Question about PACU

[Georgia peach RN]

Ok I work in a small hospital where the Out patient clinic that does all endoscopy too. I was told today that in the event of an emergant EGD due to an upper GI bleed the pt may be taken to the OR after hours and we could be called back in or have to stay late to assist the GI doctor, futher more the patient may receive general anesthsia too boot and we would also be recovering this patient. During regualar endo days we use propafol, I have never recovered a pt who has received general anesthesia and voiced my concern and asked for orintation in the recovery room on one of our "slow" days. I felt my concerns were just brushed off.

My question - How much different is this recovery?

[brownbook]

General anesthesia can be inhalation of volatile liquid aesthetic agents requiring respiratory support, deep sedation. But the term general anesthesia is also used for "only" intravenous anesthesia, respiratory support may be needed but in general the patient is less sedated.

Every patient's reaction to any anesthesia can vary. Some patients get hardly any sedation (only propofol) and are zonked, slow to wake up, require supplemental oxygen and some head tilt chin lift for (hopefully) a short time. Requiring 1 to 1 nursing close observation in recovery.

Some get intubated, volatile anesthetic agents, need respiratory support during the procedure, but wake up easily, quickly, and need less post op time and observation.

So how you recover a patient from general anesthesia varies. They may need every 5 minute vitals, 1:1 nursing, supplemental oxygen, continuous monitoring and observation, etc. for at least an hour regardless of how much, what kind, of anesthesia they received.

Assisting with an acute GI bleeder is an entirely different question. They are critically ill, require GI interventions, pressure tubes in the esophagus, lavage, injection of sclerotherapy, etc., Those interventions as a nursing skill scare me more than any post op general anesthesia recovery phase.

Your anesthesiologists is your best friend and resource. When they bring you a patient ask them what type of anesthesia did they need, is there anything special you need to watch for, etc.

[Georgia peach RN]

Thanks, that makes me feel some better, I got the assisting part down, been doing that for several years now and know what to expect and I have had to assist with GI bleeds in the past but never had to recover them. In the past we have always used propafol for all patients, just recently their has been a change in the anesthesia provider wanting to intubate prior to such procedure, use general anesthia, and the recovery phase is fairly new to me (Ive always been around but never been responsible for recovery). I did not think about the aspect that anesthesia would not be leaving me until pt is stable. Thankyou for calming my fears.

[brownbook]

I was not sure from your original post what part of GI nursing, patient recovery (PACU nursing), you had been involved with prior to this new policy.

If you have mainly been a GI procedure nurse, have never done PACU recovery I think your concerns are justified. Do you have ACLS? I am a terrible one for knowing policies and standards, but feel pretty certain a recovery nurse (PACU nurse) has to have ACLS.

I am still a little confused. Have your ever been responsible for recovering GI patients? Are you going to recover the patient then they go to med/surg? You should get some orientation to PACU recovery paperwork, protocol, before you take this on.

I think it is safe and relatively easy for you to do the job. But there are nation wide, state wide, local area wide, standards a hospital has to meet. As I said I am not a good resource for knowing those standards. Maybe you could look over your hospitals standards and policy for their PACU nurses?

[Georgia peach RN]

Yes most of my experiance is in the procedure room and yes I do have ACLS, I have been recovering out patients recently and have been oriented to this my main concern is when an emergent pt comes in after hours and goes to the OR and is intubated then the procedure is done under general anesthesia. If I happen to be the nurse who is called in I would also be responsible for recovering this patient. which I have never recovered a patient who has been intubated and given general anesthesia. I have asked to be orientated in the PACU just so that I can be familiar with the paper work and know what to expect when a pt is intubated and then extubated during recovery. I am not sure if I was heard though, I guess I will have to wine really loud.

[SandraCVRN]

Does PACU have call? At my hospital the PACU call crew comes in for any cases not going directly to SICU.

[Georgia peach RN]

In these cases our department is responsible to care for them including going to OR with GI doc. if necessary, they will not be calling in any of the OR crew for our patients. at least that is my understanding for now