Have you ever seen the NICU turned into a personal mini OR? Me either, until recently!
Some of the surgeries that are performed at the bedside in my NICU include:
PDA ligations
Hernia repairs
Repairs of intestinal perforations
Drain + chest tube placement
Although every surgery is very different, the pre/post op care is essentially the same.
PRE-OP CARE:
Ensure that all of your consent forms are signed and that the surgical team has answered all of the family’s questions.
Have the most recent labs, images and diagnostics pulled up for the surgeon to see.
Flush your IVs and make sure you have access for the anesthesiologist to administer medications.
Grab a set of pre-surgery vitals (the OR team will perform the rest during the surgery).
Ensure that a pre-op bath has been given.
Complete your pre-procedure checklist! (NPO status, time of last void, etc.).
Prepare for the family for what to expect following the surgery (i.e. will the baby be intubated, edematous, etc.).
Last but not least…the TIME OUT. This is where you state two patient identifiers (baby’s name, medical record number, birthdate, etc.) and the name of the procedure. Then once you all agree, it’s time to begin!
POST-OP CARE:
Monitor vital signs every 15 minutes x 4 sets, every 30 minutes x 2 sets, and then hourly.
Manage pain! Surgery is extremely painful, and you want to ensure your baby is properly medicated and sedated AROUND. THE. CLOCK.
Monitor for signs/symptoms of infection or a possible complication.
Monitor for bleeding, drainage, odor or basically anything coming out from the surgical site.
Notify the surgeon if the dressing becomes soiled, saturated, or starts lifting.
Update the family and keep them well-informed.