Saturday, November 15, 2008

TECHNICAL STUFF

Now that I am getting closer to the actual day of the operation (5 more days!) I figured I'd share a little technical information with you so you know what's going on or better said, what's going to happen.

"surgical approach to living kidney donation is called laparoscopic donor nephrectomy, and involves the use of small cameras and instruments inserted through the abdominal wall. During this procedure, the kidney is separated from its surrounding structures. The operation is performed using TV imaging.

Once entirely separated from its surrounding structures, the kidney is removed through a small incision usually in the mid portion of the lower abdomen. The operation can take from one and one-half to four hours or more depending on the complexity of the surgery.

After a kidney donation, as with most major operations, the patient is monitored in a post anesthesia care unit or recovery room. Blood pressure, heart rate and temperature are observed as are oxygen levels and wakefulness. The level of pain is also monitored. Most donors will come from the operating room with a Foley catheter draining the urinary bladder and with at least one intravenous line allowing fluid administration in the early post operative period. Patients are not permitted to eat or drink anything until they are fully awake, and until they have no nausea and vomiting.

After the immediate recovery period, the donor is transferred to either an intensive care/monitored bed, or to a medical-surgical ward. In either case, post operative pain control is ordered and may take the form of patient controlled analgesia (PCA), or epidural pain management. Usually, the PCA technique, which the patient can control by pressing a button, is used for the laparoscopic donor surgery and epidural pain management is considered for the patients having an open donor nephrectomy. All patients are encouraged to begin walking within 12 to 24 hours following surgery, and self-care including routine hygiene such as showering, shaving and brushing teeth can begin very soon. As a rule, the intravenous fluids are discontinued when the patient can drink or eat food by mouth. The Foley catheter is discontinued when the patient is walking and beginning self-care.

Some treatment plans related to prevention of post operative complications are part of the post donation protocols, just as they are part of patient care for any major surgical procedure. Compression stockings or elastic hose are applied to the feet and legs to prevent blood clots from forming, and small injections of heparin or a similar drug may be given at eight or 12 hour intervals to also address prevention of abnormal blood clots. This is important because one of the major complications that can occur following kidney donation is a blood clot traveling to the lung (pulmonary embolus). This infrequent, but well known, complication can be life threatening and measures to prevent blood clots traveling through the body are standard in all hospitals. As activity and walking increase, these preventive measures are stopped. As the first day or two passes, most kidney donors begin to return rather quickly to the usual activities of daily living. Food and fluid intake resume, less pain medication is needed and patients begin to anticipate discharge from the hospital to their home.

Usually, the only discharge medication required is a standard pain medicine taken by mouth; it may contain some amount of narcotic. Pain control, therefore, may be accompanied by advice not to operate a vehicle, power tool or other machine. Further, most surgeons recommend patients do not drive until they are entirely comfortable with operating a vehicle. Patients are also instructed not to lift any object heavier than approximately 10 pounds for a three to six week period following donation.

This activity restriction is to prevent the occurrence of hernia in the incision. Usually, discharge planning is completed and the patient is ready to go home on the second, third or the fourth post operative day. "

Whew!!!

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