In the Hospital
The transplant recipient is taken to ICU after surgery where IV fluids and medications will be administered through the central line, vital signs are monitored continuously and the bladder is kept empty by a catheter. There will be some pain in the surgery site and pain medication is normally administered through a patient controlled device to assure adequate pain control. Some patients may experience bladder spasms from the catheter and/or throat discomfort from the tube placed during surgery. These discomforts are only temporary and should disappear within a few days.
After the patient is settled, family and friends will be allowed to visit. Most patients are sleepy from the anesthesia and pain medication during this time.
Preventing complications after surgery is a major goal of nursing care. Lung infections, constipation, and risk of blood clots in the kidney, legs, heart, lungs and brain are potential complications after the operation. To decrease those risks, patients are asked to do the following:
- Begin deep breathing and coughing exercises once awake after surgery.
- Frequent use of the incentive spirometer (breathing exercise equipment) while awake.
- Get out of bed as early as the first day after surgery.
- Walk in the hallway, increasing the distance every day.
From the ICU, the transplant patient is moved to the Renal Unit between 24 to 48 hours after the surgery. Rehabilitation includes activities like walking in the hallway several times a day. Extensive instruction is provided for both patients and their families to ensure a smooth transmission from hospital to outpatient care. These instructions cover medications, signs and symptoms of rejection and other complications, as well as diet and exercises and what the patient can do to improve recovery.
The Daily Routine
Daily Blood Samples
Blood will be drawn daily to monitor progress and to adjust daily medicines.
- Kidney function - BUN, creatinine, electrolytes, red blood count
- Medication side effects - white blood count, liver panel, lipid panel
- Medication levels - Cyclosporine, Prograf
Each patient is weighed daily before breakfast to monitor weight change. Increases in weight usually result from fluid retention.
Measuring Fluid Intake and Output
As soon as the patient arrives on the kidney floor, nurses will begin patient education. This includes how to keep track of all the liquids taken by mouth. At the same time the nurse will note all the fluids given by IV as well as the urine output. An appropriate fluid balance is important for the proper functioning of the transplanted kidney.
During this procedure a jelly-like substance is placed on the lower abdomen. The kidney and bladder are then examined by passing a smooth hand-held device over them, allowing visualization of the kidney and its surrounding area. The purpose of this procedure is to observe the blood flow through the kidney and to find possible obstructions in the kidney or fluid collections around the kidney.
This is a special X-ray of the transplanted kidney. A radioactive substance is injected into a vein and pictures are taken of the kidney to see how it absorbs and excretes the substance. This procedure shows the blood flow and function of the kidney as well.
During the hospital stay and during the transplant clinic, members of the transplant team ensure that transplant patients have the knowledge and skills necessary to take an active role in maintaining a healthy lifestyle by providing extensive teaching and support. Transplant patients are required to:
- Make lab and clinic visits as ordered by the transplant physician.
- Measure vital signs, weight, fluid intake and urine output daily.
- Note above results in a diary. This dairy is then reviewed in the clinic.
- Take medications at regular intervals, mostly twice a day, 12 hours apart.
- Be in charge of keeping an adequate supply of medications at all times.
- Report any changes in their wellbeing.
- Report any changes in their circumstances, such as phone number or address changes, to the transplant center to ensure a seamless collaboration between patient and transplant team.
Transplant patients will be followed in the transplant clinic for 6 months, then discharged to their nephrology office. They are expected to return to the transplant clinic annually around the time of their transplant anniversary. The transplant center keeps responsibility for all their patients as long as the transplant is still functioning and has to give regular update reports to the United Network for Organ Sharing (UNOS).