Patient Education UWMC Clinic Care After Discharge For a kidney/pancreas transplant Once you are discharged from the hospital, you will enter the next phase of transplant care, outpatient follow-up. You will have multiple visits with the transplant team at UWMC outpatient clinic. Your first appointment will be scheduled for you before leaving the hospital.
UWMC Clinic Care After Discharge Page 14-2 Why follow-up care at UWMC? You will need to be assessed by the UWMC transplant team the first 3 to 6 weeks after transplant. This is the most common time for complications and rejection to occur. The transplant team will follow you closely and can diagnose and promptly treat transplant complications. You will be returned to your referring doctor s care after your lab results and drug levels are stabilized, your stent is removed (if applicable), and a biopsy, if applicable, is completed. What should I be doing at home to help prepare for these visits? Fill discharge prescriptions at the pharmacy of your choice as soon as possible after leaving the hospital. Take medications as prescribed continue learning names, functions and doses. Update your mediset and medication profiles when changes are made. Refill your mediset at least once per week. Do not take over-the-counter medications/herbal/natural medicines without doctor approval. You may use Tylenol (acetaminophen)
Page 14-3 UWMC Clinic Care After Discharge for headache, fever, or pain. Do not take non-steroidal anti-inflammatory drugs (ibuprofen [Motrin, Advil ], naproxen [Aleve ], indomethacin [Indocin ], large doses of aspirin), and menstrual cramp preparations. Watch for signs and symptoms of rejection or infection (see Discharge Checklist chapter for a list of what to look for). Take blood pressure, pulse, and temperature twice daily. Weigh yourself once daily and record these numbers in My Transplant Log. Check your blood sugars (if diabetic or pancreas transplant patient) at least twice daily and record them in My Transplant Log. Measure your daily fluid intake and urine output and record in My Transplant Log. Note any vomiting or diarrhea. Collect urine (if asked to do so). Change dressings on your wound (if asked to do so). After bathing, make sure your wound is dry. Use a clean towel and blot dry. Then paint the area using a betadine swab twice daily. Wear loose clothing to prevent rubbing on the incision that could cause irritation.
UWMC Clinic Care After Discharge Page 14-4 For kidney transplant patients: Attempt to empty your bladder at least every 3 to 4 hours. You will notice a need to urinate more often and in larger amounts, especially at night. Within the next few weeks, your bladder will enlarge and you will not have to urinate so frequently. Constipation can be serious. Never go longer than 48 hours without a bowel movement. Activity, adequate fluid, reducing pain medication and adding roughage to your diet will help. Peritoneal dialysis catheters will usually be removed 6 weeks after transplant. Continue to monitor the catheter for infection. Also, it is recommended you flush the catheter once a week until it is removed. Arrange transportation to and from clinic. Gradually increase activity at home. You are encouraged to walk and participate in basic activities of daily living (such as cooking, bathing showers preferred). Avoid lifting over 10 pounds in the first 2 months after surgery. Driving is not permitted until 6 weeks after transplant.
Page 14-5 UWMC Clinic Care After Discharge Swimming is allowed 4 weeks after transplant if incision is well-healed. No high-impact exercise such as jogging, aerobics, hiking with a heavy pack, basketball, etc. for 6 months after transplant. No exercise that twists the body such as golf for 3 months after transplant. You can usually return to work part-time in 3 weeks. For physically strenuous jobs, you should probably wait about 6 weeks. It is okay to resume sexual activities slowly, as you desire. Follow birth control precautions. This is not a time to start a family. It is not recommended to travel long distances from home yet. Avoid infectious risks. This includes crowds when possible (such as shopping at the mall) for about 3 months. Avoid handling pets and do not empty litter boxes. Wash hands often. You do not need to wear a mask, but it is recommended if you must be around dust, sick family members or friends.
UWMC Clinic Care After Discharge Page 14-6 Peritoneal dialysis catheters. Your fistula or graft is not removed. It may have clotted during or after surgery. It may or may not need to be opened up. This should be discussed with your surgeon. Healthy eating. Refer to your nutrition handbook. Keep a food log if asked to by the dietitian. There are generally few, if any, diet or fluid restrictions. Sometimes you may need to continue to watch your potassium or fluid intake. Review your Guide to Your Kidney/ Pancreas Transplant. Always call 911 for a life-threatening emergency. When should I call the transplant coordinator? Weekdays: My coordinator: _ Phone number: 206-598- After hours/weekends/holidays phone number: 206-598-6190. Ask for the kidney or pancreas transplant doctor oncall. Call if any of the following occur: Fever: Temperature greater than 100 F (38 C).
