LifeShare Of The Carolinas - LifeShare Carolinas



LifeShare Of The Carolinas

Routine Deceased Donor Orders - Pediatric

LifeShare Coordinator____________________________________ Blackberry # _____________________

• DO NOT initiate these orders until patient is declared brain dead and consent obtained for donation

• Discontinue all previous orders except those specifically continued below

• Discharge patient and readmit as “Organ Donor” prior to entering new orders

o Attending Physician/Responsible Party: LifeShare Of The Carolinas

Procedures:

______Arterial Line

______Triple or Quad Lumen Central Venous Catheter

______Bronchoscopy - If available, video record/photograph bronchoscopy

• REASON: Therapeutic and to assess for anatomical abnormalities

Obtain current Weight:____________ kg Height:_______________ in

Cardiology:

_____Stat 12 lead EKG - NO Physician Interpretation

_____Stat Echo

• STAT dictated read and electronic copy of study on disc required

• Include estimated LVEF %

• REASON: Evaluation of cardiac function

Radiology:

_____ AP Portable CXR with lung measurements to include:

• length of left lung, length of right lung, aortic knob width, diaphragm width and distance RCPA to LCPA

• If central access is pending, hold order until access is obtained

Laboratory: STAT

_____ ABG _____ HgBA1C

_____ CBC with Differential _____ Amylase/Lipase

_____ CMP _____ Troponin I

_____ PT/INR _____ Fibrinogen

_____ PTT _____ Magnesium

_____ UA with Micro _____ Phosphorus

_____ Direct Bili _____ Lactate

_____ ABO Type and crossmatch for 2 units PRBC’s, maintaining 2 units available at all times

• Subgroup A blood types

_____CMV Negative, if available

_____Blood culture x 1 with sensitivity

• May obtain from Arterial or Central Venous Line if < 12 hours post insertion

_____Urine culture and sensitivity

_____Bronchial washing x 2 for gram stain

• Obtain during bronchoscopy

• BAL sample from Right Lung and Left Lung

• Perform bacterial culture only if initial gram stain is positive

Pharmacy: STAT and all meds should be mixed in NS when possible

_____Vasopressin: Mix 40 units in 250 ml NS; Dose= 0.5 milli-units/kg/hr

• May titrate at LifeShare’s direction to achieve desired urine output of __________ml/hr

_____Artificial Tears or Normal Saline - 2 drops per eye every 2 hrs and tape lids closed

Fluids:

_____ Maintenance IVF_____________________, infused at_________ml/hr, add _________mEq KCl

_____ Start urine replacement of______________, infused at ________ ml:ml/hr

• May titrate fluids at direction of LifeShare Coordinator

Vasopressors:

______Dopamine infusion titrating dose from 1-20 mcg/kg/min

______Epinephrine infusion titrating dose from 0.1-1 mcg/kg/min

______Phenylephrine infusion titrating dose from 0.1-0.5 mcg/kg/min

______Vasopressors listed below to maintain a SBP of _____________:

______________________________________________________________________________________

______________________________________________________________________________________

Antibiotics:

______Cefazolin (Ancef) 25mg/kg IV q 8 hrs (max: 1 gm/dose)

______Ceftazidime (Fortaz) 50mg/kg IV q 8 hrs (max: 2 gm/dose)

______Clindamycin (Cleocin) 10mg/kg IV q 6 hrs (max: 900 mg/dose)

______Ceftriaxone (Rocephin) 75 mg/kg IV daily (max: 2 gm/dose)

______Continue previous antibiotic coverage as follows:

_______________________________________________________________________________________

_______________________________________________________________________________________

Hormone Replacement Protocol: (Steroid, Insulin, Dextrose and Levothyroxine should be given in rapid succession)

______Methylprednisolone (SoluMedrol) mix in NS

______30 mg/kg IV bolus over 30 minutes (Total Dose=__________mgs)

______Repeat every 6 hrs

______Repeat every 12 hrs

______Regular Insulin 0.1 units/kg IV (Total Dose=__________units)

______Dextrose

______D25

______< 6 months of age 1 mL/kg IV bolus (0.25 gm/kg/dose), max = 25gm/dose

______> 6 months to 12 years of age 2 mL/kg IV bolus (0.5 gm/kg/dose), max = 25gm/dose

______D50

______>12 years of age 25grams/1amp IV

______Levothyroxine: Mix 1000 mcg/50 ml NS (See chart below for dosing)

Bolus should be administered over 30 minutes and then start infusion as indicated below:

|Check applicable |

|Age |

|Bolus (mcg/kg) |

|Infusion (mcg/kg/hr) |

| |

| |

| |

|0-6 months |

|5 |

|1.4 |

| |

| |

| |

|6-12 months |

|4 |

|1.3 |

| |

| |

| |

|1-5 years |

|3 |

|1.2 |

| |

| |

| |

|6-12 years |

|2.5 |

|1 |

| |

| |

| |

|12-16 years |

|1.5 |

|0.8 |

| |

| |

Respiratory:

______Perform ABG’s, O2 Challenges and ventilator changes at the direction of the LifeShare Coordinator

______Chest PT and Rotation

• Keep HOB at 30 degrees

• Auscultate lung fields every hour

• Module or manual rotation every 15 minutes

• Percussion for 15 minutes every 2 hours, suctioning each time

• If hemodynamically tolerated, place in trendelenburg for percussion then suction and return HOB to 30degrees

______Rotation, PT, auscultation of lung fields prn to maintain O2 saturation of 96% or better

Nursing:

_____ Blood Glucose checks every 1 hour

• Notify LifeShare Coordinator if > 150 mg/dL

_____ NG/OG tube to low intermittent wall suction prn

_____ Record VS every 15 minutes and CVP hourly

• Notify LifeShare Coordinator if:

• Heart Rate __________ beats/minute

• Systolic BP __________mmHg

• CVP __________mmHg

• Urine output < 1 ml/kg/hr or > 5ml/kg/hr

• O2 saturation < 96 %

• pH less than 7.35

_____ Maintain patient temperature at 96.0 – 101.0 degrees Fahrenheit

• Use warming blanket and/or Baer Hugger as needed

• Record temperature hourly

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