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Discussion

bedside surgery

A prevalence question:

Yesterday I shadowed in our children's hospital level III. I had the fortune to observe a bedside surgery in which the docs opened babe's chest and sewed a patch to the pericardium. My regular preceptor (not a NICU nurse) was blown away that they essentially performed open-heart at the bedside. (and it was pretty close, I could see the heart itself beating away) Is this normal? No one on the unit seemed surprised. I kind of thought it was neat, but it was also the first surgery I've ever seen.

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We will do this if our baby is too small or too sick to survive a transport to surgery.

We do surgery at the bedside, as well. PDA ligations are always done at the bedside because it's always a small preemie who'd freeze down in the OR (even though they SAY they heat up the room, it's really not warm enough!). That's not open heart, really, in the sense that they're put on bypass or anything like that. They just put a metal clip on the vessel to close it off. Takes an hour or two to get everything set up and less than 30 minutes for the actual surgery.

When we had post-op hearts, like total repairs due to congenital heart defects, they'd open babies' chests during codes. That was never pretty. They ended up not closing any of them after awhile and used a patch to cover the chest until they were doing better a week or so later, then they'd close the chest.

If a baby has NEC and perforates, they's place penrose drains at the bedside. And if the baby is clearly not going to survive without an expolaritory lap but is way too unstable to go to the OR, they'll open up right there at the bedside.

For the PDAs and exploritory laps, we clear the bedsides next to the baby so there is plent of room, put up screen, and visitors are not allowed on the unit until after the surgery.

  • Experts

It is safer for the baby to be done right at the bedside. The unit is just closed to visitors. This has been done at the bedside as far back as I can remember. You have more staff around that is used to working with infants that small, so it can also be safer from that angle.

And as stated above, it is very hard to get an OR warmed up to the right temperature in a hurry. Not all ORs have individual controls, so it could mean having to warm up several other rooms as well.

We have a seperate room for surgical procedures.It's only yards away, but very unstable babes we have done PDA ligations at the bedside.

  • Author

Thanks, guys! One thing, though - they didn't kick anyone out of the unit.

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