5.70 |
5.32 |
4.94 |
4.56 |
4.18 |
3.80 |
3.04 |
2.28 |
1.52 |
0.76 |
Dopamine not usually needed unless urine output is low
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Epidural |
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Preferably low thoracic (T9/10), otherwise high lumbar |
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Intraop |
Initial |
Bolus 0.5 % Marcain |
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Half hour later |
Bolus of 4-5 mg diamorphine/0.050 mg fentanyl |
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Maintenance |
0.125 % Marcain with |
10/20 mg diamorphine, or |
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0.200 mg fentanyl |
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in 100 ml @ 2-5 ml/h (usually needs up to 10 ml/h) |
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IV opiates |
Initial bolus given as usual but infusion can be stopped |
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Epidural |
Generally kept for 36-48 h but where the ward care is inadequate, it may have to be stopped when the patient is discharged from the ICU |
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Standby drugs |
Naloxone 0.4 mg (if resp. rate < 8 br/min) |
) Write prescription for |
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Metoclopromide 10 mg/Ondansetron 4 mg |
) post-op use |
ABG,
Ca2+, K+, RBS at begining and after liver is out.
Coagulation
profile not usually needed.
Preparations
(Liver
Transplant – Donor;
Only
Applicable to
Dr.
Ngun K. W.)
Narkomed
Machine (To deliver air to patient)
3
syringe pumps (relaxant, fentanyl, epidural)
Glucometer
|
Cis-atracurium |
5 amp (25 ml) |
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Fentanyl |
15 amp (30 ml) |
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Marcain |
20 ml 0.5 % +Adrenaline 1:200,000 |
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|
100 ml 0.125 % |
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Lignocaine |
5 ml 2 % |
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Hep-Sal |
20-30 ml |
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Dopamine |
1 amp (Standby) |
1
x Double Transpac pressure transducer - Heparinised
2
x Blood set with Hartmann's solution
2
x 6-inch extension tubing with 3-way stopcock (1 for peripheral line, 1 for
arterial line)
3
x 200 cm small bore 1 ml dead space Perfusor extension tubing
1
x Urinary catheter (16/18FG) with urimeter
1
x N/G 12/14FG
1
x Temp. probe (Naso-pharyngeal)
2
x Plain blood bottle
2
x Heparinised (Li-Heparin) blood bottle (green top)
Dressing
pack*
Hand
towel*
Gloves
size 7*
Povidone*
Fenestrated
towel*
18G,
21G, 23G, 27G needles
5
ml 2 % lignocaine*
20
ml 0.5 % Marcain with adrenaline 1:200,000*
5
ml syringe
10
ml syringe
LOR
(Perifix) syringe
Epidural
set (18G Tuohy needle, epdiural catheter, connector, epidural filter)
Op-site
Dressing (small)*
Same
as first 5 items for epidural*
Shoulder
roll
2
x 3-way taps
Hep-Sal
x 20-30 ml*
Triple
lumen catheter set - 7FG catheter, lumen 16/18/18G x 16-20 cm
(Arrow/Hydrocath)
No. 11 surgical blade
2-0
silk with cutting needle
Needle holder
Scissors
Tegaderm
IV Dressing*
Same
as first 5 items for epidural*
Small
roll to extend wrist
20G
Insyte IV catheter
Tegaderm IV Dressing*
1
x Op-site Dressing (small) (Epidural)
2
x Tegaderm IV Dressing (CVL and IAL)
3 x Dressing pack
3 x Hand towel
3
x Gloves size 7
3
x Fenestrated towel
Povidone
NB:
The items marked with an asterisk (*) are listed elsewhere and should not be
repeated.