Admissions

Patients can be admitted to our service for many reasons. These reasons can range from being admitted for an impending liver transplant to chicken pox in a post-transplant patient. We have a few sets of orders already pre-done in the computer to try to help you with the patients being admitted for transplants.

We keep records of all of our patients in our offices that include their most recent labs and medications. When a patient gets admitted, you should contact the nurse practitioner to obtain those records if the patient is admitted during the day. If the patient is admitted at night or on the weekends, you should call security or the nursing supervisor to let you into the glass enclosed area at the back end of 3F so that you can make a copy of the office records, do not remove the chart from the office. DO NOT depend on the parents to give you the medication list. We have a lot of parents who are quite capable of maintaining an up-to-date list; however, we have many parents who know their child's meds in cc's and not mgs and this can lead to medication errors. You will learn that some of our parents do not know their child's meds at all.

We will always try to alert you of incoming admissions. Sometimes we will know days ahead of a patient being admitted for a living related transplant. However, it is not unusual to have several patients come to clinic and need to be admitted for elevated liver function tests. Frequently, these patients will be admitted for liver biopsies and treatment. We will discuss liver biopsies later.

Common Admissions

Transplant Evaluation: These patients are being admitted to undergo a battery of test and consults. There is a preset order set in the computer. After getting the patient record you can go to the right corner right next to the refresh bar is an emblem that looks like a paint palate. Click on this emblem. Than put in liver and you will be able to find the order set. Scroll through it, check what you need and then go to the bottom and click OK. Do not forget to sign the orders at the end.

Recipient (Pre-Op): Whether a patient comes in for a living related transplant or a cadaveric transplant, they will require the same pre-operative preparation. Of course, the patient receiving a cadaver transplant may present at any time of the day or night; whereas, the living related patient will be a scheduled admission. Again, a preset order set is in the computed under liver transplant recipient pre-op. The only thing that need to be discussed is the number of PRBC , plasma units, and platelet units will need to be reserved. If the patient is <1 year of age we use FFP if not we use SDP. The number of units are based on patient weight. We usually need 6 units of PRBC, 2 single donor platelets and 4 FFP or SDP. Blood should be CMV negative.

Recipient (Post-Op): These orders will usually be put into the computer by the nurse practitioners. The patient will go the PICU after surgery. This order set is broken up into three sections because of the number of orders. There is a laboratory set, a medications set, and an order set. If you need to put these orders in discuss it with the nurse practitioner or the attending.

Donor (Pre and Post-Op): When the transplant is to be a living related transplant, the donor will also be admitted and need evaluation and orders. The adults are managed by the nurse practitioners and the attendings. You should not have to get involved with the pre-op evaluation or any calls post-op. If you get a call regarding an adult patient, just refer the caller to the attending on-call.

Fever of Unknown Origin: Transplant patients are treated slightly differently when they are admitted with fever. Because of their immunosuppressed state, we obtain cultures and immediately begin coverage for both bacterial and viral sources. There are a few additional tests we like to obtain. This include a urine shell assay for CMV, an EBV titer (we use the one in the computer that is PCR sent to Pittsburgh), sed rate, and a comprehensive metabolic panel with dbili and GGT. Rejection can sometimes present with fever and this is why we get liver enzymes. This, of course, is in addition to the usual cultures, blood and urine, and nasal swabs for viral studies and RSV if indicated.