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CPTC 2018 > Organ Procurement > Flashcards

Organ Procurement Flashcards

1
Q

Where is the cannula placed for the Heart?

A

Aortic Root

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2
Q

Where is the cannula placed for the Lungs?

A

Pulmonary Artery

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3
Q

Where is the cross clamp placed?

A

Distal to the aortic root, typically aortic arch

If abdominals only may be Supra Ciliac Aorta in order to keep thoracic cavity closed

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4
Q

What is done to allow for venous drainage?

A

Vena Cava is incised after cross clamp

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5
Q

Where is the Venous cannula placed for the portal flush (aka Pre Cool) (3 options)

A

1st- Portal Vein
2nd- Inferior Mesenteric Vein
3rd- Splenic Vein

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6
Q

Abdominal Venous Drainage location

A

chest cavity or

Inferior vena cava at the level of the illiac bifurcation

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7
Q

Euro- Collins or Collins

A 
oldest- cheapest
Simple Crystalloid
high glucose
high potassium
low sodium
mimic intracellular environment.
once had Mg in original formulation. 
Originally known as Euro- Collins; called collins once Mg removed
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8
Q

Viaspan UW (Belzer’s)

A

“gold standard”

aka SPS static preservation solution

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9
Q

Heart cold time

A

Max cold time 4-6 hrs

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10
Q

Heart Solutions

A

Cardioplege
UW
HTK
Celsior

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11
Q

Lung Solutions

A

Pulmoplegia
Perfadex
UW
Euro- Collins

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12
Q

Lung cold time

A

Max cold time 4-6 hrs

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13
Q

Liver perfusion happens through what cannula?

A

Abdominal AORTIC cannula

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14
Q

Liver Solutions

A

UW

HTK

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15
Q

Celsior

A

low viscosity preservation solution
primarily used for hearts
can also be used in liver, pancreas, kidneys

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16
Q

Liver Cold Time

A

Max Cold time 24 hrs

preferred <12hrs

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17
Q

Pancreas Cold Time

A

6-12 hrs

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18
Q

Pancreas cannulation

A

no direct cannulation or perfusion

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19
Q

Kidney Cannulation

A

Aortic cannula placement is same as liver

Distal Aorta proximal to the illiac bifurcation

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20
Q

Liver Cannulation

A

Aorta proximal to the illiac bifurcation

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21
Q

Internal Packaging

A

A triple sterile barrier must protect all organs

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22
Q

Which organs REQUIRE a rigid container as one of the triple layers?

A

Kidneys
Pancreas
Extra vessels

23
Q

Mandatory info on internal packaging label

A
  • Description of the contents of the package,
  • donor ID,
  • blood type and blood subtype, if used for allocation.
24
Q

Before Cross clamp what is used to prep AORTA?

A

2 umbilical tapes

aortic cannula will be placed between these

25
Q

What is used to prep the Superior Mesenteric Artery for ligation?

A

heavy ties

26
Q

Left Kidney

A

Generally preferred for transplant
Longer renal vein
Cuff of aorta should be present
Should have PATCH of Vena Cava

27
Q

Cuff

A

Renal Artery still connected to a piece of the aorta

28
Q

Patch of the Cava

A

Renal vein remains connected to a section of the Vena Cava

Typically on Left Kidney

29
Q

Right Kidney

A

Shorter renal vein
Should have FULL Vena Cava
Cuff of aorta should be present

30
Q

Heart Storage Volume

A

1 Liter

31
Q

HTK

A

CUSTODIAL

32
Q

Pancreas preservation solutions

A

UW
HTK
Perfadex

33
Q

Intestine preservation solutions

A

UW

HTK

34
Q

Normal Hepatic Artery anatomy

A

Classic branching of the common hepatic artery from the coeliac artery, and the proper hepatic artery into right and left hepatic arteries to supply the entire liver

35
Q

replaced hepatic artery

A

one which arises from an anomalous origin and supplies a portion of the liver solely.
(commonly replaced right hepatic artery arising from the SMA
or replaced left hepatic artery arising from the left gastric artery)

36
Q

accessory hepatic artery

A

arises from an anomalous origin and supplies a portion of the liver along with another artery.

37
Q

What vein CANNOT be used for cannulation if recovering pancreas?

A

The Splenic Vein is preserved and must not be used for cannulation during pancreas recovery
(Inferior Mesenteric Vein is dissected and cannulated)

38
Q

what vasculature does the Panc need for transplant?

A
  • 2 cm of Portal Vein must remain on the pancreas side after cold preservation.
  • Portal Vein is divided between the liver and the pancreas
  • Splenic Artery ligated close to Celiac Axis to leave as much length as possible with the pancreas
39
Q

Portal Cannulation

A

The cannula is placed into the Portal Vein through the Inferior Mesenteric Vein for portal venous perfusion

40
Q

R Hepatic Artery anomaly and panceas recovery

A

If the Right Hepatic Artery passes through the head of the pancreas, the pancreas cannot be recovered.

41
Q

Pumped kidneys max cold time

A

72 hrs

Longer preservation times associated with Graft Failure, resulting in the need for dialysis until the ATN resolves.

42
Q

During recovery, plaque is noted in the distal aorta and surgeon is unable to cannulate the distal aorta due to plaque. What would he cannulate instead?

A

Cannulate the descending thoracic aorta

43
Q

On the back table you notice the kidneys appear mottled? What do you do?

A

Suggest back table flush

44
Q

Liver pre-cooling solution most commonly used?

A

LR?

45
Q

Vessels and tissue typing material is stored in what?

A

FDA approved preservation solution

in a secured refrigerator with a temperature monitor

46
Q

When should you pull the cardioplege flush solution from the cooler?

A

?

47
Q

Order of recovery in multi organ OR

A 
1- Heart
2- Lungs
3- Liver
4- Pancreas
5- Small Intestine
6- Kidney
48
Q

kidney only procurement

A
  • Thoracic cavity typically remains closed
  • cannulation- distal aorta
  • cross clamp- supraceliac aorta
  • exsanguination- vena cava incised
49
Q

Liver Procurement

A
  • Cross clamp: Supraciliac Aorta
  • Cannulation: Aorta & Portal Vein
  • Exsanguination: Vena Cava is cut at level of R Atrium
50
Q

Kidney cold time (static preservation)

A

30 hrs

51
Q

Vessels

Storage time

A

14 days

if HIV,HCV, HBV negative

52
Q

What can extra vessels be used for

A

Extra vessels must only be used for organ transplantation or modification of an organ transplant

53
Q

Who is responsible for

the Reporting Requirements for Extra Vessels

A

Transplant hospitals must report to the OPTN Contractor (UNOS) the disposition of all extra vessels, including their use, sharing, or destruction, within seven days of their use, sharing, or destruction.

54
Q

Extra Vessel packaging (8)

A
  1. Donor ID
  2. Donor blood type
  3. Donor blood subtype, if used for allocation
  4. Recovery date
  5. Description of the container contents
  6. That the extra vessels are for use in organ transplantation only
  7. IDT
  8. PHS risk status

CPTC 2018 (8 decks)

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