standard operating procedure for undertaking operations ... documents... · in the picu. this...
Post on 29-Oct-2019
2 Views
Preview:
TRANSCRIPT
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the
UHL Policies and Guidelines Library.
1 of 8
Standard Operating Procedure for Undertaking Operations and Invasive Procedures on PICU GGH 1. Introduction & Scope There are many operations and invasive procedures that are undertaken on patients in the paediatric Intensive Care environment. In most situations these procedures may be best undertaken in the operating theatre environment but in some cases due to severity of illness, lack of patient stability or the emergency situation they need to be undertaken in the PICU. This standard operating procedure (SOP) lays down what processes must be followed when undertaking operations and invasive procedures on PICU, with the aim of minimising risk and maximising patient safety.
2. Purpose This SOP applies to the following procedures on PICU:
Cardiac surgical chest opening, exploration and closure
Congenital Diaphragmatic hernia repair
Emergency laparotomy
Initiation of ECMO – Extra Corporeal Membrane Oxygenation
Balloon Septostomy
Flexible airway bronchoscopy
Skin and muscle biopsy
Chest drain insertion
Central/Arterial/PICC line/Vascath insertion
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the
UHL Policies and Guidelines Library.
2 of 8
2.1 Staffing Resource The following personnel must be present before the procedure is started, that is before administration of anaesthetic drugs or skin preparation is commenced.
The PICU Consultant on at the time of the procedure must be aware that it is
occurring.
PICU Registrar/ANP – it is the responsibilility of the PICU Consultant to
ensure that the PICU Registrar/ANP has sufficient experience to ensure anaesthetic and airway management is maintained. A Consultant Anaesthetist may be required for the more prolonged and complex cases.
Senior PICU Nurse/Bedside nurse Consultant Cardiac Surgeon/Surgical Registrar for cardiac
ECMO Consultant for ECMO cannulations/procedures
Consultant Surgeon for repair of diaphragmatic hernia/laparotomy
Theatre Scrub Nurse in cases of cardiac surgical chest opening, exploration,
closure, biopsies and the initiation of ECMO a theatre scrub nurse is essential. In an emergency ‘a competent person’ may take on this role until the arrival of the theatre scrub nurse.
Perfusionist – should be available for cannulation onto ECMO.
2.2 Minimum Monitoring
The minimum monitoring required in operations and invasive procedures undertaken on PICU:
Continuous ECG
Continuous Pulse Oximetry
Continuous End Tidal CO
Continuous invasive blood pressure monitoring or non‐invasive blood pressure monitoring at least every 5 minutes.
2.3 Minimum Vascular Access
A minimum requirement for any procedure undertaken on PICU is one working peripheral venous cannula.
Consider the need for central and arterial access
IO needle may be necessary
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the
UHL Policies and Guidelines Library.
3 of 8
2.4 Documentation
All patients undergoing surgical or invasive procedures in PICU should have the following documentation completed;
Consent form/Verbal consent documented
PICU Anaesthetic/Procedural Chart
Drug Prescription Chart
PICU Procedure Instrument checklist
Document procedure
Theatre team Documentation
WHO theatre checklist
Theatre Instrument checklist
Operation Record
Written documentation on green edged theatre sheet
2.5 Equipment Required
The equipment required will be specific to the procedure to be undertaken;
Surgical theatre packs/ theatre trolley – responsibility of Theatre Scrub Nurse
Diathermy – checked and appropriate pad applied by an appropriately trained personnel
Flip Chart Board
PICU Bedside Nurse is responsible for;
Suction
Appropriate Airway Management equipment
Temporary Pacing box attached to temporary pacing wires (cardiac patients)
2.6 Theatre Team
In all cases where a theatre team would be required, the procedure must be booked through the ‘Theatre Floor Control’ which is the responsibility of the surgical consultant or registrar.
Cardiac surgical chest opening, exploration or closure
Repair of diaphragmatic Hernia
Skin /Muscle biopsy
ECMO cannulation/decannulation (ECMO Coordinator)
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the
UHL Policies and Guidelines Library.
4 of 8
2.7 Individual Clinical Responsibilities
a. The PICU Consultant: is responsible for ensuring the PICU registrar/ANP attending the procedure is of sufficient experience to provide the clinical support required during the procedure being undertaken.
b. The PICU Registrar/ANP is responsible for ensuring the PICU consultant is
aware that the operation/procedure is occurring. To ensure that the patient is adequately monitored, to ensure that the airway is secure, the anaesthetic, drugs and fluid are correctly administered prior and during the procedure. The procedure should not commence until all these measures are in place. The registrar/ANP is responsible that all drugs and fluids used are correctly prescribed. The vital signs are correctly recorded. The PICU registrar/ANP MUST be present at the patient’s bedside throughout the procedure. The responsibility for the other patients on PICU must be delegated to other colleagues on PICU.
c. Consultant Anaesthetist should assume overall responsibility for actions
described above if required.
d. PICU Bedside Nurse should support the PICU Consultant/PICU Registrar/ANP Should ensure that the Procedure Instrument Checklist is completed
e. Theatre Nurse should ensure surgical equipment is available and theatre
WHO checklist is completed
f. Surgical Consultant and Registrar – following the procedure should ensure all appropriate paperwork is correctly completed
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the
UHL Policies and Guidelines Library.
