PEDIATRIC SERVICES

TRANSPLANTATION ,PAR
APLEGIA

NIMISHA C S
FACULTY
HOSPITAL ADMINISTRATION
 Paediatric Services

 Paediatrics (paediatrics) is the branch of medicine that deals with the medical care of infants,
children, and adolescents, and the age limit usually ranges from birth up to 18 years of age.

 The Department of General Paediatrics provides comprehensive outpatient and inpatient care
for sick infants and children up to the age of 18 years.

 The Department is comprised of general paediatricians as well as paediatric specialists with

advanced training and vast experience in every sub-discipline of paediatric medicine.

 As many as 12 to 15 percent of beds in a general hospital may be required for paediatric

patients depending on the character of the community the hospital serves.

 Parents, siblings and friends are of paramount importance in the recovery and rehabilitation of
the sick child.
• Areas of importance

 Diagnosing and treating diseases.

 Growth and development.

 Nutrition

 Immunization

 Opportunity to achieve full potential as adults.

• Services

 Adolescent Medicine  Paediatric Genetics

 Paediatric Haematology/Oncology
 Developmental & Behavioral Pediatrics
 Paediatric Infectious Diseases
 International Adoption
 Paediatric Nephrology
 Neonatology  Paediatric Neurology

 Paediatric Cardiology  Paediatric Orthopaedic Surgery

 Paediatric Pulmonology
 Paediatric Critical Care
 Paediatric Surgery
 Paediatric Endocrinology

 Paediatric Gastroenterology, Hepatology & Nutrition

• Units in Pediatric Department

 Outpatient Unit

 In Patient Unit

 Emergency Unit

 PICU

 NICU

 Medical and Surgical Wards

• Pediatric Emergency Unit

 Pediatric Emergency Unit – The Emergency Department and Trauma Center,

designed to meet the emotional and physical emergency needs of children and
their families.

 This is separate about 4,500 square foot suite, needs a separate entrance for
children and their families, and includes approximately 10-12 paediatric beds
and 2-3 isolation rooms.
Neonatal ICU
Location

 Neonatal unit should be located as close as possible to the labour rooms and obsteric operation theatre

 Adequate sunlight for illumination

 Fair degree of ventilation of fresh air

Space

 500-600 Gross square feet per bed.

 Space includes patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room
area, laboratory area and space for families

 6 Feet gap between two incubators for adequate circulation and keeping the essential lifesaving equipment
• Floor Plan

 Open encumbered space

 The walls should be made of washable glazed tiles and windows should have two layers of glass panes.

 Wash basins with elbow or floor operated taps facility having constant round-the-clock water supply
should be provided.

 The doors should be provided with automatic door closers.

 Isolation room

 The temperature inside the unit should be maintained at 28’ +_2’C, while the humidity must be above
50%.

 Portable radiant heater, infra-red lamp can be used

 Transplantation Services

What is organ transplant?

The moving of an organ from one body to another , for the purpose of replacing
the recipient’s damaged or failing organ with a working one from the donor site.
The donor can be living or deceased.
• Living Donor

• The donor remains alive and donates a renewable tissue, cell, or an organ or part
of an organ in which the remaining organ can regenerate or take on the workload
of the rest of the organ.

• Deceased Donor

• Are donors who have been declared brain dead and whose organs are kept viable
by ventilator or other mechanical devices until they can be excised for
transplantation.
• Major Organs and Tissues Transplanted

 Heart (deceased-donor only)

 Lung (deceased-donor and living-donor)

 Heart/Lung (deceased-donor and domino transplant)

 Kidney (deceased-donor and living-donor)

 Liver (deceased-donor and living-donor)

 Pancreas (deceased-donor only)

 Intestine (deceased-donor and living-donor)

 Stomach (deceased-donor only)

Tissue, Cells and Fluids

 Hand (deceased-donor only)

 Cornea (deceased-donor only)

 Skin (deceased-donor, living-donor and autograft)

 Bone marrow (living-donor and autograft)

 Bone (deceased-donor, living-donor and autograft)

