O slideshow foi denunciado.
Seu SlideShare está sendo baixado. ×

organ transplantation nurses Joel Arudchelvam.pptx

Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Carregando em…3
×

Confira estes a seguir

1 de 47 Anúncio

organ transplantation nurses Joel Arudchelvam.pptx

Baixar para ler offline

ORGAN
TRANSPLANTATION
Definition
Donor
Recipient
Graft
Organs usually transplanted
Tissues, cells usually transplanted
Types of organ donors
HISTORY OF TRASNPLANTATION
HISTORY OF TRANSPLANTATION IN SRI LANKA
Transplantation procedure
Live donor nephrectomy
Organ preservation
Renal transplantation
Donor
Post operative management
RECIPIENT – SURGERY
POST-OPERATIVE CARE
Cadaveric Transplantation
Organ ischemia
Immunological complications


ORGAN
TRANSPLANTATION
Definition
Donor
Recipient
Graft
Organs usually transplanted
Tissues, cells usually transplanted
Types of organ donors
HISTORY OF TRASNPLANTATION
HISTORY OF TRANSPLANTATION IN SRI LANKA
Transplantation procedure
Live donor nephrectomy
Organ preservation
Renal transplantation
Donor
Post operative management
RECIPIENT – SURGERY
POST-OPERATIVE CARE
Cadaveric Transplantation
Organ ischemia
Immunological complications


Anúncio
Anúncio

Mais Conteúdo rRelacionado

Mais de Joel Arudchelvam MBBS, MD, MRCS, FCSSL (20)

Mais recentes (20)

