Bedside / ICU Surgery (Decompressive Laparotomies)

[ctsurgeryscrubrn]

Hello -

In addition to my Cardiothoracic scrub position, I was nominated to join our new ‘ICU / PICU / SICU rapid response team’ that will be responsible for assisting in bedside rescue surgeries (mainly decompressive laparotomies for ACS and thoracotomies for cardiac tamponade). Does anyone have any experience with this, and any tips / suggestions?

Here are the key responsibilities of the ICU Rapid Response Team “RRT” Scrub Nurse:

• Setup of sterile field, including gloving-and-gowning of primary and support practitioners;
• Initiate life-saving measures prior to arrival of primary practitioner including measures as recommended by ACLS (e.g., closed chest compressions);
• Identification and direction of ICU nursing personnel to obtain requisite instrumentation including, but not limited to: thoracotomy tray, laparotomy setup (bookwalter retraction, etc.);
• Working with RRT Circulator to establish sterile perimeter in room; and,
• Primary operative assistance in the sterile field (including first assisting if resident / fellow is not available).

[Rose_Queen, BSN, MSN, RN]

We don't do bedside laparotomies or thoracotomies, but we have done bedside sternotomies. There is a cart that lives in the ICU that has all supplies in one place- instrument trays, drapes, gowns, gloves, sponges, battery powered bovie, suction tubing and large 3L canisters (because those little dinky 1L canisters are never enough for a blown aortic pursestring), chest tubes, sternal wires (typically only used on the ones we call TOD on). The ICU nurses receive quarterly inservicing on the cart and what gets opened immediately so that they can get started before the team arrives from 5 floors below. Could be some useful ideas to translate to your new role.

[murseman24, MSN, CRNA]

When I did rapid response we didn't have your role, and most of the patients were medical not complex surgical. I would let the ICU nurses handle the stabilization/ACLS interventions and busy yourself with the setup for the procedure. If you're on a floor that doesn't handle codes and crises often like the ICU then godspeed to you for trying to stabilize the patient and set everything up at the same time.

[ctsurgeryscrubrn]

5 hours ago, Rose_Queen said:

We don't do bedside laparotomies or thoracotomies, but we have done bedside sternotomies. There is a cart that lives in the ICU that has all supplies in one place- instrument trays, drapes, gowns, gloves, sponges, battery powered bovie, suction tubing and large 3L canisters (because those little dinky 1L canisters are never enough for a blown aortic pursestring), chest tubes, sternal wires (typically only used on the ones we call TOD on). The ICU nurses receive quarterly inservicing on the cart and what gets opened immediately so that they can get started before the team arrives from 5 floors below. Could be some useful ideas to translate to your new role.

Thank you, Rose. Always such great advice. Had an emergent laparotomy in the PICU this evening for ACS. Was a total blood bath - had to get wiped down several times by the circulator. Parents were right outside - was awful as they could hear us struggling to gain control of the bleeding and then the start of the resuscitation.

[FurBabyMom, MSN, RN]

We sometimes do a laparotomy in ICU - commonly STICU, PICU or NICU. From time to time we do open the chest in our ICUs. Our most common bedside "OR" cases are peripheral cannulations or decannulations for ECMO. We do not have a specific team for any of our ICU cases, all of us are expected to be able to do those cases.

We're not that far down the hall from our surgery ICUs. We send an ESU and a neptune to ICU when we do cases there. We have travel carts for our ICU cases. We get sent to other non-ICU outside locations too...

[ctsurgeryscrubrn]

3 minutes ago, FurBabyMom said:

We sometimes do a laparotomy in ICU - commonly STICU, PICU or NICU. From time to time we do open the chest in our ICUs. Our most common bedside "OR" cases are peripheral cannulations or decannulations for ECMO. We do not have a specific team for any of our ICU cases, all of us are expected to be able to do those cases.

We're not that far down the hall from our surgery ICUs. We send an ESU and a neptune to ICU when we do cases there. We have travel carts for our ICU cases. We get sent to other non-ICU outside locations too...

Thank you! The ex-lap we had to do bedside was on a 10 yo who had been in a bad MVA and had a major liver laceration that was done via emergent laparotomy two days before. It was a bloodbath going back in, especially in a non-operative environment.

[FurBabyMom, MSN, RN]

1 minute ago, ctsurgeryscrubrn said:

Thank you! The ex-lap we had to do bedside was on a 10 yo who had been in a bad MVA and had a major liver laceration that was done via emergent laparotomy two days before. It was a bloodbath going back in, especially in a non-operative environment.

Sending you a PM

[11blade, RN]

I would never have been a fan of this policy, until I worked at a Level 1
Trauma hospital last Summer. They built the 'new' ICU in a different building...a full quarter mile away from the OR!! Moving some of those patients with anesthesia trying to ventilate, O2 tank, IV tree of drips, traction, etc. to OR was just AWFUL. My only concern about doing those big belly cases bedside is the space to get equipment and setup in the room, and being able to keep the room cool enough. The floors and ICU rooms are like a sauna compared to the industrial A/C we have in the OR. I'm glad I wouldn't be scrubbed!!