Pacu Orientation Manual
Post anesthesia care unit(PACU). 1. ATLAS HOSPITAL P.O BOX 1101, Postal Code: 133, MBD East, RUWI. Sultanate Of Oman. Phone: 24811706 Fax:24811812 Email: atlashospital@gmail.com 12/4/2015 3:47:40 PM.
HOSPITALS Life Long Health Care www.AtlasEra.com. During The Presentation PLEASE:. Put cell-phones on silent/vibrate mode. Take emergency calls outside.
Maintain silence. HOSPITALS. Post- Anaesthesia Care (PAC) DR RAJESH T EAPEN ANESTHESIOLOGIST ATLAS HOSPITAL, RUWI. Introduction Recovery from anesthesia can range from completely uncomplicated to life-threatening. Must be managed by skilled medical and nursing personnel. Anesthesiologist plays a key role in optimizing safe recovery from anesthesia Must be carried out in a well planned, protocol based fashion 2/4/2015 3:47:52 PM 5.
PAC Definition It is the specialized care given to the patients who have undergone anaesthetic management, by a team of well trained professionals, in a specially designed, equipped and designated area of the hospital 2/4/2015 3:47:52 PM 6. PURPOSES To enable a successful and faster recovery of the patient post operatively. To reduce post operative mortality rate. To reduce the length of hospital stay of the patient. To provide quality care service. To reduce hospital and patient cost during post operative period. 2/4/2015 3:47:53 PM 7.
PAC Vs. Post operative care PAC is provided to anyone who has undergone anaesthesia anaesthesia might not be for a surgical procedure patients undergoing ECT, Narco analysis patients under going Endoscopies + all the patients who have undergone surgeries 2/4/2015 3:47:53 PM 8. PACU Definition: It is the Specially designated Specially designed Specially located Specially staffed Specially equipped for a Specific purpose! 2/4/2015 3:47:53 PM 9. History of the PACU Methods of anesthesia have been available for more than 160 years, but the PACU has only been common for the past 70 years. One can trace it to “Lady of the lamp”: F.
1920’s and 30’s: several PACU’s opened in the US and abroad. It was not until after WW II that the number of PACUs increased significantly. This was due to the shortage of nurses in the US. In 1947 a study was released which showed that over an 11 year period, nearly half of the deaths that occurred during the first 24 hours after surgery were preventable.
1949: having a PACU was considered a standard of care. 2/4/2015 3:47:55 PM 10. PACU Location Shouldbe locatedclose to the OperatingTheater Immediateaccess to x-ray, bloodbank,bloodgas and clinical labs.
An openwardis optimalfor patientobservation,with at least oneisolationroom. Centralnursingstation. Requiresgoodventilation,becausethe exposureto waste anestheticgasesmay be hazardous.
NationalInstituteof OccupationalSafety (NIOSH) has establishedrecommendedexposurelimitsof 25 ppm for nitrousoxide and2 ppm for volatileanesthetics. 2/4/2015 3:47:55 PM 11. Design of PACU Size: Ideal 1.5 PACU bed for every Operating Room 120 square foot per patient Minimum of 7 feet between beds Facilities: Fowler’s cot with side rails Piped Oxygen, Vacuum and Air Multiple electrical outlets Large doors Good lighting Isolation for Immuno-compromised patients 2/4/2015 3:47:55 PM 12. PACU PACU should be sound proof, painted in soft colour, isolated and these features will help the patient to reduce anxiety and promote comfort. 2/4/2015 3:47:55 PM 13. 2/4/2015 3:47:56 PM 15.
Pacu Orientation Manual
2/4/2015 3:47:56 PM 16. PACU Staffing One nurse to one patient for the first 15 minutes of recovery. Then one nurse for every two patients. The anesthesiologist responsible for the anesthetic remains responsible for managing the patient in the PACU. Adequate no. Of ancillary staff, such as technicians, ward boys and female attenders.
2/4/2015 3:47:56 PM 17. PACU Equipment Multi-parametric monitors (Automated BP, pulse ox, ECG) and intravenous supports should be located at each bed. Area for charting, bed-side supply storage, suction, and oxygen flow meter at each bed- side.
Immediately available - Emergency equipment, Crash cart, Defibrillator. 2/4/2015 3:47:56 PM 18. 2/4/2015 3:47:56 PM 19. Routine Post-Anaesthesia Care Criteria for shifting from OR-to-PACU Haemo dynamic stability Clinical evaluation and complete recovery from NM blockade Maintenance of Oxygen Saturation Normothermia 2/4/2015 3:47:56 PM 20. PACU Standards 1.