• Types of Transplant

 Autograft

 Allograft

 Isograft

 Xenograft

 Split transplant

 Domino transplant
• Principles of Organ Transplantation

• Pre-Operative

1. Patient selection and evaluation

• Recipient

 Patient who met the indication for transplant – organ failure

 Clinical evaluation – history and physical examination

 Immunological evaluation

 Infection screening

• Donor

 Cadaveric

 Living donor
1. Counselling

 May involve professional counsellors /psychotherapist

 Aimed at minimizing possible complications

 Need for adherence to post op maintenance complication

 Regular follow up through evaluation

 Life style modification

1. Informed Consent

• Living donor
 Superstitions relating to being reborn with a missing organ
 Education
 Religious believes
 Willingly , not for any financial reason or under duress
 Lack of consensus with family members
 Involve family
Recipient
 Surgery and anaesthetic complications
 Nature of disease and need for transplant
 Must undergo extensive screening  Outcome and complications

• Deceased donor  Need for compliance to immunosuppressive therapy

• Factors influencing refusal to consent by relatives:  Other available options

 Non-acceptance of brain death

1. Optimization of Recipient

 Getting patient ready for surgery

 Correction of anaemia

 Treatment of infection

 Central line

 Urethral catheter

1. Loading of immunosuppression 12 hrs pre-op

2. Prophylactic antibiotics
Heart Transplantation

Heart Transplant is an operation in which a diseased failing heart is replaced with a healthier donor

heart.it is usually reserved for people whose has not improved enough with medication or other

surgeries. While it is a major operation, chance of survival is good with appropriate follow-up care.
• Lung Transplant

• Lung transplant is a recommended therapeutic option for patients of end stage lung disease . Lung
transplantation involve removal of one or both diseased lungs from a patient and the replacement of the
lungs with healthy one from a donor.

• Kidney Transplant

• A kidney transplant is a surgical procedure in which a healthy kidney from either a living or deceased donor
is placed into a patient with end stage renal disease.

• Liver Transplant

• Liver transplantation is a viable treatment option for end stage liver disease and acute liver failure. It is the
second most commonly transplanted major organ after kidney.
Bone Marrow Transplant
• It involve replacement of damaged or destroyed bone marrow with healthy bone
marrow stem cells.

• Types of Bone Marrow Transplant

 Autologous bone marrow transplant – stem cells are removed and preserved
before receiving high dose chemotherapy.

 Allogeneic bone marrow transplant – stem cells are removed from another donor.

 Umbilical cord blood transplant – stem cells are removed from new born baby's
umbilical cord.
• Facilities and Space Requirements

 The CSSD department, which is usually located elsewhere in the hospital, is responsible for preparing and
autoclaving all surgical instruments, linen packs, gloves, syringes and needles.

 There should be need storage space for clean surgical supplies such as linen, tapes, bandages, parenteral
solutions, other fluids, sterile water, essential drugs and narcotics and blood supplies.

 Control station - Should be so located as to permit visual observation of all traffic.

 Operating room.

 Pre-operative holding area.

 Post-operative recovery room

• Staff Structure
 Living donor coordinator

 Transplant coordinator
 ]]Post-transplant clinical coordinator

 Transplant nursing coordinator

 Transplant social worker

 Pre-transplant clinical coordinator

 Transplant pharmacist

 Transplant counsellor
 Transplant dietician
• Transplant Coordinator

1. Employee of registered hospital

2. Qualification :

 Graduate of any recognized system of medicine

 Nurse, defined in Indian nursing council Act

 Master’s degree in public health / social work

 Qualified counsellor

3. Minimum 2 years’ experience

• Registration for Transplant

 The hospitals should register under THE TRANSPLANTATION OF HUMAN

ORGANS AND TISSUES ACT, 1994

 Before registration, a transplant coordinator should be nominated.

 No specific requirements for physical facilities and equipments, it should comply

with standards described in THE TRANSPLANTATION OF HUMAN ORGANS AND
TISSUES ACT.
 Paraplegia and Malignancy
• Paraplegia

 Paraplegia is a spinal cord injury that paralyses the lower limbs. It is a

result of severe damage to the spinal cord and the nervous system. It
mainly affects the trunk , legs and pelvic region resulting in loss of
movement
Causes of Paraplegia

Causes
 Accidents

 Spinal cord injury

 Motor neuron diseases

 Tumours or blood clots within the spinal cord

 Spina bifida

Categorization of Paraplegia

1. Complete paraplegia

2. Incomplete paraplegia
Neuro ICU

• Location

 Should be centrally located with easy access to emergency department , OPD ,

OT and other services

 Away from general hospital traffic

 Restricted entry