Post-op care carotid endarterectomy-

[bella14k]

SCENARIO: A male client in ICU following a carotid endarterectomy. His history reveals TIA of one month duration along w/ Hypertension.

One of the orders is to raise the HOB up to 30 degrees when alert.

I know that you don't want to raise the HOB past 30 degrees when a GRAFT or STENT is in place, but this sx doesn't involve it-Soo..my question is: would the reason be to keep the vessel patent?

[Episteme]

I don't know, honestly. Suppose I could look it up. But any patient who has or might get fluxes in their intracranial pressure is maintained with the head above the level of the right atrium. I know of no reason why 30 degrees would put the graft at risk. You want there to be no impedance to venous drainage of the brain.

[bella14k]

Ok so the actual Power point slide says "Order: Raise HOB up to 30 degrees when alert". So I'm assuming that means no more than 30 degrees. MAyBE the MD doesn't want the HOB to be too low (too low increases the risk of IICP and does not allow for venous drainage, like you said), and raising the HOB too high post-operatively may decrease perfusion to the brain. 30 degrees might be a good balance ..

[Episteme]

Sounds about right to me... but some of this is our assumption. See if you can find a reference, some "evidence based practice" to prove we're right.

Wow your instructor :)

[Esme12, ASN, BSN, RN]

THINK about this ....go simple.....your patient is a post op. ABC's first.

They had surgery on a vessel in their neck. It would have nothing to do with an elevated ICP and cerebral swelling.

What is a carotid endarterecomy?

Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.

Anytime you scrape anything there is swelling...right? Swelling would cause the blood flow to slow...right? If the patient can't keep their head from flopping over further decreasing blood flow.....that would be a bad thing....right?

What happens when you place an unconscious/semi-conscious person in a semi fowlers position? Can they maintain their airway effectively? Can the hold their head upright and keep from flopping forward and occluding the airway?

So why would you need to wait until alert to elevate the HOB?

[bella14k]

thats what i suspected