All patients who have received general anesthesia, regional anesthesia, or monitored anesthesia care should receive post-anesthesia management. The patient should be transported to the PACU by a member of the anesthesia care team that is knowledgeable about the patient’s condition.
Upon arrival in the PACU, the patient should be re- evaluated and a verbal report should be provided to the nurse. The patient shall be evaluated continually in the PACU.
Anaesthesiogist, concerned is responsible for discharge of the patient. 2/4/2015 3:47:56 PM 21.
PHASES OF POST OP UNIT Two phases- Phase I Phase II 2/4/2015 3:47:56 PM 22. Phase I It is the immediate recovery phase and requires intensive nursing care to detect early signs of complication. Receive a complete patient record from the operating room which to plan post operative care. It is designated for care of surgical patient immediately after surgery and patient requiring close monitoring 2/4/2015 3:47:56 PM 23. Phase II Care of the surgical patient who has been transferred from the Phase I post op unit. Patient requiring less observation and less nursing care than Phase I This phase is also known as Step down or progressive care unit. 2/4/2015 3:47:56 PM 24.
Admission Report Preoperative history Intra-operative factors: Procedure Type of anesthesia Estimated Blood Loss (EBL) Urine output Assessment and report of current status Post-operative instructions 2/4/2015 3:47:56 PM 25. Postoperative Pain Management Intravenous opioids Diclofenac, I.V. Paracetamol and anti- inflammatory drugs Midazolam for anxiety Epidural: LAAs and their adjuvants Regional analgesic blocks PCA (Patient controlled analgesia) and PCEA 2/4/2015 3:47:56 PM 26. 2/4/2015 3:47:56 PM 27. 2/4/2015 3:47:56 PM 28. 2/4/2015 3:47:56 PM 29. 2/4/2015 3:47:57 PM 30.
2/4/2015 3:47:57 PM 31. NURSING MANAGEMENT IN POST OP UNIT To provide care until the patient has recovered from the effect of anesthesia.
Assessing the patient Monitor vitals-pulse volume and regularity, depth and nature of respiration. Assessment of patient’s O2 saturation. Skin colour.
2/4/2015 3:47:57 PM 32. KEEP MONITORING VITALS 2/4/2015 3:47:57 PM 33. Check the level of consciousness. Ability to respond to commands. 2/4/2015 3:47:57 PM 34. MAINTAIN INTAKE AND OUTPUT 2/4/2015 3:47:57 PM 35. Protect airway By proper positioning of patient’s head.
By clearing airway. Oxygen therapy. Pharyngeal obstruction can occur when the patient lies on the back as there are chances for tongue to fall back.
2/4/2015 3:47:57 PM 36. Maintaining IV Stability Hypovolemic shock: can be avoided by timely administration of IV Fluids, blood and blood products and medication. Replacement of fluids.colloids and crystalloids Monitor intake and output balance. 2/4/2015 3:47:57 PM 37. ASSESSMENT OF THE SURGICAL SITE Hemorrhage It is a serious complication of surgery that can result in death.
It can occur in immediate post operatively or up to several days after surgery. If left untreated cardiac output decreases and blood pressure and Hb level will fall rapidly. 2/4/2015 3:47:57 PM 38.
Blood transfusion if necessary. The surgical site + incision should always be inspected. If bleeding- pressure dressing placed. If the bleeding is concealed, the patient is taken in OR for emergency exploration of concealed hemorrhage in body cavity. 2/4/2015 3:47:57 PM 39. KEEP THE PATIENT WARM Use warmer(Bair Hugger) blankets Use warm lights 2/4/2015 3:47:58 PM 40.
Relieving pain +Anxiety Administer opioid analgesia as per Doctor’s order. Epidural analgesia. Psychological support to relieve fear+To give support. 2/4/2015 3:47:58 PM 41. Post Operative Complications Nausea and Vomiting Respiratory Complications Failure to Regain Consciousness Circulatory Complications Fever 2/4/2015 3:47:58 PM 42.
Controlling Nausea + Vomiting This is common problem in post operative period. Medication can be administered as per doctor’s order.
Nurses at the Johns Hopkins Bayview Medical Center’s post-anesthesia care unit (PACU) work with patients as they recover from surgery and anesthesia. They play an important role in their patients’ transitions from the operating room through recovery and release.