Organ Harvesting

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Organ Harvesting. CRNAs may be called upon to harvest organs immediately after life-support is withdrawn on a terminal patient. The University of Pittsburgh Medical Center developed the “Pittsburgh Protocol” which details the procedure for procuring an organ after a “controlled” death in the operating room, ICU or PCU (VanNorman, 2003). According to the protocol, teams must wait two minutes after the “irreversible” circulatory arrest to harvest the organs. VanNorman (2003) recommends that anesthesia providers who are involved with non-heart beating cadaver organ donation have specific palliative care training. Ideally they would have been part of the interdisciplinary team treating the patient; however CRNAs may not always have the opportunity to be part of these end-of-life …show more content…

In addition to supporting palliative patients in the OR, anesthesia providers need to be prepared to care for them outside the OR as well – whether in the ICU or PCU. CRNAs may be called upon to administer anesthesia for patients undergoing tracheostomies outside of the OR. Increasing numbers of ALS patients in PCUs are having beside tracheostomies (Chan & Devaiah, 2009).
Interventional Radiology. CRNAs may also encounter palliative patients in IR. Studies have shown that nerve blocks and radiofrequency ablations can alleviate pain in patients with terminal cancer (Mercadante & Giarratano, 2012). These blocks, along with procedures such as permanent line placements, dural punctures, bone marrow biopsies, transjugular intrahepatic portosystemic shunt (TIPS) procedure, etc. may be performed in IR.
Electroconvulsive therapy. Palliative care patients may present for electroconvulsive therapy (ECT) to treat severe depression, late-stage dementia, or psychosis (Rasmussen & Richardson, 2011). Rasmussen & Richardson (2011) argue that in some cases, ECT can be considered compassionate, depending on the clinical presentation.
Terminal

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