The Investigative roles of ASIC
Topic: Perioperative Nursing Management of a Patient Undergoing a Cadaver Kidney Transplant in all Phases of the Patient Perioperative Experience.
Perioperative Nursing Management to a Cadaver Kidney Transplant Patient
Successful kidney transplant is critical and highly crucial in the context of offering improved quality and prolonged life. Consequently, it is more efficient unlike long–term dialysis thereby administered to patients having chronic or end stage renal disorder (Zuber, et al. 2011). Therefore, there is need to ensure successful transplant of a kidney from a donor and the respondent to accept the organ and function effectively. Cadaver kidney transplant involves getting a donation from a brain-dead potential organ donor (Glazer et al. 2009). The process of transplant from a dead person is a critical one and involves various perioperative measures to manage and ensure effective transplant process. This is ensured to utilise organs from healthy persons who have passed on and having proper match to the receiving patient (Doxiadis, de Fijter, Mallat, et al. 2007). This essay outlines the various perioperative nursing management to a cadaver kidney transplant in all the stages during the whole process. This will be achieved by discussing the various operations necessary in the perioperative process of cadaver kidney transplant. The processes are similar to live donor transplant only that with cadaver transplant, there is need to ensure the organ from the dead donor is fit for transplant.
Chronic renal failure or the end-stage renal disease prompts surgical procedures upon the patients whether undergoing dialysis or not (Klatte, Seitz, Waldert, et al. 2010). The carrying out of perioperative procedures to cadaver kidney transplant is equally important to ensure the patient recovers and the new kidney is accepted by their body system; that is, it matches with recipient’s body system. The responsibility for perioperative care and nursing management of chronic kidney disease patients is shared among the family physician, nephrologist, anaesthesiologist and surgeon (Heemann et al. 2011). This ensures every aspect of the nursing case is taken care of and efficiently ensured to make the patient achieve full recovery. The perioperative nursing management practices are carried out immediately before the operation and during the main surgery. The procedures are carried out to ensure that the patient undergoes successful transplant and does not attract other infections (Moroni, et al. 2010). The management practices as directed by the surgeons will see to it that the renal system gets back to normal and the excretion process runs effectively even during the operation by conducting a prior dialysis to free the body off any harmful wastes. This is crucial to ensure that once the new kidney is in operation, it is not overworked rest it fails to pick up the system effectively due to excessive work.
Perioperative procedures are carried out to ensure stable and healthy state of the patient in the course of the operation and take precautionary measures in case of any alarm. The nurses evaluates the health of the patients in regards to their blood pressure to determine probability of risk to cardiac arrest, determining blood sugars, evaluation of presence of enough blood to avoid anaemia, evaluate levels of potassium to determine whether anaesthesia is to be used, evaluating acid-base disorders for reduce perioperative risks (Evenepoel, Sprangers, Lerut, et al. 2012). The procedures are critical and are managed to ensure the body electrolytes are maintained to minimise any chance of graft rejection after transplant. Candidates for renal transplantation are subjected to extensive evaluation regarding their health among other factors that may have adverse effects on the outcome (Doxiadis, de Fijter, Mallat, et al. 2007). These are carried out to ensure that the organ is accepted by the recipient’s body and normal physiological process realised. Prior to the main operation, there are procedures and management process necessary for consideration and evaluation. Perioperative procedures are carried out to ensure compatibility and avoid infection. In respect to cadaver kidney transplant, the perioperative nursing management is critical and crucial to ensure the kidney obtained from the dead donor is effective and working prior to transplant (Glazer, et al. 2009). The organ for transplant must be obtained via consent from a healthy potential donor and calls for procedural measures to re-achieve healthy and sound renal system. Consequently, health tests like blood group, status of body functioning and blood sugars are assessed prior to conducting kidney removal from the dead donor to ensure the organ is in order. The organ is later treated with immunosuppression to promote acceptance by the recipient.
Further, the kidney recipient is administered with immunosuppression prior to operation which is vital in helping to prevent alloimmune rejection response (Rang et al. 2006). The process is conducted to achieve the following: avoid acute and chronic rejection; reduce the toxicity of drugs, as well as rates of infection and malignancy; and eventually realise very high possible rates of patient and graft survival (Egbuna, et al. 2007). Immunosuppressive agents are administered before surgery to prevent graft rejection. There is also need to look into the levels of potassium values in the body system in order to avoid anaesthesia in patients having chronic kidney disease with potassium serum level beyond 5.5 mEq per litre (5.5. mmol per litre) (Rang, et al. 2006). Nevertheless, it is necessary to administer acceptable levels of potassium level prior to the main surgery. Nurses are expected to ensure continued dialysis prior to transplant to ensure that the body waste products and excess waters are removed without stressing the transplanted organ. Continued renal replacement therapy is crucial in order to ensure fluid and electrolyte management and prevent uremia even before the surgery (Zuber, et al. 2011).
