LIVER DONOR CLINICAL PATHWAY

All patient variances are to be circled & documented in the section provided on back page. This Clinical
Pathway is intended to assist in clinical decision making by describing a range of generally acceptable intervention
and outcomes. The guidelines attempt to define practices that meet the needs of most patients under most
circumstances. However, the ultimate judgment must be made based on circumstances that are relevant to that
patient and treatment may be modified according to the individual patients needs.
WARD/ ADMISSION DAY OR DAY 0, ARRIVAL POD # 01 POD # 02 POD # 03 POD # 04 POD # 05 POD # 6 (consider Discharge)
Date: / / Date: / / TO ICU Date: / / Date: / / Date: / / Date: / / Date: / / Date: / /
Date: / /
 History and physical Before start of procedure:  Receiving notes  MD to reconcile medications  MD and Nursing to review  MD and Nursing to review  MD and Nursing to  MD and Nursing to  MD and Nursing to review
 Surgery consent  Verify and sign ABO and reconcile all and reconcile all medication review and reconcile all review and reconcile and reconcile all medication
NOTES  Anesthesia evaluation & compatibility form medication medication all
consent  Time-out to confirm patient medication
 Hepatology Consult identity and planned
procedure
 Weight  VS per RN protocol (see trigger  VS per RN protocol (see  VS per RN protocol (see VS per RN protocol (see  VS per RN protocol  VS measured and
 Labs: CBC, LFT’s,  Heart rate Continuous  LFTS including Albumin, criteria) trigger criteria) trigger criteria) trigger) (see trigger criteria) recorded within 1h of
RFTs , S/E INR, PTT,  ECG Continuous - 5 lead RFT, Electrolytes, Mg,  Daily weights, I&Os  Daily weights, I&Os  Daily weights, I&Os  Daily weights, I&Os  Daily weights, I&Os discharge. Call attending if
chest imaging, EKG, for ST analysis Phosphate, CBC  Labs: same as previous day  Labs: same as previous  Labs: same as previous day  Labs: same as  Labs: same as any new change
TESTS  COVID PCR  Arterial blood pressure  Coagulation profile including day previous day previous day
 CXR  Fingerstick glucose  Fingerstick glucose
Continuous  Fibrinogen  Fingerstick
 Fingerstick glucose 4X/day 3X/day 3 times/day  Fingerstick glucose
 CVP Continuous  Blood Sugar on Glucometer glucose 4X/day
 US liver doppler 3 times/day
 SpO2 Continuous Q1
 Ultrasound
 01 Hourly ABGS with lactate
abdomen
till serially down trend
 CXR

 As per anesthesia  Target MAP > 70  Same as prior day  Same as prior day  Same as prior day  Same as prior day  Same as prior day
based on blood loss  CVP 5-8 Enoxaparin 40 mg/d or
CARDIO- and hemodynamics


VASCULAR Heparin 5000 TDS if,

INR<1.5 and No bleeding
from surgical drains.
 Intensive spirometry Q6 hrs  Intubated  Extubated in PACU  Discontinue O2 if pulse  Same as prior day  Same as prior day  Same as prior day  Same as prior day  VS measured and
RESPI- Ox>92% after 15mins of room recorded within 1h of
RATORY air discharge. Call attending if
 Incentive spirometery x10 any new change
times q1h while awake ○ SaO2<90% and/or RR <8
or >30
 Electrolyte replacement if any  As per anesthesia based on  40 ml/kg/ 24 hour,  Decrease IV fluids by half  D/C IVFs  Same day as prior  Same day as prior   Same day as prior  same day as prior
blood loss and hemodynamics adjusted according to ○
IV FLUIDS/ patients need
RENAL

 IJ CVP catheter  Continue all lines  DC NG tube  D/C femoral line (DAY2  Same as prior day  Same as prior day  Same as prior day  Patient able to care for
 Arterial line  Line care per protocol  D / C A-Line if Lactate has Vs DAY1)  Open wound dressing  D/C epidural  D/c drain if no wound and drains
 Epidural cathater  Foley catheter- record output  Get peripheral access and significant output and  Drain care set up if
normalized  D/C foley catheter
DRAINS,  Rt drain q1h D/C CVP ultrasound negative for patient is not independent
 D/C cordis (hold heparin 4
LINES &  Foley catheter in OR  Monitor Drain Output hrs before) collection with their care
 Monitor Drain Output &
WOUND  NG tube placement in OR & Specially Look for  JP drain management
Specially Look for any taught
CARE any Blood, Bile or
Blood, Bile or Chyle in
Chyle in Drain
Drain

 NPO at Midnight  NPO  NPO  IV omeprazole 40 mg daily  Advance diet as tolerated  Regular diet  Same as prior day  Same as prior day Adequate PO intake
GI/  Start Inj D51/2 Saline x  IV omeprazole 40 mg daily  DC NG later in the day  IV medications, Tap water  Shift to oral medications
ENDOCRINE/ continous infusion over night  Electrolyte goal K > 4, Mg > 2  Liquid diet enema PRN
NUTRITION after NPO and phosphorus > 2.5

 RN to educate patient on pain  Target pain score 1-4 Target pain score 1-4 Target pain score 1-4 Target pain score 1-4 Target pain score 1-4 Target pain score 1-4  Pain controlled on oral meds
score  Titrate epidural  Same as prior day  Same as prior day  Same as prior day  Same as prior day  Same as prior day (target score 1-4)
NEURO/PAIN/  Use Paracetamol, tramadol
 D/C fentanyl , nalbine
COMFORT fentanyl, or nalbine as
needed for additional pain

***HAND HYGIENE*** ***HAND HYGIENE*** ***HAND HYGIENE*** ***HAND HYGIENE*** ***HAND HYGIENE*** ***HAND HYGIENE*** ***HAND HYGIENE*** ***HAND
 Ensure universal nasal  Tazocin 4.5gm IV 1 6 hrs  Tazocin 4.5gm IV 1 6 hrs  Same as prior day  Same as prior day  Same as prior day  Consider de-escalation HYGIENE***
ID decolonization with of abx  Same as prior day.  On oral abx for 5 days
total course
 Bath

 RN reviews clinical  Pain medication & wound care Same as prior day  Same as prior day Same as prior day Pt educated by
PATIENT Same as 
  
pathway with donor and teaching by RN  Nursing assessment of  Nursing evaluation Physicians about
EDUCATION/  Incentive spirometry teaching compliance
family psychosocial functioning and for post discharge
COPING/ needs
 Transplant needs
MENTAL surgeon/hepatologist to visit
STATUS/
PSYCHOSOCIAL
 Ambulate 3X day (more often  In bed mobilization  In bed mobilization  Fall risk assessment per  Fall risk assessment per  Same as prior day  Same as prior day Ambulatory for home and/or
as tolerated) nursing nursing PT clearance
ACTIVITY  Out of bed to chair 4X day  Out of bed to chair 4X day
 Ambulate 3X day (more  Ambulate 3X day (more
often as tolerated) often as tolerated)
 PT consult
 Shift out of ICU
LIVER DONOR CLINICAL PATHWAY VARIANCE RECORD DISCHARGE CHECKLIST
(CHECK WHEN
COMPLETE)
Date & Time Variance Physician’s Sign & I.D #
Wound care

Avoid heavy weight lifting or driving for 3-6 months

Set up clinic appointment in 1 week with

“Trigger” Criteria
Heart Rate <40 or >130
Systolic Blood Pressure < 90
Respiratory Rate < 8 or > 30
SaO2 <90% with Oxygen Therapy
Urine Output <50cc in 4 hours
Acute Change in Conscious State
Marked Nursing Concern