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Alprostadil (PGE1)
Protocol for Administration and Monitoring in Liver Transplant Patients
- Alprostadil (PGE1) is prepared as 500 µg/100mL of D5W. (final concentration = 5 µg/mL)
- If necessary, PGE1 may be prepared in a larger volume (500 µg/250 mL)
- If necessary it may be diluted is normal saline instead of D5W.
- Infusion begins shortly after reperfusion of the transplanted liver.
- Initial rate (continuous infusion) = 0.1 µg/kg/hr (based on pre-op body wt).
- Every hour, increase rate by 0.2 µg/kg/hr up to a maximum rate of 1 µg/kg/hr
- PGE1 infusion is continued throughout ICU stay unless discontinued because of hemodynamic instability, persistant fever, thrombocytopenia, etc. (see monitoring below).
- Blood pressure, heart rate, body temperature, and platelet count should be closely monitored during PGE1 infusion.
- If systolic BP <100 mm Hg or MBP < 70 or heart rate > 110, infusion is stopped until patient is hemodynamically stable. Infusion is then resumed at half the rate and titrated as tolerated.
- Infusion is discontinued gradually (see below) if there is persistent fever.
- Infusion is D/Ced gradually if platelet count drops to <40 k
- Before the patient is transferred from the surgical ICU to the transplant floor, the process of gradual discontinuation of alprostadil infusion should be started:
- The infusion rate is cut in half every two hrs x 2 and then stopped completely. During this period the pt's BP should be recorded at the beginning of each rate change and then every 30 minutes x 2
.
- If the patient is stable, the PGE1 discontinuation process may be initiated in the ICU and continued on the floor.
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