Craniotomys in the PACU

suzanne4, RN · May 20, 2005

I am going to move this to the neuro section. You will get a much better response there. :)

But a few questions come to me right away.

1. What type of patients will be coming to you, drainage of subdurals? or aneurysm clippings?

2. Will they go to an ICU afterwards or to a general ward?

3. Wil they have arterial lines and possibly ventriculostomies?

If you can post more information, then we can be more specific in our answers.

candyndel · Sep 12, 2005

Was your ICU getting them fresh post-op? If yes, you could arrange ICU RN(s) to come to the PACU to train your staff, for OT, of course.

Or

If neurosurgery is new to your facility, you could consider reaching out to another faciltity for training.

(We starting doing pPCI about 3 years ago (s/ onsite surgical back up) and all our staff went to another hospital for training.)

Or

You might consider hiring a neuro CNS to come in as a consultant and train your staff....

Good luck

Our unit will begin in the near future to recover crani's in our PACU. I am looking for some sort of training program or any info in how to inservice my staff.
tia
judy

RN34TX · Sep 12, 2005

We take crani's in our PACU, they come with preprinted standardizd orders and the MD adds and crosses out whatever they want to deviate from the standard orders.

They go straight to ICU from us or they stay here as ICU overflow if no ICU beds are available.

Elenaster · Sep 13, 2005

As a former Neuro ICU nurse and a current PACU nurse, I hope I can offer some well-rounded advice:

1. Tell your staff that neuro patients and EVDs are not that scary and with a little training, they can care for this population with confidence.

2. Find out if any of your staff nurses have neuro experience. If so, she will probably have the aptitude to learn new information quickly and become a resource person.

3. Review the Glasgow Coma scale and have your nurses practice pupil checks. These are the two main things most neurosurgeons want to know first.

4. Talk with your anesthesia personnel about post-op meds, especially narcotics. Neurosurgeons typically prefer that their patients are not heavily sedated so they can determine if neurologic deficits have improved or worsened with surgery.

sharann, BSN, RN · Sep 14, 2005

I agree with ELENASTER, neuro patients are a lot LESS scary to me as a PACU nurse than those tonsillectomies.

I recommend:

All neuro patients come on beds not gurneys to prevent excessive movement and lessens the probability of pulling out lines. Also keeps ICP down. Ever tried to move an awake craini patient from a gurney to their bed while they are combative? Dangerous for staff and patient.

Good luck, neuro is very interesting(and not as scary as a bleeding screaming young tonsil patient!)

neuroRNX7 · Sep 16, 2005

All around, good advice. From the PACU, our crani's come to our step down unit, unless they have to remain vented or need invasive ICP monitoring.

One thing I would love to see thrown out the window is the use of the GCS scoring system for inpatients. The GCS is an important assessment tool in the field or as part of ED triage. What it doesn't capture are the subtle changes in a patient's neuro status that we all need to be attuned to. The GCS is based on the patient's BEST response in a category.

neuroRNX7

As a former Neuro ICU nurse and a current PACU nurse, I hope I can offer some well-rounded advice:
1. Tell your staff that neuro patients and EVDs are not that scary and with a little training, they can care for this population with confidence.
2. Find out if any of your staff nurses have neuro experience. If so, she will probably have the aptitude to learn new information quickly and become a resource person.
3. Review the Glasgow Coma scale and have your nurses practice pupil checks. These are the two main things most neurosurgeons want to know first.
4. Talk with your anesthesia personnel about post-op meds, especially narcotics. Neurosurgeons typically prefer that their patients are not heavily sedated so they can determine if neurologic deficits have improved or worsened with surgery.