Transferring from ICU to PACU
0Aug 6, '10 by HoozdoHello to all of you PACU nurses,
Today I accepted a new job in PACU. My background is Med/Surg ICU with
some dabbling in CVICU for the past 5 years. You will start to see me hanging
out more in this forum.
I will be in phase 1 PACU in a level 1 trauma hospital. Can any of you give me
some helpful hints that are good to know in the PACU? I know I will be giving
huge amounts of narcotics and need to ship out pts ASAP.
They specifically were looking for nurses with an ICU background which leads
me to believe that there are a lot of ICU hold overs in PACU. What
do you all think?
TIA for any feedback!
1Aug 8, '10 by GHGoonetteHowdy to you too! (I presume that's what Hoozdoo means!) I've been in a PACU for 20 years, but in my country (South Africa) we still call them Recovery Rooms. Reading some of the posts of American PACU nurses, I am totally gobsmacked at the sizes referred to-65 bays! That's not a recovery room, it's a SPACE STATION!
I work in a very small hospital, we only have four theaters and four recovery bays-way too small, we need at least 6 bays for that number of theaters (minimum 1.5 bays for each theater); also, I'm not sure how your Trauma classification works, in SA level one is minor trauma and medical emergencies (hope I've got that right, I sometimes mix them up), and those are the only cases we handle. The bigger hospitals have level three traumas and take extensive injury and big MVA cases. SO, I'm not sure if I can give you anything that you don't already know!
Obviously, coming from an ICU you already know about et tubes and extubation, maintaining airways etc. In PACU I regard the tools of the trade as being my trusty valved re-breathing bag, and of course yankauers and suction tubing. We have only been equipped with pulse oximeters and dynamaps, no cardiac monitoring, but when in doubt, we grab the defib and attach the leads if we want a better picture of the cardiac rhythm. Hopefully you have better monitors!
I see you are concerned about drug administration; does this apply only to narcotics or to all substances? When the PACU is really busy it's sometimes a problem keeping track of everything that's been given, but fortunately we have billing sheets which help us find items that we may have forgotten to write up; happens very rarely, most often when patients are streaming in every 15 minutes and there are insufficient staff on duty.
When I first started in PACU in 1990, we didn't even have pulse oximeters; pulses and BPs were done manually, and our only "monitoring equipment" were our eyes, ears and hands! Hair-raising, but I learned stuff in those days that I have carried with me all through the years.
One piece of advice I can give you regarding intubated children. Take that tube out when they're just about ready to write their university entrance exams. The little darlings desat quicker than that falling lift in the first Speed movie! And beware of LMAs in children, the slightest shift can obstruct those little airways. Sometimes it's better to remove the LMA, insert an oropharyngeal airway and ventilate using a mask and your re-breathing bag.
I compare PACU with crop spraying or fighter pilots; you fly by the seat of your pants. With your ICU experience you should find it a breeze. Good luck and I hope you're enjoying yourself!
1Aug 15, '10 by azhiker96Hello Hoozdo, I think the preference for ICU experience is due to the stability or lack of stability of our patients. We often admit patients from the OR and then transfer them to ICU. Most of our patients are out patients, then a good portion are med-surg and a few ICU. Your ICU experience with assessment, airway management, room temperature blood pressures, drips, and fluid management will help you with this patient population. I love this job. I wish you the best luck and satisfaction in PACU.
1Aug 18, '10 by meandragonbrettThey wanted ICU exp because PACU nurses often deal with instability whether it be respiratory or hemodynamic issues.
Sometimes patients come out with ETTs or LMAs still in and you're expected to extubate. Sometimes you have to reintubate post-op and put on the vent.
A lot of the emergent concepts from ICU will be used in PACU.
0Jan 15, '11 by HoozdoI think you will enjoy PACU.
Biggest pearl of wisdom- do not leave the bedside of a pt with an LMA. If you
need something, yell out for it. Don't turn your back to the pt. It's a whole different
mindset than someone who is intubated.
Don't even listen to the anesthesiologist until you have that pt hooked to a
monitor. They try to give report as soon as they roll in - but you have to get that
pt monitored first.
Another big change is that you don't have time to study the hx and give an
excellent report, (like you would expect as an ICU nurse). You basically have
one hour to stabilize that pt and ship them out.
It can get hairy when you have 2 pts to stabilize and ship out. 2 PACU pts are
usually much busier than 2 ICU pts because of time constraints.
On the positive side, your ICU experience will really help you out. ICU recovers
on vents are 1:1. Most of the other nurses on my unit don't feel comfortable with
these - I say bring em on! They already have a protected airway and won't be
extubated for days.
I don't see lots of drips in PACU. I am getting rusty already. This is a level 1
trauma hospital phase 1 recovery - I am surprised the pts are usually so stable.
Congrats on your new job!
1Jan 15, '11 by HoozdoQuote from GHGoonetteYes, that's what I meant. Just woke up!Hoozdo, don't you mean "PACU recovers on vents are 1:1"?
Sounds like you're enjoying yourself-thought you would!
I agree with you about LMAs, those things can be risky, and have you noticed how much more suctioning you have to do when you remove them?
Oh yeah, those LMAs are slimy. I leave the cuff inflated so it brings up most
of the slime on top of the LMA.