Nursing care after PDA ligation

[MegNeoNurse]

Hey all. So at our last unit meeting our NICU manager announced that pediatric surgery will now be a part of our NICU medical management, and we will be starting with PDA ligations! Prior to this, the most "surgical" cases I saw in the NICU where I work were the occasional chest tube, chest drain for a PCE, and removal of abscesses.

So my question to all you nurses who work with surgical babies is, what is different with your patient care on pre/post surgical kids? I know the obvious frequency of assessment, more intense care, but what else changes?

I am *almost* a last semester nursing student (I have finals in 2 weeks for fall semester!) and am lucky enough to have a job offer in the Level III NICU where I work as a nursing assistant and unit secretary. I was so very thrilled at the news that peds surgery was coming to our hospital, as that was the only thing keeping me from being 100% about accepting the position (I hate seeing kids shipped out to other hospitals for surgical procedures and not knowing how they do, especially if they've been in the NICU for a while).

Any input is very greatly appreciated. Thanks so much in advance!

[SteveNNP, MSN, NP]

So my question to all you nurses who work with surgical babies is, what is different with your patient care on pre/post surgical kids? I know the obvious frequency of assessment, more intense care, but what else changes?

Well, it all depends on the type of surgery. Simple little procedures like PDA ligations usually just involve monitoring the site, s/s infection, bleeding, etc., but you can have complications like phrenic nerve damage (respiratory problems), lymphatic system damage (recurrent chylothorax requiring a chest tube). More involved procedures like ex-laps, bowel resections, gastroschisis/omphalocele reductions/silos, CDH repairs and open hearts all involve different types of nursing care. Hopefully your unit adjusts nursing staffing levels appropriately with the increased acuity postop pts can bring. The best advice i can give you is to get a good NICU book like Merenstein & Gardner, or the AWHONN Core Curriculum for Neonatal Intensive Care Nursing. Also Care of the Sick Neonate has some great info on surgical procedures. Best of luck with the upcoming new job!

Stevern21