Handover from OR/PACU to CICU

gassy2be · Apr 3, 2015

We get telephone report from OR prior to patient arrival. The RN and anesthesia team accompany the patient to the unit. We untangle all the lines, draw labs, ABGs; they just hand off. They bring their meds/gtts on a pump and leave it with us so we don't have to worry about starting new lines or transferring to a new pump. It goes pretty smoothly because several of the CVICU RNs will help out. And if the patient starts to go south as soon as they get to the unit, anesthesia will often step in and help.

icuRNmaggie, BSN, RN · Apr 3, 2015

The receiving nurse should be absolutely focused on taking report first from the circulator then the anesthesiologist while the receiving unit's nurse coworkers and respiratory place the pt on the monitor and vent, call Xray etc.

The anesthesiologist is signing the pt out to ICU care and that means the receiving nurse.

It is really annoying to work somewhere that does not have a common sense routine like this in place.

MunoRN, RN · Apr 3, 2015

We get report from the anesthesiologist about 30 minutes prior to arrival (I've never spoken to an OR nurse when landing a heart). When the patient arrives the anesthesiologists updates me on any changes since we spoke. We (quickly) switch the patient to our monitor, zero the lines, hook things up, xray, labs, and give the team the current CI and then they're usually on their way.

I'm perplexed why you would switch all their drips on arrival, why not continue to use the ones hung in the OR as well. Are you changing the tubing as well? That seems like an unnecessary step that could cause the patient harm and has no benefit.

Editorial Team / Admin · Apr 3, 2015

I'm a cardiac OR nurse, and we've got what I think is a pretty decent routine.

-We (circulating RN) call report to the ICU charge nurse about 30 minutes prior to expected transport time. Report includes procedure, surgeon, location of lines, location of drains, full set of hemodynamics, current drips, and any blood products given. This information is given to RN who will receive the patient.

-Patient is placed on transport monitor following surgery and just before leaving the OR. The great thing about this monitor is that it technically belongs to the ICU- it comes with a tram that gets plugged into the transport monitor and then gets plugged into the ICU bedside monitor. There is no changing of connections other than removing the tram from the transport monitor into the bedside monitor. We use the GE Transport Pro with the tram and coordinating beside system- this and other similar systems are great and mean no time without active hemodynamic monitoring.

-We call the ICU charge RN to alert that we are on the way up, plus advise of any changes.

-Upon arrival from OR, OR circulator places tram from transport monitor into bedside monitor. ICU patient care assistant connects chest tubes to suction, records amount of chest tube drainage and urine output on white board, and obtains labs. Respiratory takes care of connecting to vent. Primary RN gets report from anesthesia and circulating RN. Assisting RN if available is checking lines. Some things happen simultaneously, especially if there isn't a second ICU RN available to assist, such as ICU RN listening to anesthesia and circulator while checking lines.

Editorial Team / Admin · Apr 3, 2015

I'm perplexed why you would switch all their drips on arrival, why not continue to use the ones hung in the OR as well. Are you changing the tubing as well? That seems like an unnecessary step that could cause the patient harm and has no benefit.

Me too. The drips we use in the OR are identical to the bags obtained in the ICU. The only drip we don't start is Propofol, and unless there is a bag either empty or almost empty, switching to a new bag seems like a waste of time and resources as well as a potential patient issue with stopping a drip, even if only for a brief time.

dy3p · Apr 4, 2015

Me too. The drips we use in the OR are identical to the bags obtained in the ICU. The only drip we don't start is Propofol, and unless there is a bag either empty or almost empty, switching to a new bag seems like a waste of time and resources as well as a potential patient issue with stopping a drip, even if only for a brief time.

Well, what we do is, we prepare the drips ahead of time. These includes, nor ad, adrenaline, propofol, colloids, potassium, insulin, fentanyl etc. (compatible drugs run along the same line ofcourse) When we receive the patient, they only come with propofol, fentanyl and possibly the two inotropic support. It doesnt take too much time as it is all connected in a central line, you just have to know which line runs in which.

Id probably suggest we do that. Thank you.

MunoRN, RN · Apr 4, 2015

Well, what we do is, we prepare the drips ahead of time. These includes, nor ad, adrenaline, propofol, colloids, potassium, insulin, fentanyl etc. (compatible drugs run along the same line ofcourse) When we receive the patient, they only come with propofol, fentanyl and possibly the two inotropic support. It doesnt take too much time as it is all connected in a central line, you just have to know which line runs in which.
Id probably suggest we do that. Thank you.

I get hooking up infusions that aren't already running, but I don't get why you would replace drips that are already infusing with new ones, particularly using new lines, there's too much opportunity for variations in the amount that is actually infusing to occur, not to mention the unnecessary infection risk of replacing tubing that doesn't need to be changed.

Are they not on an insulin gtt during the case? Why the propofol?

dy3p · Apr 5, 2015

Nope, they aren't on insulin drip during the case. With regards to the propofol, I guess it has become a standard use here with studies that backs it up. Weaning from it is easier too as they say. Anyway, I might suggest that we use some of the lines from the OR. It hasn't been a problem since we've been doing this practice for more than 8-9 years. A room for improvement wouldn't hurt though. :)

PS. I'm actually in the nursing station right now and got a call fro the Anesth handing over the basic info such as procedures, lines, drains and current infusions of the patient I'll be receiving. They're coming in 15 mins. LOL.

Thanks.

SubSippi · Apr 16, 2015

All of these things happen at pretty much the same time where I work.

No report before the patient arrives...OR brings them in, and an extra nurse will come in to help. The secondary nurse will hook up lines, draw labs, zero the swan/art lines etc., while the primary does a quick assessment (listens to heart and lungs, checks swan, chest tube sites, takes note of the first set of numbers).

There is usually a CNA available that will take notes for the RN, and this makes that turnover time go much more quickly and smoothly than if the nurse was writing or tried to remember everything. They are very experienced, and know what we want them to record, so we pretty much just say a bunch of numbers at random times during the assessment (time in 1342, chest tube 1 has 75 out, swan at 50, OG at 35), and they know when we're talking to them and write it down. We have recently even made a form for them to have during this time, and they hand it to us when we're done. I love it because they can make sure all the blanks and filled in and we didn't overlook something.

This whole ordeal takes about five minutes, and anesthesia is usually standing around looking at a clipboard or talking to someone (or themselves). When we're done all we have to do is look at them and they start talking.

The OR nurses might randomly decide to hook a chest tube to suction, or run a cuff pressure, but they are usually long gone before I'm done with report from anesthesia.

I feel like our system works very well. I don't want to get report from anyone before I've looked at the patient, because then they might try to scurry away before I realize I have some questions.