PACU for cerclage

[schreiba]

Just curious what other facilities do...

We have a small PACU located in the L&D wing. This is efficiently utilizing L&D OR space with other non-L&D cases vs. remaining empty when not needed. Of the 3 OR's, one is used for MAC and general eye patients and the other for general gyn or uro/gyn procedures. The staff in this PACU have no L&D training at all and are sent from the same-day surgery unit to do holding and recovery. Usually this is uneventful, however cerclages have been added to their procedures to recover. None of the nurses in that area are excited about that, but they were comforted by the fact that the cerclages were being done early in the 12-16week range. The current issue is that we do not have a designated gestational time frame for when this patient would be recovered by L&D vs PACU. This may sound silly on the surface, but when asked if 20 weeks was acceptable, (that is what other departments use in our facility) it was deemed unnecessary. The conversation of viability arose. That was debated as well as accuracy of gestational age and what response time would be should someone prematurely deliver in holding... The situation has been brought up again as the staff was told that 23 weeks and greater are recovered by L&D. The staff ended up with a 22 and 6... L&D held firm to the 23 week cutoff.

Long story short, does your facility have a gestational designation for L&D and if so, how does that impact cerclages done after 20 weeks? Does it simply require an L&D nurse to be present during recovery in PACU?

No one is trying to shirk any responsibility here, they are just very nervous and have heard different things from different managers.

Thank you!

[klone, MSN, RN]

When I managed a large outpatient OB/Gyn practice, we did minor procedures such as cerclage placement. They were recovered by one of our nurses, so an OB trained nurse (not necessarily L&D).

I find that there is often a pissing match between OB triage and the ED when it comes to who should take the pregnant lady. Whenever that situation arises, I try to ask myself "How is the patient best served?" If she's 30 weeks, but she's c/o chest pain, then she should be in the ED. If she's 12 weeks and is having heavy lady partsl bleeding and cramping, then yeah, technically she should be an ED patient because she's pre-viable, but is that really best serving her needs? Who is the best equipped to care for this woman?

In your situation - who is best trained and prepared to care for a pregnant woman who just had a procedure related to her pregnancy? It shouldn't matter if she's 16 weeks or 23 weeks, the answer is always going to be "the OB trained nurse" in that scenario. Do what's best for the patient, and don't get hung up on the semantics of gestational age and viability.

[schreiba]

Thank you for your response! We are definitely in agreement on focusing on what's best for the patient. We have some folks that are very capable of muddying the waters with semantics so it has been a challenge for the small PACU staff as they don't want it misconstrued that they are refusing the patient simply to get out of caring for them.