Liver ablation
Bleeding risk
Bleeding risk
HIGH bleeding risk
HIGH bleeding risk
INR ≤ 1.8
Plt ≥ 50,000
CBC, INR/PT routinely recommended
Anticoagulant/Antiplatelet Agent
Anticoagulants
Antiplatelets
Antibiotics
Antibiotics
High risk patient = biliary enteric anastamosis
Severe Cefazolin allergy = hives or anaphylaxis to Cefazolin or DRESS/SJS/TEN to any beta-lactam
Low risk patient = Cefazolin
Cefazolin IV
Adult < 120kg = 2 g
Adult ≥ 120kg = 3 g
Peds = 25 mg/kg (max = 2 g)
Low risk patient with severe Cefazolin allergy = Vancomycin
Vancomycin IV
Adult < 80 kg = 1000 mg
Adult > 80 kg = 1500 mg
Peds = 15 mg/kg (max = 1500 mg)
High risk patient = Vancomycin AND Gentamicin
Vancomycin IV
Adult < 80 kg = 1000 mg
Adult > 80 kg = 1500 mg
Peds = 15 mg/kg (max = 1500 mg)
Gentamicin IV
Adult = 5 mg/kg
Peds = 2.5 mg/kg