Gift of Life Michigan
Donor Management Guidelines

When the donor is on a medication, except for current antibiotic therapy, that is not
consistent with the approved Gift of Life medication list, the medical director will be
consulted
Donor Management Goal #1: Lung Recruitment
Follow Pulmonary Management Guidelines (age 15 to 60): Attachment A including
but not limited to:
 Medications
o Narcan in conjunction with Norcuron
o Norcuron prn for peak pressures >30 cm H2O
o Albuterol and Atrovent via nebulizer or unit dose
o Mucomyst nebulizer in conjunction with Albuterol for thick secretions
o Solu-medrol
 Testing and Therapies
o Chest x-ray
o Bronchoscopy as soon as possible after brain death and consent
o ABG’s baseline and on 100% q 4 hours
o Bedside care including chest percussion therapy, turning, elevated HOB,
etc (see Attachment A).
o Ventilator Associated Pneumonia Protocol
Donor Management Goal #2: Mean Arterial Pressure >60
Levothyroxine drip (T4) and Vasopressin per Hormonal Therapy Policy 5-09.
T4 Rationale: There is a significant depletion of circulating hormones as a result of the
physiological changes associated w/brain death. These changes result in metabolic
dysfunction at cellular levels, initially affecting mitochondrial deterioration and severe
hemodynamic instability. The rapid succession of the above cocktail is to stimulate
cellular metabolism which may be impaired or stopped in the absence of normal brain
function.
1 unit Vasopressin IVP
15 mg/kg Solumedrol IVP
10 units regular insulin IVP
20 mcg T4 IVP
T4 gtt of 200mcg T4/500cc NS at initial rate of 25cc/10mcg. Increase prn by 5 mcg/hr to
max of 20 mcg/hr.
Solumedrol 15mg/kg q 6 hrs.
Page 1
Rev. 7/11/11
Maintenance IV Fluid:
Size/Age:
Sodium Level:
< 6 months
---<10 kg
---10-20 kg
--->20 kg to age 15
---15 and older
<148
IV Fluid:
IV should contain D10%
D5/ 0.2 NS/ 20 mEq/L KCl
D5/ 0.3 NS/ 20 mEq/L KCl
D5/ 0.45 NS/ 20 mEq/KCl
D5W/0.45 NS, NS, LR, (can add KCl as needed)
15 and older
D5W, 0.45NS, (can add KCl as needed)
>148
Hourly Maintenance Amounts:
Adjust rate on a case by case basis based on fluid balance status
Size:
Calculation:
<10 kg
100 mL/kg/24hours
10-20 kg
(1000 mL + 50 mL/kg for each kg >10)/24 hours
>20 kg
(1500 mL + 20 mL/kg for each kg >20)/24 hours
Adults (15 and
100 mL/hr adjusted to patient status and condition
older)
Hypovolemia: CVP < 6; PAWP <8
 Bleeding/Coagulopathy:
o Hematocrit < 30% or Hemoglobin <10 g/dL: Packed Red Blood Cells
o PT >15 or INR > 1.5: Fresh Frozen Plasma
o Platelets <100,000: Platelets
o Fibrinogen <2.9 : Cryoprecipitate
o Consult Medical Manager if diagnosed with Heparin Induced
Thrombocytopenia (HIT)
 Consider ordering a functional HIT assay
 Avoid Heparin in management of donor
 Consider the use of Argatroban 15 minutes before crossclamp 350mcg/kg IV over 15 minutes
 Utilize routine cold flush of the allograft
Age:
PRBC’s
FFP
Platelets
Cryo
Pediatric
10-15 mL/kg
10-15mL/kg
10-20 mL/kg
5-10 mL/kg
Adult
1-2 units
4 units
5 units
6 units
 Dehydration:
o Adults: Fluid bolus
o Pediatrics:
 10-20 mL/kg NS or 5-10 mL/kg 0.2NS bolus
 5% Albumin 5-10 mL/kg
Page 2
Rev. 7/11/11

