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Nursing Management of Arterial Catheters in Pacu and PTU
ASPAN NATIONAL CONFERENCE ABSTRACTS Implications for Perianesthesia Nurses: It is possible to provide individualized accurate discharge instruction to ambulatory surgery patients through a computerized order entry system; this contributes to a streamlined discharge process.
THE JOURNEY TOWARDS A CULTURE OF CERTIFICATION Team Members: Christine Wlodarczyk, BSN, RN, CCRN, CPAN Kristie Alvey, BSN, RN, CCRN, CAPN, Suzanne Steele, BSN, RN, CPAN, Annette Brancati, RN, CPAN Palmetto Health Baptist Hospital, Columbia, South Carolina Background: Historically there was no encouragement in acquiring certification. Only 8 percent of the staff were certified. Objectives: A team of certified staff nurses and leadership started teaching classes and mentoring nurses interested in becoming certified. The goal was set to have 100 percent certification in the PACU. Implementation Process: Classes are held to go over subjects of study by system, standards, and age group. Questions of the week are posted at the medication preparation cart for all staff to review. Nurses who are interested in taking the exam sit with leadership, apply and pay for the exam. Statement of Successful Practice: PACU certification has gone to 68 percent. We celebrate with the nurses that have passed by placing a banner in our PACU, plaques on the wall signed by our Nursing Leadership, and during Certified Nurse Day with a luncheon attended by our Chief Nursing Officer and Chief Operating Officer. Each newly certified nurse receives an ID badge holder with their certification letters on them. Our quest for certification has grown to include nurses from Outpatient, ICU, and Ambulatory. Implications for Practice: Studying for certification has increased our depth and breadth of knowledge to help us with patient care issues. It has increased camaraderie in the Perioperative Service area among nurses and physicians who encourage and celebrate each nurse as they sit for and pass their exam. Last but not least, it has given us a common goal of 100 percent certification and a level of excellence in our nursing practice area.
NURSING MANAGEMENT OF ARTERIAL CATHETERS IN PACU AND PTU Primary Investigator: Erlien Sutedja, RN, ADN U. T. M. D. Anderson Cancer Center, Houston, Texas Co-Investigators: Claire R. Zimmermann, BSN, RN, CPAN, Cecilia Rima Rodriguez, RN, ADN, CPAN, Yolanda de Leon Ayson, BSN, RN, MSN, Judith Payne, PhD, RN, AOCN Arterial catheters (AC) are widely used intra-operatively and post-operatively for continuous blood pressure monitoring and blood sampling. The care of AC is routinely managed in critical care settings. Arterial catheters are often used during surgery and kept in place for an extended time. When the patient meets discharge criteria in Post Anesthesia Care Unit (PACU), the anesthesiologist signs out the patient ending his role and responsibility for the overall care. Patients go from the PACU to Post Anesthesia Transition Unit (PTU) with the AC in place. This practice is not supported by the literature. With the creation of PTU in 2007, patients were being transferred to PTU for continuous monitored care. The care and maintenance of AC is carried through for overnight observation.
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The cannulation of AC is prolonged and discontinued without a physician’s order. The purpose of this project was to establish an evidence-based practice policy in the management of arterial catheters in a monitored non-critical care setting. Electronic databases used were PubMed, CINAHL, Scopus, Medline, ProQuest, and limited to 1993 to 2010, English, research-based, human, and adult. Key search terms were arterial catheter, adverse effect, radial artery, peripheral arterial catheter, indwelling, surgery, post-anesthesia, intensive care, arterial cannulation, time complication. Nineteen articles were identified; eight articles did not meet our inclusion criteria and were excluded, resulting in eleven articles. Monitoring and troubleshooting of AC requires training, education, and experience. The knowledge and expertise of the nurse in the maintenance of these catheters are critical to successful recovery, safety, and quality of patient care delivery. Patients with AC must be managed safely when the primary physician has determined that it is necessary to keep the arterial catheter for overnight monitoring in the PTU. The competency of the nurse and length of time the AC is left cannulated are vital to address. A collaborative policy has been developed to promote safety and continuity of care in the management of AC in PACU and PTU. This evidence-based policy will ensure a standardized approach in the management of arterial catheters in PACU and PTU.