5 of 8
3. Education and Training
No new education or training is required to implement this SOP. Training and raising awareness are on-going processes. On-going awareness is promoted through the induction and continuous bedside teaching. Training is provided for medical staff during lunchtime teaching (Wednesdays) and other sessions, and at junior doctors’ induction training. Nursing education supported by the Practice Development Teams and Nursing Educators. 4. Supporting References and Related documents
WHO guidelines for safe surgery : 2009 : safe surgery saves lives.
UHL Management of Surgical Swabs, Instruments, Needles and Accountable Items (Swab Policy) 2015, B35/2007.
UHL Sharps Management Policy. B8/2013.
UHL Infection prevention policy: B4/2005
UHL Safety Standards for Invasive Procedures Policy: B31/2016
5. Key Words
Operations, Invasive Procedures, Paediatric Intensive Care.
CONTACT AND REVIEW DETAILS
Guideline Lead (Name and Title)
Jenny Burgess – Senior Sister
Executive Lead:
Simon Robinson
REVIEW RECORD
Description Of Changes (If Any)
No content changes, format update and addition of sections2,4 & 5
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the
UHL Policies and Guidelines Library.
6 of 8
PICU Procedure Instrument Checklist
For use with procedures on PICU
Affix Patient Label Date:
Procedure:
DEVICE TYPE COUNTED
OUT
COUNTED
BACK IN
Observer
Signature
Operator
Signature
Guide wire
Cannulas
Needles
Suture Needles
Blades/Scalpels
Needle Holder
Artery Forcep
Forceps
Swabs
Scissors
Use the table above as a checklist to record all instruments used.
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the UHL Policies and
Guidelines Library.
All instruments used must be accounted for at the end of the procedure and the operator and observer must sign to say this has been completed.
Have all the sharps been disposed of safely? YES NO
PLEASE FILE THIS FORM IN THE PATIENT NOTES ON COMPLETION
SOP for Operations /Procedures on PICU Flowchart
Does the procedure/operation require activation of the SOP?
Cardiac surgical chest opening, exploration & closure, Balloon Septostomy, ECMO
cannulation/decannulation, CDH Repair, Chest drain insertion, Skin & Muscle biopsy
Are the necessary personnel present?
PICU Consultant/Registrar, PICU nurse, Surgical Consultant/Registrar, Theatre Team,
ECMO Consultant/Coordinator, Anaesthetist, Perfusionist
Is there adequate monitoring?
Pulse oximetry, ECG, BP
Is there adequate Access?
Peripheral line, Central line and Arterial line
Is all the necessary equipment present and checked?
Surgical instruments, diathermy, suction, pacing box, surgical light
Complete WHO checklist ‐ Sign In Time Out
Proceed with agreement of all personnel involved
Procedure takes place
Complete Procedure Instrument Check listComplete Procedure Instrument Check list
Title: Operations and Invasive Procedures on PICU
Version: 2 Approved by PICU/CICU Clinical: August 2018
Trust Ref: C162/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the UHL Policies and Guidelines Library.
Procedure Date: Time: Ward: Indication: Operator: Assistant: Observer:
This checklist should be completed by an observer and filed in the patient’s medical notes.
If a significant breach of aseptic technique is observed the observer must stop the procedure.
Procedure Elective Emergency Re‐wire Ultrasound guided Landmark guided
Catheter type Size of lumen Number of lumens Batch Number Name
Insertion site Subclavian: Right Left Internal Jugular: Right Left Femoral: Right Left
Before the procedure
1 Indication checked Yes
2 Bed space isolated (close curtains around) Yes
3 Hands washed by operator and assistant Yes
4 Hat and mask worn by operator and assistant Yes
5 Sterile gloves and sterile gown worn by operator and assistant Yes
During the procedure
7 Chloraprep© applied procedure site and allowed to dry for 30 seconds Yes
8 Use a large drape to cover the patient in a sterile manner Yes
9 Continuous Sterile Zone maintained Yes
10 Sterile sheath and sterile gel used with ultrasound probe (if applicable) Yes
After the procedure
11 Injection site caps placed using ANTT Yes
12 Sterile dressing (Tegaderm) applied using ANTT technique Yes
13 Dispose of sharps including guide wire Yes
14 X‐ray confirmation of line position (except femoral lines) Yes
15 File this checklist in the patient’s medical notes Yes
16 Restock as per Paediatric Central Line Box/Tray Checklist Yes
Complications
Pneumothorax Arterial puncture Malposition Haemorrhage
Unable to cannulate Other (document in medical notes)
Number of attempts No complications
Date of catheter removal
Infection detected: Yes No If yes, date of positive culture
Reason for removal
Culture result
top related