Preparations at the Hospital
When you arrive, you will change into a hospital gown (sometimes called a "johnny"). A family member should take your clothing and other personal belongings home with them. Do not bring valuables or large sums of money to the hospital. A nurse or aide will place the things that you want to keep with you (your bathrobe, slippers or small amount of cash) in a bag, lock the bag in a closet, and return it to you after your surgery.
Team members will prepare you for surgery:
- A nurse will weigh you, take your temperature, pulse, and blood pressure, and count your respirations (breathing rate).
- A doctor or nurse practitioner will perform a physical examination, which will include listening to your heart and lungs and examining your abdomen and groin.
- You will meet with the transplant surgeon and sign a consent form for the operation.
- We will start an intravenous (IV) line in your arm so we can give you any necessary IV medications such as those to prevent dehydration and infection. This line and other lines will still be in place when you wake up after your operation.
- We will take blood from your arm to send to the laboratory for necessary tests, including kidney and liver function tests, and red and white blood cell counts.
- A nurse sends your urine sample to the laboratory.
- We may take a chest X-ray if you have not had one recently.
- We may do an electrocardiogram (EKG) if you have not had one recently.
- We will bring you to the hospital floor called the "anesthesia holding area" or directly to the operating room. Your family can stay with you until that time.
The Anesthesia Holding Area
There is a lot of activity in the anesthesia holding area as medical staff continue to prepare you for surgery:
- The anesthesiologist will ask you to sign a consent form so we can give you anesthesia to make you sleep during the operation.
- Staff may place IV (in the vein) and arterial (in the artery) lines in your arm and on the side of your neck. These will still be in place when you wake up after the surgery.
- We will also place EKG leads on your chest to monitor your heart.
- You will receive a subcutaneous (under the skin) injection of heparin, a blood thinner used to prevent blood clots from forming in your legs during surgery. (You will also receive heparin after surgery.) Additionally, we will put compression boots on your legs to help with your circulation. You will still have the compression boots on when you awake from surgery.
- You will receive a dose of intravenous antibiotics before surgery to prevent infections in your surgical incision.
- You will take by mouth one of the immunosuppressive drugs (Mycophenolate Mofetil) used to prevent rejection of your new liver and the anti-fungal drug fluconazole to prevent yeast infections after transplant.
We need to do all of these preparations to perform the transplant operation safely. When they are complete, we will wheel you into the operating room on a stretcher for your transplant operation.
Anesthesia to Make You Sleep
The anesthesiologist will give you intravenous medication to make you sleep during the surgery. The anesthesia team monitors your blood pressure, heart rate, breathing, and blood chemistries very closely during the entire operation.
Preparations Once You Are Asleep
Once we give you the anesthesia, and you are asleep, staff will:
- Place a breathing tube (called an endotracheal tube or ET) in your throat and connect it to a machine (respirator) that will breathe for you.
- Insert a soft, small tube called a Foley catheter into your bladder to drain your urine.
- Insert a soft tube through your nose or mouth into your stomach. Called a nasogastric (NG) tube, it keeps your stomach empty to prevent vomiting and choking.
You will be taken to the Surgery Intensive Care Unit after surgery. You will still be asleep when you are transferred. Both the ET and NG tubes will still be in place until you are awake and strong enough to breathe on your own. The ET will then be removed. The NG tube is usually removed within a day after removing the ET tube. The Foley catheter will remain in place for several days.