The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [617]
Preprocedural considerations
The recovery period is potentially hazardous. Therefore, when the patient arrives in the PACU, individual nursing care is required until patients are able to maintain their own airway (AAGBI 2002).
Equipment required in the PACU
Speed, efficiency and economy of movement are essential when time becomes a critical factor in the ultimate safety of the patient in the recovery room.
Basic equipment for monitoring airway maintenance: wall-mounted piped oxygen with tubing and facemask (with both fixed and variable settings), a T-piece and full range of oral and nasopharyngeal airways. Spare oxygen cylinders with flowmeters should also be available in case of piped oxygen failure.
Suction: regulator with tubing and a range of oral and endotracheal suction catheters. An electric-powered portable suction machine should also be available in case of pipeline vacuum failure.
Sphygmomanometer and stethoscope: automatic blood pressure recorders are a valuable means of saving time and minimizing disturbance to patients, especially those in pain or disorientated, leaving the nurse’s hands free to attend to other needs. However, such equipment can be non-functioning in certain cases, for example shivering or profoundly bradycardic patients, or if electrical and mechanical failure occurs. Therefore, manual equipment must always be available.
Pulse oximeter.
Miscellaneous items: receivers, tissues, disposable gloves, sharps container and waste receptacle.
These should be available at the patient’s head in each recovery bay and the equipment should be compatible between the operating theatres and the recovery room. This must be arranged for ease of access and always be clean and in full working order.
There should be other equipment centrally available for respiratory and cardiovascular support.
Self-inflating resuscitator bag, for example Ambu-bag and/or Mapleson C circuit with facemask. These allow maintenance of a clear airway by tilting the chin upwards and administering oxygen.
Full intubation equipment: laryngoscopes with spare bulbs and batteries, range of endotracheal tubes, bougies and Magill forceps, syringe and catheter mount. This is to ensure that the patient can be intubated quickly during an emergency.
Anaesthetic machine and ventilator: to ensure that the patient can be reventilated if extubated too early or not fully reversed from the anaesthetic.
Wright respirometer: to measure that the patient is breathing deeply enough to allow adequate gaseous exchange.
Cricothyroid puncture set: to access the thyroid surgical site to release pressure and prevent airway obstruction due to a haematoma. This is an emergency situation.
Range of tracheostomy tubes and tracheal dilator: in case an emergency tracheostomy needs to be performed.
Intravenous infusion sets and cannulae, range of intravenous fluids.
Central venous cannulas and manometer: in case an insertion is required in recovery and to allow manual measurement of the central venous pressure (monitor failure).
Emergency drug box/trolley: contents in accordance with current hospital policy. This is to ensure that all emergency drugs are in one place in the event of a cardiac/respiratory arrest.
Defibrillator: required during a cardiac arrest to restart the heart.
Further support equipment, such as nerve stimulators, should be available centrally, whenever possible being stored on trolleys for ease of transportation (AAGBI 2002).
Procedure guideline 14.5 Transfer to PACU
Procedure
Action Rationale
1 The scrub nurse accompanies the patient with the anaesthetist to the recovery area. A handover is given that includes:
the surgical procedure performed
information including allergies or pre-existing medical conditions, for example diabetes mellitus
the patient’s cardiovascular state and pattern of anaesthesia used
the presence, position and nature