Clinical Operations

Pre-Donor Management Recommendations

1. Hemodynamic Support(BP):

  • If needed give fluid boluses to maintain a SBP great than 100 mmHg and MAP greater than 60 mmHg.
  • If Pt. is on vasopressors, give fluid bolus before increasing drip rate.
  • Review pts labs to see if blood products(PRBCs, Albumin) may be requiered.
  • If there is no response to previous therapies start:
    1. Dopamine drip from 0.5 to 20 mcgs/kg/min.
    2. Levophed drip, titrate loading dose to maintain MAP abover 60mmHg.
    3. Neosynephrine drip from 5-200 mcgs/min, titrate to effect.

2. Intravenous Fluids:

When possible switch MIVF to 0.45% NS, if CVP is being monitored, maintain below 6mmHg, replace electrolytes has needed.

3. Labs/Tests:

  • Initial EKG
  • PCXR daily
  • CBC, CMP, PT, PTT, INR, Mg, Phosp every 12 hours, there may be a request for cardiac panel if needed.
  • Type and Crossmatch
  • ABG every 12 hours
  • Initial U/A with reflex

Please replace if:

  • Hbg is less than 9
  • Hct is less than 30
  • Plts are less than 90
  • Mg is less than 1.5

4. Vital Signs:

SBP above 100 mmHg and MAP above 60 mmHg, Maintain Temp between 97 to 99ºF, U/O should not be greater than 350 ml/hr, if it is order specific gravity and osmlality. If pt is in DI treat with DDAVP or start Vasopressin drip to maintain u/o between 100-200 ml/hr.

5. Respiratory Care:

  1. Maintain pt. on correct ventilatory setting, correct with ABG results if needed.
  2. If not on PEEP, place setting to +5
  3. Maintain pO2 greater than 100 mmHg.

6. Cultures:

If pt admission is greater than 72 hours, blood and urine cultures will be required.