Download LifeSharing Pediatric Donor Management Goals

TITLE: GUIDELINES FOR MANAGEMENT OF
PEDIATRIC DONORS
PROCEDURE LEVEL:
1
RELEASE DATE:
01/19/2010
EFFECTIVE DATE: 01/22/2010
DOCUMENT NUMBER: ORCL-016
REVISION: C
1.0 PURPOSE
Establish guidelines for the physiologic management and organ placement
of pediatric organ donors.
2.0 STATEMENT OF POLICY
2.1 Lifesharing will maximize the number of transplantable organs through
the development and implementation of standardized physiologic
management guidelines.
2.2 Lifesharing will collaborate with the Pediatric Intensive Care Unit
(PICU) medical staff to optimize donor management.
2.3 Donor vital signs, medications, and fluid/blood replacement should be
ordered and treated appropriately based on weight and age of the
donor.
2.4 Accurate and timely documentation of all donor management requests
and activities by Procurement Coordinator.
3.0 DEFINITIONS
N/A
4.0 PROCEDURE
4.1 Hemodynamic Parameters: Blood pressure and heart rate should be
maintained to ensure adequate organ perfusion according to the
donor’s age. Lowest acceptable Systolic blood pressure= (2 x Age in
years) + 70
Abnormal Vital Signs
Infant
Toddler
School Age
Adolescent
Pulse
>160
>140
>120
>110
Systolic Blood Pressure
<60
<75
<85
<90
4.2 Vasoactive Drips:
4.2.1 Minimize vasopressors. Refer to Pediatric Organ Donation
Standing Orders for management of hypotension utilizing
dopamine, vasopressin, and neosynephrine in sequence of
priority.
4.2.2 Prioritize the weaning off of Epinephrine infusions using
other fluids and/or medications.
4.2.3 Review plan for initiating/weaning of vasoactive medications
with Administrator on call.
Page 1 of 3
Documents printed from ImageSilo are for reference only.
TITLE: GUIDELINES FOR MANAGEMENT OF
PEDIATRIC DONORS
PROCEDURE LEVEL:
1
DOCUMENT NUMBER: ORCL-016
RELEASE DATE:
01/19/2010
EFFECTIVE DATE: 01/22/2010
REVISION: C
4.3 Hormonal Resuscitation Protocol:
4.3.1 Use on all brain dead, potential heart donors to optimize
cardiac function.
4.3.2 Use on brain dead, non-heart donors if they are dependent
upon large doses of one vasopressor/inotrope or on multiple
vasopressors/ inotropes to minimize possible organ
dysfunction from use of these drugs.
4.3.3 Refer to Pediatric Organ Donation Standing Orders (ORCLF006) for initiation and dosing of Levothyroxine/Hormonal
Resuscitation Protocol.
4.4 Echocardiogram: Start Hormonal Resuscitation Protocol several hours
prior to obtaining echocardiogram so that the echo will reflect a heart
that is recovering from the adverse effects of brain death. If possible,
wean vasopressors/inotropes to a minimal dose prior to obtaining
echocardiogram. If possible, do not obtain an echo if the patient is
profoundly hypotensive or tachycardic.
4.5 Urine Output: Urine output should be maintained at a minimum of 1-2
ml/kg/hour. Refer to Pediatric Organ Donor Standing Orders for
fluid/blood product replacement and management of diabetes
insipidus.
4.6 Temperature: Maintain donor’s body temperature at 35.5-37.5 Celsius
utilizing a heating blanket.
4.7 Laboratory Values
4.7.1
All laboratory values should be maintained within the normal
range, corrections should be made according to policy
Pediatric Organ Donor Standing Orders.
4.7.2
Appropriate laboratory tests should be performed at least
every four hours and prn to prevent electrolyte imbalances
common with brain-death. Cardiac enzymes need only be
done for potential heart donors.
4.7.3
The frequency and amount of additional laboratory tests
performed is based on the individual donor and situation,
(minimum every four hours)
4.8 Pulmonary: Optimize cardiopulmonary function. Refer to Pediatric
Organ Donor Standing Orders for specific evaluation and treatment
guidelines of potential lung and heart donors.
4.8.1 Maintain a PO2 >100 mm Hg with the lowest FIO2.
4.9 Antimicrobial Therapy
4.9.1
One hour prior to the operating room (OR), all donors will
receive Ancef 25 mm/kg as prophylaxis against possible
infection.
4.9.2
Ceftriaxone 75mg/kg/day (not to exceed 2 gm/day) if
aspiration is known or strongly suspected.
Page 2 of 3
Documents printed from ImageSilo are for reference only.
TITLE: GUIDELINES FOR MANAGEMENT OF
PEDIATRIC DONORS
PROCEDURE LEVEL:
1
DOCUMENT NUMBER: ORCL-016
4.9.3
4.9.4
RELEASE DATE:
01/19/2010
EFFECTIVE DATE: 01/22/2010
REVISION: C
Continue previously ordered antibiotics, if donor is already
being treated for specific infectious process.
Consult with AOC to determine whether Ancef/Rocephin
should be discontinued if patient already receiving previous
antimicrobial therapy.
5.0 REFERENCES
5.1 Pediatric Organ Donation Standing Orders (ORCL-F006)
Page 3 of 3
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