Diabetes Insipidus: urine output >4 mL/kg/hr
o Serum Osmolality > 295 , Urine Osmolality > 300 ,
o Specific Gravity < 1.005
o Manage electrolyte imbalances
o Replace fluid loss as needed
o Vasopressin or Desmopressin titrated to achieve u/o 1-3 mL/kg/hr
o DDAVP 0.3 mcg/kg over 30 minutes (max 4 mcg)

A Creatinine Clearance is not required but may be requested by a transplant
center:
o Creatinine Clearance:
volume of urine
Urine Creatinine x min. of collection X 1.73
Serum Creatinine
BSA

Hypervolemia: CVP > 10; PAWP >12
 Lasix, Bumex or Mannitol
 Consider decreasing hourly intake rate
Donor Management Goal #3: Less than 2 Vasopressors
Levothyroxine drip (T4) and Vasopressin per Hormonal Therapy Policy 5-09.
Cardiac Algorithm: Attachment B:
Attempt to wean vasopressors as able in the following order:
1. Neosynephrine
2. Epinephrine
3. Levophed
4. Dopamine
Hypotension: MAP <60, CVP >6
 Initiate T4 therapy
 If CVP <6: consider treatment for hypovolemia
 Add pressors in the following order:
o Dopamine < 10 mcg/kg/min (consider tachycardia when starting)
o Levophed
o Neosynephrine
 Rule out causes of decreased preload, such as increased intra-thoracic pressure
related to ventilator status.
 Consider pulmonary artery catheter to further assess hemodynamic status\
Page 3
Rev. 7/11/11
Hypertension: MAP >90,
 Wean vasopressors in the order listed above.
 CVP > 10: consider treatment for hypervolemia
 Assess for intolerance to T4 therapy (Policy 5-09)
 Rule-out temporary effects of brain stem herniation
 Hydralazine, Nitroprusside, or Nicardipine (avoid Beta-blockers if heart is being
considered for transplant).
 Consider beta-blocker administration if heart has been ruled out.
Arrhythmias:
 Correct Electrolytes
 Atrial fibrillation or flutter, SVT:
o Diltiazem or cardioversion
 Lethal arrhythmias:
o ACLS Protocol
Low Ejection Fraction and/or Heart Failure: EF <45, CI < 2.2.
 See Cardiac Algorithm: Attachment B
 Consider effect ventilation settings has on cardiac output and preload.
 Consider use of Dopamine over other vasopressors
 Consider the use of Dobutamine or Primacor (Milrinone)
 Rule out coronary artery disease, cardiac contusion, myocardial stunning, etc.
Donor Management Goal #4: pH 7.35-7.45
Baseline ABG and repeat every 4-6 hours
Always treat pH, not CO2


