Transplant
Kidney
- Access
- Large PIV x2. Can consider arterial or central line if needed.
- Airway
- Oral ETT
- Induction
- Standard
- Maintenance
- Gas and paralytic
- Emergence
- Awake
- Antibiotics
- Cefazolin
- Position
- 0
- Immunosuppressant
- Either thymoglobulin (0.22 micrometer filter + separate peripheral line needed, administered over 6 hr. Give 500 mg methylprednisolone prior) (associated with pancytopenia) or basiliximab (surgeon might choose if patient has low WBC).
- Diuretic
- Mannitol/furosemide requested before reperfusion, which occurs at end of arterial anastomosis.
Check with surgeon for fluid goals and MAP goal prior to reperfusion.
Avoid morphine (renal metabolites: morphine 3-glucuronide (neurotoxic), morphine 6-glucuronide (alleviates pain)).
Do not place BP cuff or PIVs in lower extremities (technically only need to avoid the laterality that surgeon will be grafting on to the iliac artery and vein, as that will be cross clamped during renal anastomosis, though additional caution is often reasonable).
Using a hemodialysis catheter? Use aseptic technique. It contains a reservoir of heparin flush that needs to be aspirated.