Transplants

[NurseLay]

How different is it caring for a post transplant patient than from regular surgical patients? I am looking for information particularly about kidney, liver, and pancreas transplant patients. Any other info would help.

Thanks!!!

[RNperdiem, RN]

A transplant patient will be put on "protective precautions". They are immunosupressed.

These patients will go to ICU or a stepdown unit post-op.

In the hospital labs for blood levels of tacrolimus are drawn, and the docs adjust the dose daily.

Pain control varies. It seems liver transplant patients require very little pain control, the kidney donors need a lot(live donor).

The patients and their families have been orientated to the donor program and the hospital long before the surgery. Unlike patients that come in for emergency surgery, transplant patients are familiar with illness, doctors and hospitals.

[NurseLay]

A transplant patient will be put on "protective precautions". They are immunosupressed.

These patients will go to ICU or a stepdown unit post-op.

In the hospital labs for blood levels of tacrolimus are drawn, and the docs adjust the dose daily.

Pain control varies. It seems liver transplant patients require very little pain control, the kidney donors need a lot(live donor).

The patients and their families have been orientated to the donor program and the hospital long before the surgery. Unlike patients that come in for emergency surgery, transplant patients are familiar with illness, doctors and hospitals.

Are any of the transplants vented or on drips or anything to that effect?

[RN1982]

Depending on the liver tranplant patient, most of the ones I get, come back with fentanyl and versed gtts and are still vented. They also have an a-line, swan cath, plus dopamine and amicar gtts. They also get frequent lab draws post op for the first 24 hours and depending on the patient, they also receive multiple blood products.

[poppy07]

what would you say you spend most of your time doing with these liver patients, for example? Do they have a lot of drains that you have to empty/monitor every hour? Did you learn to monitor the Swan in that unit or elsewhere? Are you giving tons of meds/ blood? Checking labs how often, like what? Thanks

[RN1982]

I learned about the swan in orientation. If the patient does indeed come from OR with a swan, we measure the cardiac output every 4 hours.The drains that liver transplant patients usually come back with are JP drains and we monitor every 4 hours or more often if needed. They usually have a lot of IV meds. And we draw CBC w/ platelets, Lytes, Liver profile most of the time...i might be missing some other labs.

It truly just depends on the transplant. Most of the time kidney/pancreas transplant patients come back from OR extubated and awake.

[NurseLay]

what would you say you spend most of your time doing with these liver patients, for example? Do they have a lot of drains that you have to empty/monitor every hour? Did you learn to monitor the Swan in that unit or elsewhere? Are you giving tons of meds/ blood? Checking labs how often, like what? Thanks

You asked a lot of good questions! Thanks for that!

[NurseLay]

I learned about the swan in orientation. The drains that liver transplant patients usually come back with are JP drains and we monitor every 4 hours or more often if needed. They usually have a lot of IV meds. And we draw CBC w/ platelets, Lytes, Liver profile most of the time...i might be missing some other labs.

When the transplant patients that you deal with return intubated, do they ususally stay intubated for a while, or is the main goal extubation like asap? I'm asking because I work in a Neuro ICU and a Burn/Trauma ICU and most of the patients in the units are usually intubated for like two days or more, but when they come back from surgery they are almost intubated within an hour or two.

[RN1982]

When the transplant patients that you deal with return intubated, do they ususally stay intubated for a while, or is the main goal extubation like asap? I'm asking because I work in a Neuro ICU and a Burn/Trauma ICU and most of the patients in the units are usually intubated for like two days or more, but when they come back from surgery they are almost intubated within an hour or two.

Depends mostly. We usually let them rest for a day on the vent and start CPAP trials at 6am after we do a sedation vacation. I've had some tranplant patients on the vent for up to 3 days and they've all done very well.

[NurseLay]

Is pain management a really big issue with transplant patients?

[RN1982]

Is pain management a really big issue with transplant patients?

Depends on the patient. Some have pain issues, some don't.

[ghillbert, MSN, NP]

Depends on the transplant too - lungs tend to have a ton of pain.