Central Mindanao University

College of Nursing
University Town, Musuan, Maramag 8710
Bukidnon
Tel No. 088-356-1910/13 Tele Fax No. 088-356-1912
Email add: nursing@cmu.edu.ph
Website: www.cmu.edu.ph

Ward Class

Prepared by:
Mejos, Mary Grace V.

Topics:
Heart Transplant Surgery
Cystoclysis

November 13, 2017

Heart transplant surgery
Heart transplant surgery is an open heart surgery that takes several hours. If you've had
previous heart surgeries, the surgery is more complicated and will take longer. You'll receive
medication that causes you to sleep (general anaesthesia) before the procedure. Your
surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing
throughout your body.
In this procedure, your surgeon will make an incision in your chest. Your surgeon will
separate your chest bone and open your rib cage so that he or she can operate on your heart.

Your surgeon then removes the diseased heart and sews the donor heart into place. He or she
then attaches the major blood vessels to the donor heart. The new heart often starts beating
when blood flow is restored. Sometimes an electric shock is needed to make the donor heart
beat properly.

You'll be given medication to help with pain after the surgery. You'll also have a ventilator to
help you breathe and tubes in your chest to drain fluids from around your lungs and heart.
After surgery, you'll also receive fluids and medications through intravenous (IV) tubes.

Why it's done

Heart transplants are performed when other treatments for heart problems haven't worked,
leading to heart failure. In adults, heart failure can be caused by several conditions, including:

A weakening of the heart muscle (cardiomyopathy)

Coronary artery disease

Heart valve disease

A heart problem you're born with (congenital heart defect)

Dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled

by other treatments

Amyloidosis

Failure of a previous heart transplant

In children, heart failure is most often caused by either a congenital heart defect or a
cardiomyopathy.
Another organ transplant may be performed at the same time as a heart transplant (multiorgan
transplant) in people with certain conditions at select medical centers. Multiorgan transplants
include:

Heart-kidney transplant. This procedure may be an option for some people with
kidney failure in addition to heart failure.

Heart-liver transplant. This procedure may be an option for people with certain liver
and heart conditions.

Heart-lung transplant. Rarely, doctors may suggest this procedure for some people
with severe lung and heart diseases, if the conditions aren't able to be treated by only a
heart transplant or lung transplant.

Complications of surgery

Heart transplant surgery requires open heart surgery, which carries the risk of many
complications, including:

Bleeding

Infection

Blood clots

Heart attack

Stroke

Death

Risks of having a heart transplant

Although receiving a donor heart can save your life, having a heart transplant has many risks.
Risks include:

Rejection of the donor heart. One of the most significant risks after a heart transplant
is your body rejecting the donor heart.

Your immune system will see your donor heart as a foreign object that's not supposed to
be in your body. Your immune system will try to attack your donor heart. Although all
people who receive a heart transplant receive immunosuppressants medications that
 reduce the activity of the immune system about 10 percent of heart transplant
recipients still have some signs of rejection that need treatment during the first year
after transplantation. This is often effectively treated with medication.

Usually the rejection is without any symptoms and requires only an adjustment of
medications. If you miss doses of medications, however, the rejection can be severe and
very serious. It's important that you follow the instructions as explained by your
doctors.

To determine whether your body is rejecting the new heart, you'll have frequent heart
biopsies to test your heart tissue during the first year after your transplant. After the first
year, the number of biopsies is significantly reduced.

Problems with your coronary arteries. After your transplant, it's possible the walls of
the arteries in your heart (coronary arteries) could thicken and harden, leading to
cardiac allograft vasculopathy (CAV). This can make blood circulation through your
heart difficult and can cause a heart attack, heart failure, abnormal heart rhythms
(arrhythmias) or sudden cardiac death.

Your doctor may recommend annual tests after your transplant to monitor your
coronary arteries for CAV.

Medication side effects. The immunosuppressants you'll need to take for the rest of
your life may cause kidney damage and other problems. Other complications of these
medications can include high blood pressure, high cholesterol, diabetes and a condition
in which your bones become thin and weak (osteoporosis).

Cancer. Immunosuppressants can also increase your cancer risk. Taking these
medications can put you at a greater risk of skin cancer, non-Hodgkin's lymphoma and
other solid tumors. Regular checkups are necessary to detect the development of cancer.

Infection. Immunosuppressants decrease your ability to fight infection. Some heart

transplant recipients may develop an infection that requires them to be admitted to the
hospital during the first year after their transplant. The risk of infection decreases over
time as the amount of immunosuppressant medication is decreased.
Taking the first steps

If your doctor recommends that you consider a heart transplant, you'll likely be referred to a
heart transplant center for an evaluation. You're also free to select a transplant center on your
own. Check with your health insurance provider to see which transplant centers are covered
under your insurance plan.

