|
|
|
NATCO Executive Office
Group: Administrators
Last Login: 4/27/2011 10:50:25 AM
Posts: 20,
Visits: 128
|
|
Welcome - attached are a set of instructions on how to get started with the NATCO Instant Forum. Enjoy.
Janene Dawson
Associate Executive Director NATCO, The Organization for Transplant Professionals
P.O. Box 15384
Lenexa, KS 66285-5384
Phone: (913) 895-4612 ext. 4780 or
(785) 822-0877
Fax: (913) 895-4652
Web site: www.natco1.org
|
|
|
|
|
Forum Newbie
Group: Forum Members
Last Login: 4/3/2009 4:48:30 PM
Posts: 5,
Visits: 8
|
|
| Recently I had a donor who was in massive DI, decreased Hgb, high Na, elevated CVP, chest x-ray with atelectasis, effusion and some fluid on board. This was day 3 post admission after a 12' fall with SDH that progressed to brain death despite surgical intervention. We give a unit of PRBC to replenish the Hgb, but then were faced with the dilemma how best to remove the extra fluid on board. Without Vasopressin, U/O was over 1000ml/hr, and Na-165. Didn't feel comfortable stopping/lowering vasopressin as it would have lead to further electrolyte imbalances. We gave Lasix (20mg IV) to remove fluid, decrease CVP but try to control electrolytes. In the end, we managed to improve lung function, and transplanted all organs. However, some blood showed up in the urine but kidneys worked OK after transplant. What would have have you done? Decrease/stop vasopressin or use diuretics to remove the extra fluid on-board?
- Laszlo Kalmar, RN
- Organ Donation Specialist
- BC Transplant
- Vancouver, BC
|
|
|
|
|
Forum Member
Group: Forum Members
Last Login: 4/9/2011 7:51:09 PM
Posts: 41,
Visits: 479
|
|
Laszlo Kalmar (4/1/2009)
Recently I had a donor who was in massive DI, decreased Hgb, high Na, elevated CVP, chest x-ray with atelectasis, effusion and some fluid on board. This was day 3 post admission after a 12' fall with SDH that progressed to brain death despite surgical intervention. We give a unit of PRBC to replenish the Hgb, but then were faced with the dilemma how best to remove the extra fluid on board. Without Vasopressin, U/O was over 1000ml/hr, and Na-165. Didn't feel comfortable stopping/lowering vasopressin as it would have lead to further electrolyte imbalances. We gave Lasix (20mg IV) to remove fluid, decrease CVP but try to control electrolytes. In the end, we managed to improve lung function, and transplanted all organs. However, some blood showed up in the urine but kidneys worked OK after transplant. What would have have you done? Decrease/stop vasopressin or use diuretics to remove the extra fluid on-board? Laszlo, First I want to commend you on the excellent outcome. I might suggest that in this case it appears that the CVP may have been a poor predictor of the patients intra-vascular volume. Did you have a swan ganz in place (surrogate)? Was the patient also dependent on inotropes? The story you painted would suggest that perhaps the patient needed more volume. Certainly the PRBC's were indicated, and I'm curious what crystalloid you chose? Often people seem to switch to D5W too soon, which ulitmately may cloud the picture with osmotic diuresis. Instead I prefer 0.45%NS or 0.225% if it's available. I have heard of simultaneous administration of both mannitol and vasopressin. I have not tried this myself or seen reports of this in the literature.
John E Belcher BS, CCEMT-P, CPTC, CTBS
Donation CoordinatorNew England Organ Bank
|
|
|
|
|
Forum Newbie
Group: Forum Members
Last Login: 4/3/2009 4:48:30 PM
Posts: 5,
Visits: 8
|
|
| John Thanks for your feedback. No, we didn't have a Swan-Ganz catheter, only CVC. It was the middle of the night, with no intensivist around. Pt. was on Levophed of 6, CVP-10, peripheral edema, wet chest x-ray, Hgb-78. We tried to use the PRBC to draw in the fluid into the vascular space. Hgb increased to over 100, came off the Levophed, and CVP decreased to 5. Urine output and electrolytes stabelized with Vasopressin infusion. I believe the crystalloid we used was D5W1/2NS. Thanks
- Laszlo Kalmar, RN
- Organ Donation Specialist
- BC Transplant
- Vancouver, BC
|
|
|
|