CLINICAL ACTION FOR POST OPERATIVE RESPIRATORY DEPRESSION OF PACU RELATED RAPID RESPONSE TEAM (RRT) CALLS Emylene Untalan, BSN, RN, CCRN, CPAN, Minerva Mendoza, BSN, RN, CCRN Baylor University Medical Center, Dallas, Texas Michael Ramsay, MD, Gerald Murphy, MD, Anna Cortez, BSN, RN,CPAN, Minnie Stephens, RN, CPAN, Charis Barron, BSN, RN, Krista Nina, BSN,RN, Chanel Moore, BSN, RN, CPAN, Agnes Brightbill, BSN, RN A PACU nurse is often faced with a challenge of balancing adequate pain management and airway management with adequate ventilation in the immediate post operative period. Data gathered from 2007 - 2008 yielded an increasing number of over sedation RRT calls to nursing units involving PACU patients. During a nine month time period, there were 48 incidences of post operative respiratory depression (PORD) perceived to be PACU related, ten of which were related to PACU. PACU immediately implemented a process improvement plan to identify patients at risk for PORD. The objective was to reduce over sedation RRT calls 50% by July 2009. Clinical actions involved effective communication and collaboration between anesthesia providers and PACU staffs. PACU staffs were re-educated on opioid delivery and patient variables. Nursing practice was also updated to focus on the stir-up regimen as well as the creation and implementation of oxygen trial withdrawal. Clinical outcomes included early recognition of PORD through oxygen trial withdrawal in PACU. As evidence based resources has indicated that pulse oximetry is only accurate in the absence of oxygen, 83% reduction of RRT calls related to over sedation was achieved in July 2009. PACU, risk management, and the office of patient safety joined efforts to address patients identified at risk for post operative
THE JOURNEY TOWARDS A CULTURE OF CERTIFICATION Team Members: Christine Wlodarczyk, BSN, RN, CCRN, CPAN Kristie Alvey, BSN, RN, CCRN, CAPN, Suzanne Steele, BSN, RN, CPAN, Annette Brancati, RN, CPAN Palmetto Health Baptist Hospital, Columbia, South Carolina Background: Historically there was no encouragement in acquiring certification. Only 8 percent of the staff were certified. Objectives: A team of certified staff nurses and leadership started teaching classes and mentoring nurses interested in becoming certified. The goal was set to have 100 percent certification in the PACU. Implementation Process: Classes are held to go over subjects of study by system, standards, and age group. Questions of the week are posted at the medication preparation cart for all staff to review. Nurses who are interested in taking the exam sit with leadership, apply and pay for the exam. Statement of Successful Practice: PACU certification has gone to 68 percent. We celebrate with the nurses that have passed by placing a banner in our PACU, plaques on the wall signed by our Nursing Leadership, and during Certified Nurse Day with a luncheon attended by our Chief Nursing Officer and Chief Operating Officer. Each newly certified nurse receives an ID badge holder with their certification letters on them. Our quest for certification has grown to include nurses from Outpatient, ICU, and Ambulatory. Implications for Practice: Studying for certification has increased our depth and breadth of knowledge to help us with patient care issues. It has increased camaraderie in the Perioperative Service area among nurses and physicians who encourage and celebrate each nurse as they sit for and pass their exam. Last but not least, it has given us a common goal of 100 percent certification and a level of excellence in our nursing practice area.