When evaluating a heart transplant center, consider the number of heart transplants a center
performs each year and transplant recipient survival rates. You can compare transplant center
statistics on the web using a database maintained by the Scientific Registry of Transplant
Recipients.

Also consider additional services that may be provided by a transplant center. Many centers
may coordinate support groups, assist with travel arrangements, help you find local housing
for your recovery period or direct you to organizations that can help with these concerns.

Once you decide where you would like to have your heart transplant, you'll need to have an
evaluation to see if you're eligible for a transplant. During an evaluation, your doctors and
transplant team will conduct a physical examination, order several tests, and evaluate your
mental and emotional health. The evaluation will check to see if you:

Have a heart condition that would benefit from transplantation

Might benefit from other less aggressive treatment options

Are healthy enough to undergo surgery and post-transplant treatments

Will agree to quit smoking, if you smoke

Are willing and able to follow the medical program outlined by the transplant team

Can emotionally handle the wait for a donor heart

Have a supportive network of family and friends to help you during this stressful time
Your transplant team will also discuss with you the benefits and risks of a transplant and what
to expect before, during and after a transplant.

Waiting for a donor organ

If the transplant team determines that you're a candidate for a heart transplant, the transplant
center will register you on a waiting list. At any given time, there are about 3,000 people in
the U.S. waiting for heart transplants. Unfortunately, there aren't enough hearts for every
person in need, and some people die while waiting for a transplant.

While you're on the waiting list, your medical team will closely monitor your condition and
alter your treatment as needed. Your transplant team may temporarily remove your name
from the waiting list if you develop a significant medical condition, such as a severe infection
or stroke, which makes you temporarily unable to have a transplant while you recover.

Your doctors may recommend that you participate in a cardiac rehabilitation program while
you wait for a donor heart. Cardiac rehabilitation is a program of exercise and education
designed to help improve your health before and after your heart transplant.

If medical therapy fails to support your vital organs as you wait for a donor heart, your
doctors may recommend you have a device implanted to support your heart while you wait
for a donor organ, such as a ventricular assist device (VAD). These devices are also referred
to as a bridge to transplant because they stabilize your condition until a donor heart is
available.

When a donor heart becomes available, the donor-recipient matching system considers
several factors to make a match, including:

Medical urgency of potential recipients

Blood type (A, B, AB or O)

Antibodies the recipients may have developed

Size of the donor

Time spent on the waiting list

After the procedure

After you've had surgery to place your donor heart, you'll stay in the intensive care unit
(ICU). You'll generally be moved to a regular hospital room after a few days in the ICU, and
you'll usually remain in the hospital for a week or two. The amount of time you'll spend in
the ICU and in the hospital can vary.

After you leave the hospital, you'll be closely monitored at your outpatient transplant center
by your transplant team. Due to the frequency and intensity of the monitoring, many people
stay close by the transplant center for the first three months. Afterward, the follow-up visits
are less frequent, and it's easier to travel back and forth for follow-up visits.

You'll also be monitored for any signs or symptoms of rejection, such as shortness of breath,
fever, fatigue, not urinating as much or weight gain. It's important to let your transplant team
know if you notice any signs or symptoms of rejection or infection.

After your heart transplant, you'll have several follow-up appointments at the transplant
center. You'll have regular tests, including blood work, echocardiograms, electrocardiograms
and heart biopsies.

To determine whether your body is rejecting the new heart, you'll have frequent heart
biopsies in the first few months after heart transplantation, when rejection is most likely to
occur. The frequency of necessary biopsies decreases over time.

During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to
your heart. A doctor runs a biopsy device through the tube to remove a tiny sample of heart
tissue, which is examined in a lab.

You'll need to make several long-term adjustments after you've had your heart transplant.
These include:

Taking immunosuppressants. These medications decrease the activity of your

immune system to prevent it from attacking your donated heart. Because your immune
system will most likely never completely accept the new organ, you'll take some of
these medications for the rest of your life.

Immunosuppressant medications may cause noticeable side effects. For example, when
taking post-transplant drugs such as corticosteroids, your face may become round and
full, and you may gain weight, develop acne or facial hair, or experience stomach
problems. Some side effects of immunosuppressant drugs may be more noticeable when
you first start the drugs, but they may decrease in severity over time.