During the surgery, there is need to minimise excessive bleeding and this is ensured by controlling the occurrence of uremia to the patient. This condition can lead to platelet dysfunction and result to enhanced perioperative bleeding (KDIGO 2009). To minimise uremic complications, patients having end stage renal disease are put into dialysis process a day prior to surgery. In respect to the bleeding and platelets functioning, it is advisable that the patient ought not to be subjected to antiplatelet agents, aspirin and dipyridamole (Persantune) within 72 hours prior to surgery with patients having end stage renal disease or uremic chronic kidney disorder (Zuber, et al. 2011). It is also crucial to note that given agents having minor platelet effects on patients without uremia can have exaggerated effects on patients having end-stage renal disease and may theoretically raise the risk of intraoperative bleeding.
With respect to haemodialysis, it is critical to avoid the use of heparin. In normal circumstances, a small amount of heparin is utilised in the process of haemodialysis with a residual anticoagulant effect that last for even two and a half hours (Ciapetti et al. 2009). With respect to the effect of heparin to intraoperative bleeding is not very clear and therefore the need to avoid use of heparin or wait at least 12 hour after the last haemodialysis to commence surgery procedures. Renal functions decline orchestrated by decreased renal production of erythropoietin, the patient is prone to anaemia (Zuber, et al. 2011). This calls for perioperative measures by nurses to ensure sufficient blood supply to the patient in case of anaemic conditions.
With cadaver transplant, the organ is thoroughly examined for any infections from the dead donor prior to the eventual death. Amid the fact that the dead person may be termed healthy prior to death, thorough medical check-up ensures no current of prevailing conditions can jeopardise the success of the transplant. The organ is removed surgically by the surgeons and specially placed under sterile conditions to safeguard the organ from any opportunistic infections (Rang et al. 2006). Consequently, the organ must be transplanted within the specified duration from the time of removal from the cadaver donor to the kidney transplant recipient. The correction of severe anaemia is crucial to the patient of cadaver kidney transplant to alleviate complications arising from perioperative loss of blood and haemodilutional effects that may arise (KDIGO 2009). Consequently, this calls for sufficient supply of required blood of the patient to ensure ready and steady supply for transfusion. One possible downside regarding to product transfusion is the formation of an anti-body. This may reduce the future chances of the patient for successful transplant, therefore during the operation; operative nurses ensure management practices looking into all ways of doing away with emergence of antibodies.
Further, hyperkalemia is also checked regularly in the operation process as it may occur with intraoperative infusion of blood supply due to cellular lysis (KDIGO 2009). The precautionary nursing management measure looks into preventing cellular lysis in the patient circulatory system during transfusion. Blood sugars are also monitored and subsequent administration of low dosage of dextrose infusions made with respect to detection of hypoglycaemia (Heemann et al. 2011). Normal levels of sugars are necessary to ensure the body reacts normally in the excretion process after transplant. In case of excessive work with low or high blood sugars, the new organ may be rendered useless.
With resistance of bacteria to prophylactic antibiotics there is a need to establish the effective option for the patient as many patients with chronic renal failure receive them for surgical procedures (KDIGO 2009). A preferable option is the first generation cephalosporin within a dosage appropriate for renal functioning which would act effectively as a choice for empiric therapy. With regard to blood pressures as earlier illustrated, preoperative and intraoperative hypertension is common with patients having chronic renal ailment and is enhanced by various factors (Klatte, Seitz, Waldert, et al. 2010). The factors include anxiety, stress of surgery prompting catecholamine response, as well as baseline hypertension arising from kidney failure. Measures are thereby taken to reduce effects of stress, lessen anxiety and steady the patient through the surgery. For patients with hypertension, there are exceptions allowing for continuity with antihypertensive drug therapy through the surgical period (Klatte, et al. 2010). This is crucial for the wellbeing of the patient, as well as ensuring reduced occurrence of complications during and after the transplant. There are drugs that should be discontinued with surgery, these incorporate antihistamines and decongestants as they may lead to rebound hypertension. With diuretics, for patients with chronic kidney ailment, there is need to discontinue 2-3 days prior to surgery (Glazer, et al. 2009). This is crucial with perioperative procedures as its discontinuation avoids possible volume depletion and intraoperative hypotension that may worsen the functioning of the renal system.
