Post-Operative Care and Considerations[edit | edit source]
Patient Transport to ICU[edit | edit source]
- Generally patient is extubated in operating room, transfer gurney or bed, then to Assist with patient transfer to ICU
- Ensure monitoring, O2 tank, facemask and self inflating bag is present, monitor chest tube output , make sure gurney is locked and pushed against OR table prior to transfer.
- A full report/ safe handoff in ICU attending anesthesia, surgeon, MD from ICU, bedside nurse and operating room nurse should be present.
- Safe handoff evidence-based medicine article
Management in ICU and Recovery[edit | edit source]
Immediate Post-Operative PDA Closure[edit | edit source]
- Recovery in ICU unless alternate location dictated by other patient needs
- Routine sedation unless concern for Pulmonary hypertension dictates need for aggressive sedation/paralysis for up to 12-24h
- CXR on arrival
- No anticoagulation is recommended related to this procedure
- Monitor chest tube output (should be minimal) if exceeds more than 5 ml/kg first hour, or 2ml/kg after first hour please notify surgeon.
- Keep chest tube in place until after infants take first 2 bottles for potential chylothorax
- Provide antibiotics until chest tube removed
- Echo in AM to assess PDA, LPA and LV function
- In the setting of new LV dysfunction, recommend repeat echo in 2-7 days based upon clinical status
- In the absence of new LV dysfunction, recommend repeat echo at follow-up
- Diet: clears advance as tolerated
- Pain: Tylenol and Ibuprofen schedule and alternating, narcotics if pain persist,
- Vital signs and level of consciousness: awake and comfortable, VS within normal limits for child this age.
- Body temp: normal thermic in neonate especially monitor for hypothermia immediately post-operatively.
- Wound care: keep clean and covered for first 24 hours or until Chest tube removed
- If you reside in a country with contaminated water use bottled water or sterile water to clean wound
Midterm/Late Post-PDA Closure Management[edit | edit source]
- Routine follow-up echo ~prior to discharge unless recent echo obtained due to LV dysfunction, or other indications
- In patients where concern arises for branch PA stenosis/obstruction, recommend lung perfusion scan prior to hospital discharge (if accessible)
- Stitch from CT should be removed 7-10 days after removal- or use of dissolvable suture during surgery (ie: Vicryl)
- Outpatient follow-up (or inpatient assessment if remains in house) should be arranged for ~6 months post-PDA closure