Anúncio

organ transplantation nurses Joel Arudchelvam.pptx

  1. 1. Joel Arudchelvam MBBS, MD ( SUR ), MRCS (ENG), FCSSL ConsultantVascular andTransplant Surgeon ORGAN TRANSPLANTATION
  2. 2. Transplantation Removal of organs or tissues from one individual and placing it in another individual  Recipient
  3. 3. Transplantation Removal of organs or tissues from one individual and placing it in another individual  Recipient
  4. 4. Transplantation Removal of organs or tissues from one individual and placing it in another individual  Recipient
  5. 5. Transplantation Removal of organs or tissues from one individual and placing it in another individual  Recipient GRAFT
  6. 6. TRANSPLANTATION The Miracle surgery of Cosmas & Damian AD 287
  7. 7. Organs usually transplanted  Kidney  Liver  Pancreas  Heart  Lungs  Intestine
  8. 8. Tissues, cells usually transplanted  Skin  Cornea  Islets of Langerhans  Bone marrow  Heart valve  Bone
  9. 9. Types of organ donors  Live Donor  Deceased / Cadaveric Donor  Donation after brain death (DBD)  All Brain stem functions are absent/ patient on ventilator support  Donation after cardiac death (DCD)  Patient who has irreversible or an injury incompatible with life.  Does not fulfill the brain death criteria
  10. 10. Types of organ donors  Live Donor  Deceased / Cadaveric Donor  Donation after brain death (DBD)  All Brain stem functions are absent/ patient on ventilator support  Donation after cardiac death (DCD)  Patient who has irreversible or an injury incompatible with life.  Does not fulfill the brain death criteria
  11. 11. HISTORY OF TRASNPLANTATION  1902 Experimental transplants and anastomosis techniques in animals - Alexis Carrel  1954 First successful kidney transplant  1963 First liver transplant
  12. 12. HISTORY OF TRANSPLANTATION IN SRI LANKA Organ Year Surgeon Kidney 1985 Prof. A. H. Sheriffdeen Liver 2010 Prof Mandika Wijeratne Lungs 2011 Japanese and SL surgeons Pancreas (Simult. Panc / Kid) SPK 2016 Dr . Joel Arudchelvam En bloc Kidney Transplantation 2017 Dr . Joel Arudchelvam HeartTransplantation 2017 Kandy team Lower LimbTransplantation 2017 Dr . Joel Arudchelvam
  13. 13. Transplantation procedure Suitable Donor Organ retrieval Organ preservation Transplantation
  14. 14. Live donor nephrectomy  Lateral decubitus position  lower costal margin over the kidney rest  kidney rest is raised and the operating table is flexed
  15. 15. Live donor nephrectomy  Incision in line with the 12th rib.  Kidney, ureter, vessels mobilised
  16. 16. Donor nephrectomy  Removal of kidney [* nurse to note down renal artery clamp time]
  17. 17. Organ preservation  Kidney perfused with cold preservation solution  HistidineTryptophan Ketoglutarate (HTK) solution
  18. 18. Organ preservation
  19. 19. Organ preservation Histidine-tryptophan- ketoglutarate (Custodiol HTK solution) Composition
  20. 20. Donor nephrectomy  Closure with ‘1’ PDS - half circle , 36 mm to 48 mm / ‘1’Vicryl - half circle , 36 mm to 48 mm
  21. 21. Renal transplantation • Curved supra inguinal incision (Modified Gibson) • Inverted ‘J’/ ‘Hockey stick’
  22. 22. Renal transplantation • Iliac vessels and bladder dissected extra peritoneally’
  23. 23. Renal transplantation – Iliac vessel mobilisation
  24. 24. Renal transplantation  Renal vessels ananstomosed to iliac vessels
  25. 25. Renal transplantation Ureter anastomosed to the bladder (Ureteroneocystostomy)
  26. 26. Surgical aspects
  27. 27. Donor On arrival to the theatre check  Documents  Investigations  Renal angiogram  DTPA  TED stockings
  28. 28. Donor Nephrectomy - Equipment  Ligaclips (medium and large)  Right angle * 3  Silk ties (0 /3-0)  4-0 or 5/0 Polypropylene sutures ,round body / taper point needle ½ , double arm , 17 mm ( for R nephrectomy)  Rib spreader  1 PDS
  29. 29. Back table - for perfusion of kidney  Large basin  2 L of sterile slush (prepared by freezing saline and crushing)  Fine needle holder  Mosquitoes * 4  De Bakey * 2  Dissecting scissors  KidneyTray  SilkTies (3-0)  5-0 Prolene sutures  18 G cannula  HTK solution – 1L with perfusion set
  30. 30. Donor Post operative management  D0  IV Fluids  MonitorVital Signs  Monitor IP / OP  D1  Mobilise  Remove catheter  Enoxaparin S/C  Start oral
  31. 31. RECIPIENT On arrival to the theatre check  Documents  Investigations  Immunosuppressive drugs  Basiliximab 20mg IV  Methylprednisolone 1000mg IV on induction  Antibiotics - Cefuroxime 750mg IV or co amoxyclav on induction  Netilmicin / Gentamicin  TED stockings
  32. 32. RECIPIENT - SURGERY  Heparinised saline (2500 units in 500ml N- saline)  Thompson retractor / bookwalter retractor  5F 0r 4.8F double J stent - 12cm, with guide wire
  33. 33. RECIPIENT - SURGERY  5/ 0 Polypropylene sutures ,round body / taper point needle ½ or 3/8 circle, double arm , 17 mm * 5  6/0 Polypropylene sutures ,round body / taper point needle ½ circle,double arm Prolene 13mm needle * 2  5/0 PDS round body / taper point needle ½ or,double arm Prolene 17 mm needle * 3
  34. 34. RECIPIENT - SURGERY  Prior to re-perfusion of the kidney  125ml of 20% Mannitol (25g) and frusemide 100mg IV  Keep warm saline ready
  35. 35. POST-OPERATIVE CARE  ICU  HR 60 -90 bpm  BP - 130/80 - 150 - 90 mmHg(MAP 90- 100 mmHg)  CVP - 4 - 8 mmHg or 8 -12 H2O
  36. 36. Post operative fluid replacement protocol  Following live donor renal transplantation polyuria is common  UOP less than 50 ml/hour - UOP + 40ml of fluid  UOP more than 100 ml/hour give volume to volume replacement of fluid  UOP more than 500 ml/hour - UOP - 50ml of fluid  UOP more than 1000 ml/hour - UOP -100ml of fluid
  37. 37. POST-OPERATIVE CARE  SE, Urea, Creatinine, FBC daily  Analgesics - Fentanyl  Cefuroxime – 750mg IV 8-hourly for 48 hours  Mycophenolate mofetil 1g po bd  Cyclosporin 5mg/kg po bd or tacrolimus 0.05mg/kg po bd.
  38. 38. From D1  Mobilise  Immunosuppression [ from D1 to 7]– discuss with nephrologist  Methylprednisolone or prednisolone daily  Mycophenolate mofetil  Cyclosporin or tacrolimus .  Basiliximab 20mg IV – Day 4.
  39. 39. From D1  IV fluids ( N saline) is given to replace urine output until the oral intake improves to more than 1000mls per day.  Start oral diet from D1  Co-trimoxazole  Valganciclovir  Remove catheter on D5 - discuss with surgeon  Clip removal at 3 weeks  Stent removal at 1 month by urologist
  40. 40. Cadaveric Transplantation  Keep Ice ready ( frozen hartmann solution / Saline, at least 16 and slush ice from OTJ )  Back table ready when kidney arrives
  41. 41. Organ ischemia
  42. 42. Organ ischemia
  43. 43. Immunological complications  Hyperacute -  Occur due to the pre- existing antibodies  Occurs soon after the organ is reperfused.  Due to ABO incompatibility / pre-existing HLA antibodies.  Acute rejection –  3 to 5 days following transplantation  The immune system newly recognises the graft  Generally T cell mediated (acute cellular rejection) sometimes due to antibodies (acute humoral rejection)
  44. 44. Immunological complications  Chronic rejection –  Due to accumulation of injuries over long period  Graft gradually loses its function
  45. 45. Rejection diagnosis  How to recognise  Deteriorating renal function  Evidence of increased resistance to blood flow within the kidney – increased RI  Confirmation renal biopsy
  46. 46. ThankYou !

×