LifeShare Of The Carolinas
Routine Deceased Donor Orders - Pediatric
LifeShare Coordinator____________________________________ Blackberry # _____________________
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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
_____ CBC with Differential
_____ CMP
_____ PT/INR
_____ PTT
_____ UA with Micro
_____ Direct Bili
_____ HgBA1C
_____ Amylase/Lipase
_____ Troponin I
_____ Fibrinogen
_____ Magnesium
_____ Phosphorus
_____ 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
Page 1 of 3 – Pediatric
Signature:_____________________________________________ per LifeShare Standing Orders/Protocol
LifeShare Organ Recovery Coordinator
Date:___________________ Time:__________________ UNOS: ___________________
Revised 2/28/2012
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
Page 2 of 3 – Pediatric
Signature:_____________________________________________ per LifeShare Standing Orders/Protocol
LifeShare Organ Recovery Coordinator
Date:___________________ Time:__________________ UNOS: ___________________
Revised 2/28/2012
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 <__________ or > __________ beats/minute
 Systolic BP <__________ or >__________mmHg
 CVP <__________ or >__________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
Page 3 of 3 – Pediatric
Signature:_____________________________________________ per LifeShare Standing Orders/Protocol
LifeShare Organ Recovery Coordinator
Date:___________________ Time:__________________ UNOS: ___________________
Revised 2/28/2012