How many codes happen in a PACU?

Editorial Team / Admin · Mar 16, 2014

I don't think anyone would be able to give you a number as it can vary depending on type of facility, size of facility, and patient population served by a facility. At my facility, they seem to happen very rarely and in spurts. Also, the vast majority of our "codes" are really airway issues and not true CPR/dysrhythmia codes.

Part of the reason you may not hear them call a code blue in PACU overhead is because many facilities handle OR and PACU codes within the department. After all, we have ACLS prepared nurses and anesthesia right there.

ICU vs PACU is also going to vary facility to facility. At mine, every effort is made to get vented patients who are going to stay vented (not just need a little support over a slow wakeup) to the unit, as well as patients expected to expire in a short time (get family to bedside to say their goodbyes). Doesn't always happen as a lot depends on bed and ICU nurse availability (i.e., there may be an empty bed, but the nurse covering those two beds has a 1:1 patient in the other bed and can't take another patient).

TraumaORnurse · Mar 16, 2014

Where I work, there aren't many codes in PACU and those that do occur are not paged to the code team. They are internal surgery codes, so available OR staff and Anesthesiologists respond. We do typically call the Critical Care doctor in house to come and assist.

Also, any patient that is to remain intubated and vented post-op goes straight to ICU, bypassing PACU. If a patient is going to ICU, but is successfully extubated in the OR, they go to PACU first. The rate exception is an unplanned ICU transfer and there is not a bed available. The patient will go to PACU on a vent while ICU is moving patients to open up a bed. But then we try to keep an RT there, the OR charge nurse comes over, and the Anesthesiologist will typically stay. We try to move them as quickly as possible since they require more focused attention and there are typically other patients needing post-op care.

Maddy_Rose · Mar 17, 2014

Part of the reason you may not hear them call a code blue in PACU overhead is because many facilities handle OR and PACU codes within the department. After all, we have ACLS prepared nurses and anesthesia right there.

Oh I feel a bit silly now, I remember someone telling me that ICUs don't broadcast their codes for that same reason. Thanks very much for your answer, it didn't realize that most codes would be airway issues. Is that because of sedation and artificial airway use?

Sezza83, BSN, RN · Mar 17, 2014

The only codes we broadcast are neonatal codes blues and major hemorrhages. Basically so a neonatologist can come in and NICU is aware. And if the patient is bleeding the pathologist can run urgent bloods and start preparing blood products. Other than that everyone you need is there.

Our intubated also bypass pacu but if tbeyre extubated or have a LMA its off to pacu they go.

**NICU Guy, BSN, RN** · Mar 17, 2014

I worked as a NA in PACU for 2 yrs and did not have a single code. Respiratory issues due to anesthesia happen every so often, but no true codes. Like the previous posters stated, you have your own code team already there (Anesthesiologists for airway, Nurses for drugs, NAs for compressions). Any patients on vents or really critical (open heart surgeries) go straight to ICU.

RnTx09 · Mar 25, 2014

I have worked pacu for 4 years. We do care for critical patients but we are able to see and stop a lot of potential problems before they happen. We have the luxury of having lots of team work, anesthesiologist and MDs at hand all the time. Any problem arises we are on it. We do have a handful of codes a year but when codes do happen, we have everybody and everything we need in arms reach. The reason I love pacu is because of the variety of things I get to deal with every day!!

Pacu.teletriagern · Jun 29, 2014

I agree with the others. I have only once called a real code in the PACU, on a patient we cardioverted, cardio left because everything looked ok, and then we lost the rhythm. All the rest of the incidents are handled with the PACU staff and anesthesia. And again, its almost always airway related.

Many times ICU will go straight back. Almost always if they are vented and in the unit preop. Sometimes and with certain MDs the patient will make a pit stop in PACU and then go to ICU. Depends.