Liver Transplant II

Our set-up for a liver transplant is pretty involved and can take me up to an hour. Although we use one of the large cardiac rooms, with all the equipment, it feels pretty crowded. We even have a floor plan to detail where everything goes. After we induce anesthesia and intubate the patient, we still have at least half an hour's worth of preparation. We place multiple lines including a femoral arterial line (believing that especially in cirrhosis, central pressures are more accurate than peripheral pressures). Sometimes, we'll also place a radial arterial line just for blood draws as we can be sending off a lot of blood gases, blood counts, and coagulation samples during the procedure. We then place two large 9 French introducers into the left internal jugular vein. We place a pulmonary artery catheter through one of these introducers. We hook them up to a Level 1 rapid transfuser and a Belmont rapid transfuser. We also have a backup Level 1 in the room in case one of the transfusers fails. Then depending on the surgeon, we may place additional 16 gauge central lines in the femoral and right internal jugular veins which allow the surgeons to rewire into a bypass cannula. We hook up our drips; routinely, I make phenylephrine, epinephrine, vasopressin, and octreotide. Lastly, we place a transesophageal echocardiogram probe. This can be a little tricky as patients often have esophageal varices that can hemorrhage, but the TEE allows us to visualize the cardiac contractility and volume status. By the time all this is done, I'm pretty spent, and we haven't even made incision.