Average recovery times?

luvbug080688 · Aug 12, 2012

Where I work, we have 2 phases to our recovery:

1) PACU: they hang out with us there on their gurney for a minimum of 20 minutes....

....after that....

2) APU: they then hang out here for a minimum of an hour. the first 30 minutes they are there, they remain on the gurney, unless their need to pee is ridiculously high and they are capable of getting up. after they get up at the 30 minute mark to pee, they get put into a chair for the last 30 mintues of their stay.

Obviously, if they aren't okay to move after the minimum stay in either of the rooms, they stay for how long they need. But for those that are doing swimmingly post surgery, they only have to stay with us for 1:30.

sukiathome · Aug 12, 2012

About 40 minutes. We have to move them out and get them out because the next "bunch" of patients is on their way out whether we have the room or staff there!

meandragonbrett · Aug 15, 2012

General= 45 min in phase one MAC= 20 min in phase oneWhy would you be keeping somebody 1-2 hours in PACU unless theycre unstable or are waiting on a bed assignment?

GHGoonette, BSN, RN · Aug 17, 2012

I think you're referring to what we refer to as "day patients". They come for minor surgery and are discharged within 6 hours of admission. If they have been sedated, they take about 10 minutes to wake up, after which they are transferred to their room on a gurney, and helped into a chair. After they have used the bathroom and have had something to eat, they are discharged if no N&V or urine retention.

If they have had anaesthesia, they stay a minimum of 20 minutes in PACU; once stable and pain-free, they are transferred to the ward on their own beds. They are closely monitored for a minimum of two hours and are discharged if no complications.

luckynurse_1234 · Sep 8, 2012

Ah, I was wondering about the "nausea and pain free" part. A few nurses that worked in other hospitals told me sometimes you have to send the patient home puking because they won't feel better until they sleep it off and get the anesthsesia out of their system. And I always seem to get hung up with the chronic pain patients who take enough narcotics at home to kill a horse and have done so for 10-20 years AND they expect to have zero pain after their lap.chole., hernia repair, etc.

meandragonbrett · Sep 8, 2012

Ah, I was wondering about the "nausea and pain free" part. A few nurses that worked in other hospitals told me sometimes you have to send the patient home puking because they won't feel better until they sleep it off and get the anesthsesia out of their system. And I always seem to get hung up with the chronic pain patients who take enough narcotics at home to kill a horse and have done so for 10-20 years AND they expect to have zero pain after their lap.chole., hernia repair, etc.

As for those that are barfing their brains out.....IVF and Inapsine! Chronic pain pts get appropriate doses of narcotic and non-narcotic and then our anesthesia staff will d/c them from PACU.

brownbook · Sep 9, 2012

All you need to do is follow your anesthesiologists orders.

Hopefully the anesthesiologists told you the patient was on a lot of pain meds at home and warned you you might need to give more than the usual dose.

Give all the pain meds ordered, give them sooner rather than later, don't let the patients pain get ahead of them. Ask the patient what has worked for them in the past, what they think will help them. Then call the anesthesiologists, tell them you have given the patient all the pain meds ordered, they still rate their pain as _____, and what do they suggest.

Same with nausea, give them all the anti emetics ordered, if this is not their first surgery/nausea experience ask them what has worked for them before. Then call anesthesia and tell them what you have done and what the patients complaints are.

Sometimes they do need to go home and sleep it off.

GHGoonette, BSN, RN · Sep 11, 2012

Ah, I was wondering about the "nausea and pain free" part. A few nurses that worked in other hospitals told me sometimes you have to send the patient home puking because they won't feel better until they sleep it off and get the anesthsesia out of their system. And I always seem to get hung up with the chronic pain patients who take enough narcotics at home to kill a horse and have done so for 10-20 years AND they expect to have zero pain after their lap.chole., hernia repair, etc.