Respiratory Acidosis/Alkalosis: Adjust minute ventilation (rate and or/volume)
Metabolic Acidosis:
o If Sodium is less than 140: Sodium Bicarbonate
o If Sodium is greater than 140 and donor is making urine: Tromethamine
(THAM)
o If Sodium and Chloride are elevated and K is low or normal, consider
using Potassium Acetate.
Page 4
Rev. 7/11/11
Donor Management Goal #5: Final 100% FiO2 ABG= PO2 >300 or P/F
ratio >3
Ventilator Settings:
 Volume Ventilation
o Tidal Volume 10-12 mL/kg of Ideal Body Weight
o Adjust rate for pH 7.35-7.45
o PEEP 5 cm H2O
 Pressure Ventilation
o Consider if peak airway pressure is greater than 35 mm H2O
o Adjust rate for pH 7.35-7.45
o PEEP 5 cm H2O
 Other setting changes to decrease peak pressure and minimize wasted
ventilation:
o Flow-decrease to 40-50 Liters/min
o Inspiratory pause
o Peak Airway Pressures < 30 cm H2O
o Minute Ventilation = TV x RR
Pulmonary Edema, ARDS:
 Increase FiO2 and PEEP (maximum 10 cm H2O)
 Diuretics, avoid Colloids
 Consider proning
Donor Management Goal #6: Sodium 135-155
Hypernatremia: Sodium >145
 Change IV fluids (see maintenance IV fluid chart)
 Free water down NG
o Adults: 200-400 mL every 4 hours
o Pediatrics: 50-200 mL as tolerated
o High Na+ WITHOUT polyurea
 1L 0.2 NS = UO ml/ml with 0.2NS
 Maintenance of D5/ 0.2NS or D5W
 1L D5W Bolus
 Free water 200-400cc NGT q2hrs
Hyponatremia: Sodium <135
 Change IV Fluids to 0.9%NS
 If <128, consider 3% NS (through central line)
Page 5
Rev. 7/11/11
Hyperkalemia: Potassium > 4.5
 Remove K from IV’s
 For pediatrics, consult with Medical Manager and/or Pediatric Intensivist.
 Consider use of following for adults to push K into cells:
o D50 1 amp
o Regular Insulin 15 units
o Sodium Bicarbonate 1 amp
o Calcium Gluconate 1 amp
 Consider Kaexylate down NG (consult with Medical Manager)
 If renal failure is present, consult with clinical resource and medical manager
regarding dialysis.
Hypokalemia: Potassium < 4.5
 If K is consistently low, consider addition of KCl to primary IV fluid
 Be aware that Insulin and Albuterol push K into the cells
Normal or High
Low Phosphorus
Metabolic Acidosis/
Phosphorus
Hyperchloremia
Pediatric
KCl 0.5-1 mEq/kg
KPhos 0.1-0.3
Kacetate 1-4
over 2 hours
mmol/kg over 4-6
mEq/kg in 24
hours
hours
Adult
KCl 20-60 mEq at 20 KPhos 10-15 mmol K actetate 40 mEq
mEq an hour
over 4-6 hours
Hypocalcemia: Ionized Calcium < 1.13
Calcium Chloride or Calcium Gluconate
Hypomagnesemia: < 2.0
Magnesium Sulfate
Hyperglycemia: Blood Glucose >200
 Maintain Blood Sugar between 70 and 200
 Use Regular Insulin IV, monitor K
 Consider using donor hospital’s Critical Care Continuous Insulin Infusion Protocol
(or see Insulin Continuous Infusion Guidelines below)
 Avoid D5W, if possible
 Check glucose as appropriate
 If patient is hyperglycemic, sodium could be low
Page 6
Rev. 7/11/11
Insulin Continuous Infusion Guidelines:
Initiate drip:
Glucose
121-180
181-240
Insulin
1-3 units/hr
2-3 units/hr
241-300
6 units IVP
4-5 units/hr
301-360
8 units IVP
5-6 units/hr
Adjust According to Blood Glucose Levels every 1-2 hours
Current Infusion: Current Infusion: Current Infusion:
Glucose
1-5 units/hr
6-10 units/hr
11-16 units/hr
111-140
Increase by 0-1 Increase by 0-2 Increase by 0-3
unit/hr
unit/hr
unit/hr
141-180
Increase by 1-2 Increase by 1-3 Increase by 3-5
unit/hr
unit/hr
unit/hr
181-240
Increase by 1-2 Increase by 1-3 Increase by 4-6
unit/hr
unit/hr
unit/hr
240-300
3 units IVP
5 units IVP
6 units IVP
Increase by 2-3 Increase by 3-5 Increase by 4-6
unit/hr
unit/hr
unit/hr
301-360
4 units IVP
7 units IVP
8 units IVP
Increase by 2-4 Increase by 3-5 Increase by 4-6
unit/hr
unit/hr
unit/hr
>360
5 units IVP
9 units IVP
10 units IVP
Increase by 2-4 Increase by 4-6 Increase by 5-7
unit/hr
unit/hr
unit/hr
>360
10 units IVP
6-8 units/hr
Current Infusion:
>16 units/hr
Call MM
Call MM
Call MM
Call MM
Call MM
Call MM
If blood glucose is below desired range:
80-110
No change
70-79
Decrease rate by 50% and recheck in 1 hour
60-69
Hold infusion for 1 hour and restart at 50% previous rate then recheck
in 1 hour
Less than 60 Discontinue infusion, consider giving D50
Hypoglycemia: Blood Glucose <50
 Administer D50
 If trouble controlling blood glucose, consider infusion of Dextrose in primary IV