Because immunosuppressants make your body more vulnerable to infection, your

doctor may also prescribe antibacterial, antiviral and antifungal medications.
 Some immunosuppressants could also worsen conditions or raise your risk of
developing conditions such as high blood pressure, high cholesterol, cancer,
osteoporosis or diabetes.

Over time as the risk of rejection is reduced, the doses and number of anti-rejection
drugs can be reduced, but you'll need some immunosuppressant medications
indefinitely.

Managing medications, therapies and a lifelong care plan. After a heart transplant,
taking all your medications as your doctor instructs and following a lifelong care plan is
important.

Your doctor may give you specific instructions regarding lifestyle guidelines, such as
wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and
being careful to lower your risk of infection in daily life.

Follow all of your doctor's instructions, see your doctor regularly for follow-up
appointments, and let your doctor know if you have any signs or symptoms of
complications.

It's a good idea to set up a daily routine for taking your medications so that you won't
forget. Keep a list of all your medications with you at all times in case you need
emergency medical attention, and tell all your doctors what you take each time you're
prescribed a new medicine.

Cardiac rehabilitation. Cardiac rehabilitation programs incorporate exercise and

education to help you improve your health and recover after a heart transplant. Staff
members trained in cardiac rehabilitation may help you adjust to healthy lifestyle
changes such as regular exercise and a heart-healthy diet after your transplant.

Your transplant team may also suggest that you begin a cardiac rehabilitation program
prior to your transplant to improve your health.

Emotional support. Your new medical therapies and the stress of having a heart
transplant may make you feel overwhelmed. Many people who have had a heart
transplant feel this way.
 Talk to your doctor if you're feeling stressed or overwhelmed. Transplant centers often
have support groups and other resources to help you manage your condition.

Conclusion

Most people who receive a heart transplant enjoy a high quality of life. Depending on your
condition, you may be able to return to many of your daily life activities, such as returning to
work, participating in hobbies and sports, and exercise. Discuss with your doctor what
activities are appropriate for you.

Some women who have had a heart transplant can become pregnant. However, discuss with
your doctor if you're considering having children after your transplant. You'll likely need
medication adjustments before becoming pregnant, as some medications can cause pregnancy
complications.

Heart transplant recipient survival rates vary based on a number of factors. A 2014 report by
the Organ Procurement and Transplantation Network and the Scientific Registry of
Transplant Recipients stated that the overall survival rate in the U.S. is about 88 percent after
one year and about 75 percent after five years.

Cystoclysis
Cystoclysis or bladder irrigation may be defined as the process of flushing the bladder with
normal saline continuously to prevent or treat clot formation, allowing urine to flow freely
and maintain IDC patency. Here, a special catheter is used. It may also be used to instill
medications such as antibiotics for treating bladder infections, is done over a period of time,
and runs continuously.
Other purposes of bladder irrigation includes relieving bladder spasms as draining urine from
the bladder can relieve spasm; wash out any residue urine or sediment; prevent formation of
calcific deposits in and around the indwelling catheter; and to drain the bladder when acute
urinary retention is present. However, like any other invasive procedure, cystoclysis must be
performed aseptically so as to prevent infection.

Usually, this is indicated for patients with Urinary Tract Infection, post-genitourinary
surgery, prostatic hematuria, urinary retention, and for patients who had undergone
prostatectomy.

To perform this procedure, you may need:

3 way catheter
9% sodium chloride irrigation bags as per facility policy
continuous bladder irrigation set and closed urinary drainage bag with anti-reflux
valve
 Chlorhexidane 0.5% with 70% alcohol wipes
Non sterile gloves
Personal protective equipment
Underpad (bluey)
IV pole

Nurses Role
As nurses participating in this intervention, we must always be aware of our responsibilities
and role. Prior to the procedure, you must first check the doctors order for the type or
irrigation and irrigation solution needed. Confirm clients identity and explain procedure to
the client. Make sure that the patient understands it well and you may need to obtain
informed consent.

Gather materials and make sure that everything is in order and complete. Then, perform
medical handwashing and provide privacy to the patient.
During the procedure aseptic technique must be observed. First you must drape the patient
exposing the leg where the catheter is being taped. Then, do gloving and cleanse the catheter
injection port with an antiseptic swab. Remember to maintain sterility at all times and make
sure that you are only exposing the site.

Swab IDC irrigation and catheter ports with chlorhexidine swabs and allow drying. After
that, remove the spigot from the irrigation lumen of the catheter using sterile gauze and
discard the spigot. Connect the irrigation set to the irrigation lumen of the catheter still
observing the aseptic technique. Then remove the spigot or old drainage bag from the
catheter lumen using sterile gauze and apply catheter drainage bag maintaining clean
procedure.