Yeah, as MDB said, intractable N&V will respond to Inapsin, but this is where your pre-op preparation of the patient is so important. That question "Have you had previous anaesthetics?" and its follow-up, "Did you experience any adverse reactions?" should warn the anaesthetist what to expect. Many of the guys I work with, if they get that info pre-operatively, will give Inapsin, and possibly even Granisetron, intra-operatively. Hey presto - no N&V!

Patients who are on heavy-duty painkillers at home should also disclose this information; however, if it's related to substance abuse, they probably won't. They'll give themselves away when they need enough induction to knock a horse out, and when they're experiencing "excruciating pain" after having had a foreign body removed from their outer ear. Give them NSAIDS and tell them it's a very strong substance that will likely knock them out and that their discharge meds will help them sleep.

Painful invasive procedures will require a more aggressive approach than the above scenario; however, such patients should not be done in an ambulatory setting. Heavy-duty prescription drugs - should presuppose problematic underlying conditions, so the patient requires the facilities of a fully-equipped theater complex.

MsBruiser · Sep 15, 2012

With no complications, I was able to do three sets of vitals and either initiate discharge (outpatient) or request a room assignment (in-patient). There were always outliers. You should NEVER have to send someone home puking. Ever. Some nurses did. A funny aside, our idiot former educator always told us to just send them home - then she had an outpatient procedure and puked her guts out. Promethazine worked wonders.

If I suspected a chronic pain patient I would slam 'em fast with 100 Fenanyl (charting it appropriately, of course). Followed by q 5 doses of Dilaudid up to about 2 mg. Followed by more Fentanyl. Watching respers, of course (never once had a problem). By treating aggressively up front, I was usually able to safely get 'em in and out. There were always outliers (usually younger GYN patients), but they were probably bound to be inpatients anyway. I avoided PO medications at all costs.

PACU was all about finding a method and pattern that works for you...feel the flow! Best inpatient job around...

Perpetual Student · Sep 16, 2012

I work both phase I and phase II in a mixed inpatient and outpatient department. We typically use the gurney from the time the patient changes into the clothes until the time he goes home/to the floor. So furniture isn't really a factor in our practice.

Typical phase I time is about 45 minutes for most outpatient general anesthesia cases. We hold onto everyone for at least 30 minutes, in part due to the amount of time it takes to get the post-op orders from the surgeon and get our paperwork done. Ideally, the patient will be awake, have his pain under control, and not be particularly nauseated by the time he's transferred to phase II or the floor. I've kept inpatients for a few hours even when a bed is available in order to get their pain under control and then make sure they keep breathing. I'll take however long I need to, though I do try to move people as soon as they're ready for the next step.

Phase II time is typically about 40 minutes, though both can vary considerably based upon patient needs. I've occasionally received a patient out of the OR, recovered 'em, and discharged 'em to home in about an hour. One little boy who was very eager to go to a BBQ comes to mind. If only the men were always as manly as that boy!

Treat opiod tolerant patients aggressively, taking into account their usual routine, their level of sedation, and degree of pain. It is unrealistic to expect to not hurt, but pain should be minimized. If they're inpatients, don't hesitate to throw in some benzodiazepines, esp. in drug abusers. If they're outpatients, consider small doses of midazolam (sometimes even .5mg of midaz can do wonders).

I don't mess around with nausea, either. Complain to me and you're going to be getting an antiemetic every 5-10 minutes until I run out of ordered drugs (and I'll seek further drugs to cover other receptors as needed) as well as an appropriate volume of fluid. While it is indeed true that often time does a lot to help with nausea, the drugs do work and it's only humane to use them.

Granted, if you've given ondansetron, metoclopramide, droperidol, a scopolamine patch, and fluid to a patient who still feels nauseated, he may need to go home that way. I wouldn't rush him, though. I've had some folks who do indeed want to get a move on once you've thrown the kitchen sink at 'em. They're gonna be nauseated wherever they are, might as well get home where they can be more cozy. Also, don't forget other measures such as a wet, cool cloth.