fluids, with Insulin infusion.
 CORRECTED GLUCOSE if > 300 = Corrected Sodium + 1.6 meq for each
100 gm/dl of glucose > 100
*Alternative therapies and medications may be utilized with Medical
Manager approval on a case by case basis.*
Page 7
Rev. 7/11/11
Mean PA = Average of systolic + diastolic NL = 20
 PA systolic = RV
 PA diastolic = LV
PCWP Normal = 2-5 less than the PA diastolic NL = 8-12
Corrected PCWP = PWP x 1.3 – PEEP
SVR= MAP – CVP / CO x 80 NL 800-1200
PVR= MPAP – PCWP / CO x 80
NL < 250
MAP= Diastolic x 2 + systolic / 3 NL 80-100
CO = NL 4-8
Page 8
Rev. 7/11/11
Gift of Life Michigan Medication List
Medication
Albuterol
Adult Dose
2.5-5 mg Q4 hours
Pediatric Dose <40kg or <16
years or
1.25-5 mg Q4 hours
Nebulizer or unit dose
Amiodarone
Life threatening arrhythmia:
150 mg IV bolus over 10 min;
repeat if needed in 10 and 30
min; then 1mg/min for 6 hrs;
then 0.5 mg/min for 18 hours.
Pulse less V-fib or V-tach:
5mg/kg rapid IV bolus not to
exceed 300 mg
Perfusing Tachycardia: 5 mg/kg
IV over 50 min; repeat twice up
to total loading dose of 15 mg/kg
Ancef
1 gm Q 8 hours IV
Argatroban
350 mcg/kg IV over 15 min
prior to cross-clamp
0.5 mg, typically given with
Albuterol
0.5-1 gram IV
0.5-1 gram IV
600 mg Q8 hours IV
50-100 mg/kg/day IV split into 3
doses every 8 hours
350 mcg/kg IV over 15 min prior
to cross-clamp
0.25, typically give with Albuterol
Atrovent
Nebulizer or unit dose
Calcium Chloride
Calcium Gluconate
Clindamycin
Desmopressin
(DDAVP)
Diltiazem
(Cardizem)
Dobutamine
*consult MM
Dopamine
Epinephrine
Furosemide (Lasix)
Glucose 25%
(D50)
Hydrocortisone
(Solu-Cortef)
Hydralazine
(Apresoline)
Insulin- regular
Lidocaine
Levothyroxine
4-8 mcg/day IV in 2 divided
doses
0.25 mg/kg IV bolus then 10-15
mg/hr
3-20 mcg/kg/min IV
10 mg/kg IV
100 mg/kg IV
25-50 mg/kg/day IV split into 4
doses every 6 hours
2-4 mcg/day IV in 2 divided
doses
0.25 mg/kg IV over 2 min then
5-15 mg/hr
3-20 mcg/kg/min IV
3-20 mcg/kg/min IV
1-4 mcg/min IV
20-120 mg IV
1 amp (25 grams)
3-20 mcg/kg/min IV
0.05-0.3 mcg/kg/min IV
0.5-1 mg/kg IV
1-2 mL/kg IV
15 mg/kg Q6 hours
6 mg/kg IV Q6 hours
5-10 mg IV q 10-15 min
(max of 10-15 mg Q4-6 hours
2-10 units/hr IV can be titrated
higher to maintain blood
glucose 70-200.
50-100 mg IV bolus; then 10-20
mcg/kg/min
20 mcg bolus; then 10-20
mcg/hr
0.1-0.2 mg/kg/dose IV q 4-6
hours up to 1.7-3.5 mg/kg/day
0.05-0.2 unit/kg/hr IV, titrated for
blood glucose 70-200.
Page 9
1 mg/kg bolus IV; repeat in 15
min x2 then 20-50 mcg/kg/min
Refer to Policy 5-09
Rev. 7/11/11
Magnesium Sulfate
1-2 grams IV
Mannitol
50-200 gm/24 hours IV in
divided doses
Methylprednisolone 15 mg/kg Q6 hours
(Solu-Medrol)
Mucomyst
3-5 mL of 20% solution or
*Nebulizer only given
10 cc of 10% solution Q4 hours
when combined with
Albuterol
Mucomyst
*as needed to
25-50 mg/kg/dose IV diluted to
20% solution
0.25-0.5 g/kg IV every 4-6 hours
6 mg/kg Q6 hours
3-5 mL of 20% solution or
10 cc of 10% solution Q4 hours
600 mg PO pre-procedure
-------------------------------------------
minimize contrast
related renal toxicity
Narcan
*follow dose
8 mg IVP
Not commonly given
immediately with
Norcuron
Nicardipine
Nitroprusside
(Nipride)
Norcuron
(Vecuronium)
Norepinephrine
(Levophed)
Potassium Acetate
Potassium Chloride
Potassium
Phosphate
Primacor
(Milrinone)
*Consult MM
Saline 3%
Sodium
Bicarbonate
THAM
(Tromethamine
Vasopressin
5-15 mg/hr until desired BP
reached, then maintenance of
3 mg/hr
0.3-10 mcg/kg/min IV
10 mg IVP
Initially 0.5-12 mcg/min
20-60 mEq
40 mEq/L IV
10-15 mmol IV
50 mcg/kg IV over 10 min
0.375-0.75 mcg/kg/min
Mixed with 0.45 or 0.9 NS
40 mL/hr for 3 hours
1 amp or 50 mEq IV
Base deficit x kg x 1.1= amount
in mL of 0.3 molar solution
0.008-0.67 units/min
Page
10
-----------------------------------------0.5-8 mcg/kg/min IV
0.08-0.1 mg/kg IV; then 0.05-0.1
mcg/kg/min maintenance
0.05-0.3 mcg/kg/min IV
1-4 mEq/kg in 24 hours
0.5-0.1 mEq/kg over 2 hours
0.08-0.36 mmol/kg/dose over 46 hours
50 mcg/kg IV over 10 min
0.375-0.75 mcg/kg/min
Mixed with 0.45 or 0.9 NS
5 mL/kg IV to raise Na by 4
mEq/L
1 mEq/kg/dose of 0.3 molar
solution over 20-30 minutes
1mL/kg for each pH unit below
7.4
0.5-10 miliunits/kg/hr
Rev. 7/11/11
Pulmonary Management Guidelines
Attachment A
CRITERIA:





This lung donor management routine will be considered on donors between the ages of 15-60 years old.
Individuals > 60 or < 15 will be assessed on an individual basis.
Medical history does NOT rule out lung donation.
DCD Donors/No lung consent does not rule out utilization of pulmonary management guidelines.
Bronchoscopy will be assessed on a case by case basis.
For DCD Donation, certain aspects of guidelines will be utilized on a case by case basis.
MEDICATIONS:












15 mg/kg Solu-medrol IVP at start of case as initial dose. Repeat with 15 mg/kg of Solu-medrol every
6 hours thereafter. If the patient is already on a T-4 drip, do not repeat the dose but follow with the 15
mg/kg dose 6 hours after the drip was hung.
Ancef 1 gram Q 8 hours, if allergic to PCN, use Clindamycin 600 mg Q 8 hrs.
Call Pharmacy after sputum gram stain result is returned to see if antibiotic adjustments need to be
made.
Narcan 8 mg IVP at BEGINNING of case combined with Norcuron 10 mg IVP.
Narcan Rationale: Used in effort to prevent or minimize Neurogenic Pulmonary Edema
Norcuron can be given before or after Narcan.
Norcuron may be repeated prn. (Half-Life is 25-40 minutes)
Norcuron rationale: Helps to decrease spinal reflexes and relaxes the diaphragm and other respiratory
muscles to help ventilate.
If Norcuron is not available consider: Pavulon 0.05- 0.2 mg/kg IV (half-life is approx 110 min),Nimbex 0.150.2 mg/kg IV (half-life is 20-45 min)
Albuterol 2.5 mg or 5 mg and 0.5 mg Atrovent Q 4 hours. In-line nebulizer is first choice, if unavailable use
unit/dose puff. Do not break ventilator circuit if possible; use a spring loaded nebulizer adaptor. Rationale:
Every time you break the circuit de-recruiting of the lungs takes place.
.Observe for Sinus Tachycardia.
Mucomyst nebulizer, 3-5cc of 20% solution or 10cc of 10% solution Q 4 hours. Use ONLY in conjunction
with Albuterol, never alone. Use only if patient has thick secretions.
DIURETICS:




Lasix 20-80 mg IV, Bumex 0.5-1 mg IVP
Mannitol-Adult dose 300-400 mg/kg, usually given in conjunction with lasix
Consider if PO2 is worsening and/or fluid balance is positive.
Patient is hemodynamically stable ( minimal pressors) see Policy 5.6
VENTILATOR SETTINGS:




Volume Ventilation (AC Mode)
Suggested Tidal Volume (10-12cc/kg) ideal body weight. May go up to 15cc/kg.
Ideal body weight calculations: Male:50 kg + 2.3 kg per in. >60 inches, Female:45 kg + 2.3 kg per in. > 60
inches
Peak airway pressure should be kept < 35. (Reduce TV if > 35 or change to Pressure Control)
Page
11
Rev. 7/11/11




Adjust A/C rate to keep PCO2 between 35-45 mmHg (as long as PH is 7.35-7.45)
PEEP of +5-8 cm H2O
FiO2 at 40%
If ABGs are WNL, maintain current settings or increase volumes/and or rate to optimize donor
management guidelines. I.E. PO2 > 300, P/F Ratio > 3. (P/F Ratio = maintenance FIO2 x 3).
 Slow flows to 40-50 lpm and/or increase inspiratory pause. RATIONALE: This decreases peak inspiratory
pressure, minimizes “wasted ventilation” (time between exhalation and initiation of next breath), and
increases mean airway pressure resulting in less trauma and increased oxygenation.
 All lung offers will be made on a PEEP of 5, according to UNOS Policy.
Pressure Control Ventilation



Maintain peak airway pressures of less than 35 cm H2O.
Adjust rate to keep PCO2 between 35-45 mmHg. (even if TV drops <10 cc/kg) and as long as PH is
between 7.35-7.45
PEEP +5-8 cm H2O
MANEUVERS TO IMPROVE LUNG FUNCTION:






Alveolar Recruitment Maneuver- Place vent in CPAP for 30 sec @ 40 cm of H20
Decrease peak flows to 40-50 lpm (slower inspirations) Rationale: Decreases lung damage and increase
mean airway pressure which affects oxygenation.
Alveolar Recruitment Maneuvers (ARM): CPAP 40 cm H20 for 30 Seconds
o Do every 20 minutes x 3.
o May be done at a lower pressure if vent is not able, or if the patient doesn’t tolerate 40 cm H20.
o In order to RE-RECRUIT alveoli, perform once every time the circuit is broken, or patient is
suctioned.
o DO NOT PERFORM ARM IN THE PRESENCE OF: Severe Bronchospasm, Bullous emphysema,
Untreated Pneumothorax, Unilateral Lung Disease (not suspected of being atelectasis), and
Hemodynamic Instability.
Use a PEEP valve when going to OR (set PEEP at +10 cm H20)
Prone patient (If other treatments have failed and patient is hemodynamically stable)SJAA, WBRO, and
Spectrum have proning beds available-contact resource manager
Nitric Oxide @ 40 ppm may be indicated as salvage therapy to treat refractory hypoxia that may be due to
high pulmonary vascular resistance. Contact resource manager.
ARTERIAL BLOOD GASES:







Baseline ABG on settings listed above
Follow with O2 challenge on 100% FiO2
Repeat baseline ABG Q 4-6 hours
Always treat PH, not CO2
Repeat O2 challenge within 2 hours of procurement surgery and prn
Treat Metabolic Acidosis with NaHCO3 unless Sodium is >140.
If Sodium is greater than 140, use THAM (acid-base buffer without sodium). Consult Pharmacist for dosing.
PT MUST BE MAKING URINE PRIOR TO USING THAM.
CHEST X-RAYS:


Baseline CXR within 4 hours of consent
Repeat CXR within 4 hours of procurement surgery
Page
12
Rev. 7/11/11
BRONCHOSCOPY:




As soon as possible after consent and brain death
Evaluate the endo-bronchial tree, right and left side, for lesions, signs of infection, and overall condition of
the endo-bronchial tissue
Obtain bronchial washings for culture and gram stain
USE VERY LITTLE SALINE DURING BRONCH. (10cc may be used to clear plug)
BEDSIDE CARE:

Chest PT Q 2-4 hours as indicated
 Q 1-2 hour tilting side to side- Rationale: Allows mobilization of secretions and opens atelectatic
regions
 Q 2-4 hour ET Tube suctioning as indicated
 Place patient on specialty bed if possible. (Percussion and rotation)
 Oral care q 1-2 hours
 No ETT cuff leak-Ask RT to add 2-3 cc air to minimal occluding volume. Rationale: Reduces
ventilator associated pneumonia
 HOB elevated at least 30 degrees- Rationale: Drops the diaphragm and reduces ventilator
associated pneumonia and opens lungs.
 Deep glottic suctioning and oral care. Rationale: prevents aspiration.
HEMODYNAMICS:
 Transduced central line/swan for CVP/PAP/PCWP monitoring. (Thoracic not femoral for adequate
readings)
 Maintain CVP 6-8 mmHg
 Maintain PAWP 8-12 mmHg
Page
13
Rev. 7/11/11
Cardiac Donor
Management
Guidelines
Attachment B
Obtain urine drug screen test
if not previously done &
patient admitted less than 36
Hormonal Therapy
Regimen per
protocol
Place Pulmonary Artery Catheter
Patient with history of smoking, drug
abuse, HTN, cardiac disease, on more
than 1 inotrope or requested by TC
Goals: MAP > 60 mm Hg
PCWP 8-12 mm Hg
CVP 6-10 mm Hg
C.I. > 2.5-3.5L/min-m2
Dopamine
< 10 mcg/kg/min
as indicated
Hemodynamic
Management
Vasopressin
0.5-4 units/hr
Pressors should be weaned in this
order:
Primacor < 0.75 mcg/kg/min
Neosynephrine < 0.5 mcg/kg/min
Epinephrine < 0.05 mcg/kg/min
Levophed < 0.05 mcg/kg/min
Dopamine < 5 mcg/kg/min
Dobutamine < 5 mcg/kg/min
as indicated
Only Use Dobutamine w ith MM input
Minimum: Adults patients
Central line with CVP monitoring
(thoracic pref erred, f emoral f or
trends)
Obtain Initial Echo
r/o structural abnormalities
(substantial LVH, valvular
dysf unction, congenital lesions
Obtain echo at lowest doses of
inotropes and as long as time
permits.
LVEF > 45%
LVEF < 45%
Continue
Hemodynamic Management
Continue
Hemodynamic Management
Repeat echo warranted if
cardiovascular
improvement
If no improvement
contact RM/MM
Solumedrol
Adults: 15mg/kg
Peds: 6mg/kg
Using Dopamine/Nipride conjunctively and/or
to increase C.O. & decrease PAWP
Heart Catheterization
Considerations:
Males > 40, Females >45, Center Request,
Cocaine Usage, Smoking History. Always get
right & left sided catheterization & float
SWAN or maintain SWAN
May get approval from resource manager if pt
meets above and cardiologist is in hospital
ready to do cath ASAP.
Approval by RM/MM
Proceed with
Thoracic Offers
* NOTE: All Pressors/Ionotropes can cause significant hypotension or hypertension. Evaluate patient's
Pagehematocrit, ionized calcium, & volume status prior to administering. Loading doses are not alw ays recommended.
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