The cadaver kidney transplant calls for critical measures to ensure the donor’s kidney is in perfect condition prior to transplant, apart from the critical matching physiological aspects, there also need for ensuring hygiene and alleviating infections (Doxiadis, de Fijter, Mallat, et al. 2007). In essence, there is also need to maintain a urinary catheter patency and closed system with the latter ensuring minimal risk to urinary tract while the former being crucial in keeping the bladder decompressed and prevent pressure on suture lines (Glazer, et al. 2009). There have been great concerns with respect to the cadaver kidney transplants and there has been an upper limit of the number of cadaveric transplants that can take place. In essence for this essay, is the perioperative procedures within the nursing profession carried out as management measures to ensure a successful transplant. It is therefore crucial to ensure effective perioperative nursing management practices during cadaver kidney transplant to ensure a success kidney transplant and enhance life of the patient.
In conclusion, cadaver organ transplant is essential in ensuring lifesaving as getting live donors for kidney transplant is not sufficient for all patients in need of kidney transplant. However, there is a greater need to look critically at the perioperative nursing management practices to ensure successful transplant and subsequent effective renal system after surgery. The carrying out of such an intrusive procedure is advantageous in the sense that the patient’s life is enhanced and can live a more natural life after the surgery and be aided by immune-suppressants (KDIGO 2009). Although there are other remedies and therapies for end stage renal diseases, renal failure proves very fatal and kidney transplants present an opportunity to ensure life. Further, kidney transplant is the preferred treatment mode that is cost effective and ensures quality of life enjoyed by the patient after the surgery. In essence, with the advantages of kidney transplant, the source of kidney for transplant has been a great topic for study.
Ciapetti, M., di Valvasone, S., di Filippo, A., Cecchi, A. and Peris, A., 2009.
Low Dose Dopamine in Kidney Transplantation.41(10): 4165-4168.
Doxiadis, N., de Fijter, J., Mallat, M., et al., 2007. Simpler and Equitable Allocation of Kidneys from Post-mortem Donors Primarily Based on Full HLA-DR Compatibility. Transplantation. 83(9): 1207-1213.
Egbuna, O., Taylor, J., Bushinsky, D. and Zand, M., 2007. Elevated Calcium Phosphate Product After renal Transplantation is a Risk factor for Graft Failure. Clinical Transplantation. 2194): 558-566.
Evenepoel, P., Sprangers, B., Lerut, et al., 2012. Mineral Metabolism in Renal Transplant Recipients Discontinuing Cinacalcet at the Time of Transplantation: A Prospective Observational Study. Clin Transplant. 26(3): 393-402. Epub 2011/10/20.
Glazer, E., Akhavanheidari, M., Benedict, K., James, S. and Molmenti, E., 2009. Cadaveric Renal Transplant recipients can Safely Tolerate Removal of Bladder Catheters within 48 hours of Transplant. Inter-nation Journal of Angiology. 1(2):2.
Heemann, U., Abramowicz, D., Spanoviski, G. and Vanholder, R., 2011. European Renal Practice Work Group on Kidney Transplantation. Endorsement of the Kidney Disease Improving Global Outcome (KDIGO) Guidelines on Kidney Transplantation: A European Renal Best Practice (ERBP) Position Statement. Nephrology Dialysis Transplantation. 26(7): 2099-2106.
Hickson, L., Gera, M., Amer, H., et al., 2009. Kidney Transplantation for Primary Focal Segmental Glomeruloscelerosis: Outcomes and Response to Therapy for Occurrence. Transplantation. 87(8): 1232-1239.
KDIGO, 2009. Kidney Disease: Improving Global Outcome (KDIGO) Transplant Work Group. KDIGO Clinical Practice Guideline for the care of the Kidney Transplant Recipients. American Journal of Transplantation, 9(3): S1-S157.
Klatte, T., Seitz, C., Waldert, M., et al., 2010. Features and Outcomes of Renal cell Carcinoma of Native Kidneys in renal Transplant Recipients. BJU International. 105(9): 1260-1265.
Moroni, G., Gallelli, b., Quaglini, S., Banfi, G., Montagnino, G. and Messa, P., 2010. Long- term Outcome of Renal Transplantation in Adults with Focal Segmental Glomeruloscelerosis. Transplant International. 23(2): 208-216.
Rang, S., West, N., Howard, J. and Cousins, J., 2006. Anaesthesia for Chronic Renal Disease and Renal Transplantation. European Association of Urology, 4: 246-256. London: Elservier B. V.
Zuber, J., Le Quintrec, M., Sberro-Soussan, R., Loirat, C., Fremeaux-Bacchi, V., Legendre, C., 2011. New Insights into Post-renal Transplant Hemolytic Uremic Syndrome. Nature Reviews Nephrology. 7(1): 23-35. Epub 2010/11/26.