NURSING MANAGEMENT OF ARTERIAL CATHETERS IN PACU AND PTU Primary Investigator: Erlien Sutedja, RN, ADN U. T. M. D. Anderson Cancer Center, Houston, Texas Co-Investigators: Claire R. Zimmermann, BSN, RN, CPAN, Cecilia Rima Rodriguez, RN, ADN, CPAN, Yolanda de Leon Ayson, BSN, RN, MSN, Judith Payne, PhD, RN, AOCN Arterial catheters (AC) are widely used intra-operatively and post-operatively for continuous blood pressure monitoring and blood sampling. The care of AC is routinely managed in critical care settings. Arterial catheters are often used during surgery and kept in place for an extended time. When the patient meets discharge criteria in Post Anesthesia Care Unit (PACU), the anesthesiologist signs out the patient ending his role and responsibility for the overall care. Patients go from the PACU to Post Anesthesia Transition Unit (PTU) with the AC in place. This practice is not supported by the literature. With the creation of PTU in 2007, patients were being transferred to PTU for continuous monitored care. The care and maintenance of AC is carried through for overnight observation.
197
The cannulation of AC is prolonged and discontinued without a physician’s order. The purpose of this project was to establish an evidence-based practice policy in the management of arterial catheters in a monitored non-critical care setting. Electronic databases used were PubMed, CINAHL, Scopus, Medline, ProQuest, and limited to 1993 to 2010, English, research-based, human, and adult. Key search terms were arterial catheter, adverse effect, radial artery, peripheral arterial catheter, indwelling, surgery, post-anesthesia, intensive care, arterial cannulation, time complication. Nineteen articles were identified; eight articles did not meet our inclusion criteria and were excluded, resulting in eleven articles. Monitoring and troubleshooting of AC requires training, education, and experience. The knowledge and expertise of the nurse in the maintenance of these catheters are critical to successful recovery, safety, and quality of patient care delivery. Patients with AC must be managed safely when the primary physician has determined that it is necessary to keep the arterial catheter for overnight monitoring in the PTU. The competency of the nurse and length of time the AC is left cannulated are vital to address. A collaborative policy has been developed to promote safety and continuity of care in the management of AC in PACU and PTU. This evidence-based policy will ensure a standardized approach in the management of arterial catheters in PACU and PTU.
CLINICAL ACTION FOR POST OPERATIVE RESPIRATORY DEPRESSION OF PACU RELATED RAPID RESPONSE TEAM (RRT) CALLS Emylene Untalan, BSN, RN, CCRN, CPAN, Minerva Mendoza, BSN, RN, CCRN Baylor University Medical Center, Dallas, Texas Michael Ramsay, MD, Gerald Murphy, MD, Anna Cortez, BSN, RN,CPAN, Minnie Stephens, RN, CPAN, Charis Barron, BSN, RN, Krista Nina, BSN,RN, Chanel Moore, BSN, RN, CPAN, Agnes Brightbill, BSN, RN A PACU nurse is often faced with a challenge of balancing adequate pain management and airway management with adequate ventilation in the immediate post operative period. Data gathered from 2007 - 2008 yielded an increasing number of over sedation RRT calls to nursing units involving PACU patients. During a nine month time period, there were 48 incidences of post operative respiratory depression (PORD) perceived to be PACU related, ten of which were related to PACU. PACU immediately implemented a process improvement plan to identify patients at risk for PORD. The objective was to reduce over sedation RRT calls 50% by July 2009. Clinical actions involved effective communication and collaboration between anesthesia providers and PACU staffs. PACU staffs were re-educated on opioid delivery and patient variables. Nursing practice was also updated to focus on the stir-up regimen as well as the creation and implementation of oxygen trial withdrawal. Clinical outcomes included early recognition of PORD through oxygen trial withdrawal in PACU. As evidence based resources has indicated that pulse oximetry is only accurate in the absence of oxygen, 83% reduction of RRT calls related to over sedation was achieved in July 2009. PACU, risk management, and the office of patient safety joined efforts to address patients identified at risk for post operative