Duke University



Withdrawal of Life Support Checklist For 6 EastBefore withdrawing life support, a huddle should occur and the following checklist reviewed.Huddle participants: Required: Care Nurse, Provider, R.T.Present if available: Nurse Clinician, Charge Nurse, Chaplain, Fellow, Attending, Case ManagerPolicy/Regulations:DNAR order signed by attending?Withdrawal of Life Support form signed by 2 attendings?Carolina Donor Services notified (800-252-2672)?Patient:Time of withdrawal? Are all family/friends here that want to be here?What are we withdrawing (ventilator, vasopressors, IABP, BIPAP ,CRRT,ECMO etc.)In what order are we withdrawing the life support items?If extubating, what are we extubating to (room air, FM, O2 etc.)?Before extubation the RN should collaborate with the RT about the patient's drive to breath. This will help determine the level of sedation, air hunger and comfort care that may be needed.Does the patient have an ICD or pacemaker? If so, is the ICD shock function deactivated?On days call device nurse clinician (970-9623),EP fellow on call or nights- page the CCU fellow to turn off the AICD. You can use a magnet to deactivate the AICD. Magnet does not turn of pacer.What symptoms do we anticipate (pain, air hunger, SOB, anxiety, secretions, seizures)? What is the plan for managing each symptom?Are the meds to manage symptoms readily available at bedside?If using a continuous infusion for symptom management, does the care nurse have the key?Make sure that the continuous symptom management medications are NOT ordered as a palliative care order set. This will not give you the option to give prn medications in a timely manner for air hunger. Order the medications as a continuous and prn bolos off the bag. The nurse should program the pump under ICU settings.Are restraints off?Family:Have we explained the procedure and dying process to the family?Chaplain notified and is he/she available to support family?Bereavement Care Tray ordered (681-2727)?Would the family like to speak with Decedent Care before the withdrawal? If so, have they been notified (681-6264)?Does the family want to be in the room at the time of withdrawal (are there enough chairs in the room)?Environment:Is there a waiting room available/unlocked for family and stocked with tissues?Is the monitor in the room on privacy screen or off?Has all unnecessary equipment been removed from room? ................
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