Interviewing for SICU/transplant

Here.I.Stand, BSN, RN · May 2, 2014

I really enjoyed this pt population! (That's past tense because the hospital I work at now doesn't do them.) You're right--they come out of surgery very sick still. You've got all your typical major postop issues, and then some.

Lots of times their coags still need correcting. These cases can be very long, and where I worked they bypassed the PACU and came straight to the SICU. (I remember one pt had been in the OR for 10 or 12 hrs, and then came to us bleeding from many orifices.

Fluid balance can be an issue, and lots of times they'll be on a fluid replacement protocol where you replace their fluids at an equal rate to that lost. For example, they lose 100 ml from the hours of 0100 and 0200; so at 0200 you set the rate at 100 ml/hr for 1 hr. This is in addition to their maintenance fluid.

You give a lot of albumin and a lot of blood products. They might be on vasoactive drips like many ICU pts are. They need pretty frequent labs.

Pain control is a challenge; these are HUGE incisions.

You have to suspend any judgmental attitudes that you may have, because truthfully a lot of people who need a liver transplant need it because they drank through the one they were born with. I want to say when I worked in that SICU, a pt needed to be clean&sober for 6 mo. to be eligible, but that aside the available liver is going to go to the one who needs it the most. A 55 y/o w/ alcoholic cirrhosis could well get a liver (or part of one) before an 18 y/o with liver CA.

Oh, and there's that little thing that we need to monitor them for--acute rejection.

I'm sure I'm leaving out something important; I feel like I am forgetting something, but I'm about ready to sleep. Good providence on your interview!