Remember not the start bladder irrigation until the urine of the patient is flowing freely. If it
is, then you must unclamp the irrigation flask that was used to prime the irrigation set and set
the rate of administration by adjusting the roller clamp. Regulate the flow well.

We must ensure that there is adequate supply or irrigants nearby as this procedure may be
done continuously and as necessary depending on the degree of the hematuria.

After each flask is complete, empty urine drainage bag and immediately record urine output
on the fluid balance chart, before you begin with next irrigation flask. Also, to prevent
infection especially those catheter related UTIs, the nurse must ensure that regular catheter
care is given and must be documented in the nurses notes as well as NCPs.
Not only should you note the amount of urine output, but the nurse must also note the
descriptions such as urine color and degree of hematuria, as well as patients comfort.

Complications
Bladder rupture
Bladder injury
Infection
Trauma to the wall of the bladder
Bladder distention
Bladder spasm
Conclusion
Bladder irrigation is a flushing or washing out with a specified solution, usually to wash out
the bladder and sometimes to apply a medication to the bladder lining. Usually, this is
indicated for patients with Urinary Tract Infection, post-genitourinary surgery, prostatic
haematuria, urinary retention, and for patients who had undergone prostatectomy.

References:

Mancini D. Indications and contraindications for cardiac transplantation.

http://www.uptodate.com/home. Accessed April 8, 2016.

Colvin M, et al. OPTN/SRTR annual data report 2014: Heart. American Journal of
Transplantation. 2016;16:115

Goldman L, et al., eds. Cardiac transplantation. In: Goldman-Cecil Medicine. 25th ed.
Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed April
7, 2016.

https://www.mayoclinic.org/tests-procedures/heart-transplant/details/results/rsc-
20206368
Name: Date:
Encircle the correct answer.

1. Heart transplantation is reserved for people who have severe heart failure, coronary artery
disease, or other severe heart disorders and who cannot be treated effectively with drugs or
other forms of surgery. Which of the following can keep people alive for weeks or months
while waiting for a compatible heart?
a. Immunosuppressant
b. Implantable artificial heart
c. Hearts from animals
d. Complete bed rest
2. What machine is connected to keep oxygen-rich blood flowing throughout the body?
a. heart-lung bypass machine
b. heart bypass machine
c. suction machine
d. none of the above
3. What diagnosis in adult patients is the most common indication for heart transplantation?
a. Ischemic cardiomyopathy
b. Pregnancy-induced cardiomyopathy
c. Congenital deformity
d. Re-transplantation
4. Heart transplant surgery requires open heart surgery, which carries the risk of many
complications, these are the following except;
a. Bleeding
b. Infection
c. Death
d. None of the above
5. What type of anaesthesia is given to the client who will undergo heart transplant surgery?
a. Local Anaesthesia
b. General Anaesthesia
c. Epidural Anaesthesia
d. No Anaesthesia
6. Although receiving a donor heart can save your life, having a heart transplant has many risks,
excluding;
a. Rejection of the donor heart.
b. Problems with your cardio-respiratory system
c. Problems with your coronary arteries.
d. Medication side effects
7. When a donor heart becomes available, the donor-recipient matching system considers
several factors to make a match, including:
a. Medical urgency of potential recipients
b. Size of the donor
c. Antibodies the recipients may have developed
d. All of the above
8. Heart transplants are performed when other treatments for heart problems haven't worked,
leading to heart failure. In adults, heart failure can be caused by several conditions, including:
a. Amyloidosis
b. Bronchopneumonia
c. Dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by
other treatments
d. All of the above
 9. These medications decrease the activity of your immune system to prevent it from attacking
your donated heart. Because your immune system will most likely never completely accept
the new organ, you'll take some of these medications for the rest of your life.
a. Corticosteroid
b. Bronchodilator
c. Immunosuppressant
d. None of the above
10. This procedure may be an option for some people with kidney failure in addition to heart
failure.
a. Heart-Liver Transplant
b. Heart-Kidney Transplant
c. Kidney Transplant
d. None of the above
11. It is defined as the process of flushing the bladder with normal saline continuously to
prevent or treat clot formation, allowing urine to flow freely and maintain IDC
patency.
a. Cystoclytosis
b. Cystoclysis
c. Cystosis
d. None of the above
12. What is the other term of the answer of number 11?
a. Bladder irrigation
b. Bladder ligation
c. Bladder suctioning
d. None of the above
13. 16. Give 4 of its complications.

17- 20. To perform this procedure, you may need: (give 4)