Common meds in transplant ICU

[Melissa1986]

I'm going to start my final clinical in nursing school next week, and will be working in a transplant ICU. This clinical is what my school calls immersion, which is basically an internship. It is more freedom and responsibility than regular clinicals. I'd like to know some commonly used medication for this type of unit so that I can be better prepared for clinical on monday. Thanks.

[Esme12, ASN, BSN, RN]

What kind of transplants?

[Esme12, ASN, BSN, RN]

http://www.med.umich.edu/trans/public/pdf/6_medications.pdf

Immunosuppression for Renal Transplant Patients; Common Medical Problems in Renal Transplantation

There is another site that is specific just to ICU....ICU FAQs for critical care and those drugs meds and vents.

[Melissa1986]

I'm assuming its any/all types of transplants. Thanks for all of the links.

[NurseKatie08, MSN]

I work with liver/kidney transplants in a med surg setting...depending on your center's preferences, I'd expect to be giving/seeing: tacrolimus, sirolimus, cyclosporine, thymoglobulin, mycophenolate, nystatin, bactrim, pentamidine, valgancyclovir. I'm sure there are more that escape me at the moment. Good luck in your placement!

[Esme12, ASN, BSN, RN]

I moved your thread to the MICU SICU section for the best answers.....I never worked transplant.

[JeanOfAllTraits]

They will either do solid organ ( kidney, liver, pancreas) or heart and lung or both. Solid organ and heart/lung are very different transplant processes.

You'll likely see the meds Katie mentioned, antirejections, bacterial and fungal prophylaxis, possibly schedule antiemetics depending on surgeon preferenc. Additionally, working ICU, you're going to see the critical care side aspects. Dopamine to increase contractility rather than other vasopressors which could damage the organs. Insulin drips, electrolyte replacements, and beautiful, oh so wonderful sedation. Propofol, versed and fentanyl are what my facility uses but it can vary across hospitals.

Have fun! These transplants are life changing and have a huge education and psychosocial aspect.

[core0]

Fundamentally, the ICU care of transplant patients is critical care. The patient population depends on how the ICU is run. For our ICU you would be dealing with pre liver transplant patients, post op liver transplant patients, the occasional renal transplant patient and any solid organ transplant patient that gets septic or has other problems.

Know your basic pressors such as norepinephrine and vasopressin. Lots of insulin gtts.

ICU immunosuppression will generally be steroids and mycophenelate mofetil (MMF). We also use monoclonal antibodies such as Basiliximab. Prograf is added later, sometimes on the floor. A lot of these patients will have significant renal failure. Other meds such as a PPI, and prophylaxis meds such as Acyclovir and bactrim might be started in the ICU.

Generally you will see two types of patients. Those that go in sick and come out relatively sick and those that come in relatively well and move through the ICU quickly. Understand the MELD score for livers and read up on HCC for livers.

[Scooby-Dooby-Doo]

I'm a transplant-surgical ICU nurse at a big university teaching hospital and level 1 trauma center as well as main transplant center, and I have to agree with the above posters. I have worked with tacrolimus, cyclosporin, mycophenolate, nystatin, bactrim, gancyclovir, neupogen, and a whole bunch of antibiotics and antifungals. You will also need to draw peak-trough levels for some of these meds like tacrolimus and if the patient become septic, anticipate to add vancomycin and cephalosporin to that mix.

Don't just know your antifugals, antiretrovirals/antivirals, and antibiotics as well as immunosuppressant drugs, but also what they anticipate for and what to expect as well as why they are being given. That can really paint a big part of the picture of the patient's diagnosis and potential problems.

Personally, I feel that pre-transplant patients are like MICU cases and post-transplant patients are like SICU cases, so in a way, you get the best of both worlds. Transplant liver patients deal with multi-multi-multi-systems since it affects everything! Not just neuro or cardio or pulmonary. Just off topic but relative, most transplant patients, especially liver and kidey, will be on dialysis, so we transplant nurses are also trained on dialysis.

Finally, as with other critical care realms and specialized ICUs (burn, trauma, neuro, etc...) transplant ICU is no exception for vasopressors and vasoactive drugs. You'll need to know your pressors like Vasopressin, dopamine, epinephine, norepi/levophed etc... because once your hemodynamics change, so does your dosing and titration of vasopressors.

Good luck! Transplant ICU is not easy but once you get the hang of things, I feel that you can go to other ICUs adjusted easily.

[Here.I.Stand, BSN, RN]

I used to work in the SICU/CVICU at my state's U hospital. At that place the livers went to the SICU; the hearts, lungs, and heart-lungs went to CVICU. (Kindeys and pancreases went to the solid organ transplant floor post-PACU. They didn't go to the ICU unless there was some other complication or issue.)

In addition to the above (all great info!) you'll want to review at least the basic vent settings, since (I assume) they'll come to you still intubated. Review PA catheters, since at least the hearts/lungs will likely come back with one.

[pugmom79]

I'm on a transplant pcu and see all the abdominal transplants. I agree with all of the Meds and ideas lol thee posters mentioned. This is my second nursing job. I was on a med tele floor and I love where I'm at now. Good luck!!