Page 14-7 UWMC Clinic Care After Discharge Pain: Increasing pain, especially abdominal pain. Breathing: Shortness of breath or coughing. Wound: Redness, tenderness, swelling or drainage from your incision. Nausea, vomiting, diarrhea or inability to keep medications or fluids down. Urine: Inability to void or sudden decrease in urine output (kidney transplant), bloody urine, or pain with urination. Blood sugar: Blood sugars over 200mg/dl (pancreas transplant) or blood sugars regularly over 300mg/dl. Constipation: You have not had a bowel movement for over 48 hours. Questions about medication administration (dosing instructions, missed doses) or other concerns. What do I bring to these clinic visits? Guide to Your Kidney/Pancreas Transplant (you may need to review or refer to it). My Transplant Log and all records you have been keeping track of at home.
UWMC Clinic Care After Discharge Page 14-8 Urine collections (take to lab) if asked to do so. Medication Profile or list and mediset (pillbox) (filled or loaded with medications). Your filled prescriptions in their original containers. Family member or friend. Something to do while waiting. Questions for the transplant team. What will the clinic day look like? Before you arrive at the medical center: You may eat breakfast before your clinic appointment unless instructed not to do so (if asked to fast). You may take all morning medications except immunosuppressive medications. You should arrive at the lab for a blood draw between 7:30 a.m. and 8 a.m. After your blood draw, you should take your morning immunosuppressive medication doses with a snack or beverage. Check in at UWMC Transplant Clinic front desk at your scheduled appointment time.
Page 14-9 UWMC Clinic Care After Discharge Attend clinic appointment in the Transplant clinic at assigned time (usually between 8:30 a.m. and noon). The time you will leave the medical center for home depends upon how early your clinic appointment is, how many people you need to see, or any additional procedures required (such as staple/stent removal/iv infusion). Your coordinator may call you at home to discuss late laboratory results (drug blood levels) and advise you of any changes in medication doses. Stay on your current medication dosages and schedules until told to change. It is a good idea to make sure your coordinator knows how to reach you, especially if you are from out of town and not staying at your own home. What will these clinic visits involve? Blood draws to check medication levels. Blood draws to check the function of your kidney or pancreas. Visits with the transplant doctors and coordinators which include: Checking your surgical incision to make sure you are healing properly.
UWMC Clinic Care After Discharge Page 14-10 A physical exam to find out how you are recovering from surgery, including the taking of vital signs (blood pressure, weight, temperature) and monitoring for signs of rejection or infection. A review of your medications. A review of your lab results. Possible visits with ancillary transplant team members, including social work, dietary and pharmacy. Procedures such as ureteral stent removal, wound staple removal, and biopsies. Possible readmission to the hospital if you need inpatient treatment for complications. How often will I attend clinic? You will have regular visits at UWMC Transplant Clinic for a period of 3 to 6 weeks. After that period, you will be cleared by the transplant team to go to your primary care nephrologist. However, you will occasionally return to UWMC Transplant Clinic for a follow-up visit.
Page 14-11 UWMC Clinic Care After Discharge When this transfer of care happens depends on how well your new kidney or pancreas is functioning and whether there are any transplant complications that must be watched closely. After transfer of care occurs, your general medical care as well as all transplant issues will be managed by your nephrologist or primary care doctors. Here is the recommended schedule of lab tests and clinic visits after transplant: Time Post-Op 1-5 Weeks 6-12 Weeks 3-6 Months 6-12 Months After 12 Month Labs 3 times /week 2 times /week 1 time /week 2 times /month 1 time /month Clinic Visits 2-3 times/week 1 time /week 2 times/month 1 time /month 1 time /month
UWMC Clinic Care After Discharge Page 14-12 Questions? Your questions are important. Call your transplant coordinator during business hours. 206-598-8881 Box 356174 1959 N.E. Pacific St., Seattle, WA 98195 206-598-8881 University of Washington Medical Center 03/2003 Rev. 01/2005