| In preparing the environment |
| Deliver prophylactic antibiotic and sodium heparin 5000 IU/ml to the anaesthesiologist; |
| Request the following: 01 surgical apron, 02 large basins, 01 kidney dish, 01 needleless cotton suture 0, 01 impermeable sheet, 01 LAP (two main drapes, two sides, two secondary drapes), 01 side table, 01 packet of large compresses, 02 pairs of surgical gloves, 02 Backhaus clamps, 01 IV pole with four hooks or two brackets with 02 hooks each, 01 large milky-white trash bag, 01 sharp object collector. |
| In preparing the auxiliary table for infusion |
| Expose material on the auxiliary table in the following order: 01 LAP, 01 impermeable sheet, 01 surgical gown and 02 pairs of surgical gloves. |
| Perform antisepsis of hands and forearms; |
| Robe with sterile gown and two pairs of gloves; |
| Open on the table assist a large drape, impermeable sheet and then another large drape; |
| Cover serum support(s) with a sterile drape secured with the Backhaus clamp or the cotton suture, thereby avoiding equipment contamination at the time of perfusion; |
| Organize one basin next to the other with large compresses between them; |
| Mount the scalpel cable with #24 blade, keeping it in the external position of the right-side basin; |
| Position the hammer between the basins when not used; |
| Protect frozen physiological solution with the compresses and break them into small pieces, using the hammer; |
| Use the mounted scalpel handle to cut the frozen 0.9% saline bags and scrape the large chunks of ice, putting them in one of the bowls to cool the abdominal cavity as soon as the perfusion begins; |
| Assemble the perfusion system putting two Reynald clamps (tube) on each piece, with a nearby next to the dropper and the other below the air removal device; |
| Deliver to the circulating nurse the tips of the pieces requesting that they connect 04 0.9% frozen saline solutions at each end and place them on the IV pole hooks; |
| Undo the tube clamps cautiously in order to cool and remove the air from equipment. Only half the air removal device must be filled so that the flow and discharge of the solution into the basin or kidney dish can be seen; |
| Place one nelaton Nr. 12 probe at the end of the irrigation equipment to infuse the preservation solution through the portal vein and at the other a No. 06 endotracheal tube to infuse the preservation solution through the aorta artery, then deliver the ends of the equipment to the surgical technician; |
| Give the surgical technician 02 20 ml syringes and a kidney dish with 0.9% cold saline from the perfusion system, approximately 500 ml for washing the gallbladder and removing the bile; |
| Put a 20 ml syringe with needle for blood collection on the surgical technician's table; |
| Ask the surgeon to collect blood and material for biopsy prior to perfusion; |
| Receive the collected materials from the surgeon and perform the following: |
| Deliver the exam collector containing the biopsy to the circulating nurse, requesting that they immerse it in formalin and then identify it with the donor's name, cause of death, blood type and date. The vial with the biopsy should be packed in two small plastic bags and placed in the cooler; |
| Connect the syringe to the 40X12 needle and give it to the circulating nurse requesting that they distribute blood in 01 EDTA tube, 01 gel tube and 01 vial for blood culture and then identify them. |
| Ask the circulating nurse to prepare the tubes with EDTA and gel in two small plastic bags and in the cooler, then put the vial containing blood for blood culture into two small plastic bags; |
| Test the drainage of the perfusion catheters, together with the surgeon, carefully releasing the tube clamps of the portal vein and aorta artery, then clamp them; |
| Ask the circulating nurse, on the verge of clamping the aorta, to remove the empty bags of physiological solutions and put 04 cold preservation solutions in each infusion entry. |
| At the time of perfusion |
| Start the perfusion when the aorta is clamped, checking the time and then writing down the onset of cold ischemia; |
| First release the clamp from one side of the infusion equipment that will irrigate the aorta, checking whether the flow is steady, and then release the other clamp of the portal vein, observing the air removal device drain. Tell the doctor if irrigation ceases or decreases. When the first side finishes, release the other; |
| Observe when draining of the preservation solution finishes and note end of perfusion; |
| Ask the circulating nurse during the perfusion process to compress the solutions to drain faster and thus decrease the time of perfusion, if necessary; |
| Ask the circulating nurse to immediately warn the OR nurse of the transplant hospital if the liver is feasible for implant, as per surgeon's information after completion of the infusion. |
| In preparing the Back Table |
| Place a big sterile bag over the basin, covering the edges of the basin; |
| Break the frozen saline into small pieces and place in the first large sterile bag over the basin; |
| Place the second large plastic bag over crushed ice, also covering the basin; |
| Place the third large plastic bag folded next to the bowl; |
| Request two pairs of sterile gloves for the surgeon, exposing them on the Back Table; |
| Organize the Back Table box' surgical instruments, threads, 60ml and 20ml syringes; |
| Leave all material organized and protected with a sterile field until the arrival of the liver. |
| In preparing the liver on the Back Table |
| Deliver the basin with sterile bags and crushed ice for the surgeon to place the liver; |
| Ask the surgeon to release the ends of the infusion equipment, place the irrigation tip of portal vein on the Back Table and dispose of the other equipment that was in the aorta artery; |
| Assist the surgeon in preparing the liver, noting the presence of lesions and anatomical variations and then register on the donor sheet; |
| Ask circulating nurse to put another preservation solution in the portal vein equipment; |
| First perfuse the portal vein with the nelaton Nr.12 probe, then the artery with a ferrule, and with the same ferrule perfuse the common bile duct; |
| Deliver the 60 or 20ml syringe to the surgeon to verify the integrity of the vessels; |
| Assist the physician to close the first bag, then tie the second bag, placing them in the third bag and tie all with cardiac tape; |
| Condition the liver in cooler containing ice cubes; |
| Seal the insulated box with tape, keeping the organ at 4°C; |
| Identify the cooler by putting a label with: name (donor's initials), Transplant Centre General Registration number (RGCT), date of harvest, cause of death, age, weight, blood type, aortic clamp time and which and what amount of preservation solution; |
| Receive venous and arterial grafts immersed in preservation solution from the surgical technician, packing it in the first sterile small bag; |
| Place the venous and arterial grafts packed in the first package in another secondary plastic bag; |
| Deliver the grafts the circulation nurse to identify the secondary packaging material type, with donor data (full name, blood type, date, weight, age, cause of death) and store in cooler near the liver. |
| Check and pack all contaminated materials in plastic bags; |
| Deposit needle stick materials in appropriate container; |
| Finish completing the donor sheet; |
| Fill in used medical and hospital supplies sheet; |
| Arrange transport to return to the hospital, with the materials properly prepared and organized on the push cart. |
