Stanford PACU Rotation Educational Site
Please note, the PACU rotation has been significantly reorganized this year. The following is a basic outline of daily and weekly activities for the rotation. Refer to the PACU syllabus for complete goals and objectives and didactic materials. Over the coming year, changes may be made to the rotation as needed, thus this handbook may not be completely up to date for PACU.
7:00-8:00 AM Directed reading time in PACU. Refer to syllabus for materials
8:00 AM-6:00 PM
- Daily patient care issues:
- Admit/receive new patients from main OR and assume PACU management of them.
- Check OR schedule and call/confirm OR’s with epidural cases
- Complete postop epidural order forms on patients with epidurals.
- Attend to patient management issues including treatment of pain, airway and ventilatory concerns, PONV, epidurals, hemodynamic derangements, lines, postop CXR’s, laboratory studies, and progress of recovery from anesthesia.
- Maintain close communication with primary anesthesia team regarding patient issues, problems, and new developments.
- Monitor patient progress toward PACU discharge.
- Primary patient care input will be from the attending anesthesiologist for individual patients. Back up and emergency support from anesthesia OR schedular (phone: 6.0249).
- Write post-anesthesia note.
- Maintain close communication with primary anesthesia team regarding patient issues, problems, and new developments.
- In coordination with PACU charge nurse, help manage overall patient flow especially during busy periods.
- Admit/receive new patients from main OR and assume PACU management of them.
- Daily educational and teaching activities:
- Review at least one primary article relevant to PACU of your choosing. PDFs of articles on PACU computer terminal and on departmental educactional CD PACU file.
- Keep up on-line log of all relavent procedures (emergency intubation, epidurals, lines, etc.
- Review the PACU teaching modules.
- Submit your self assessment form.
- Review at least one primary article relevant to PACU of your choosing. PDFs of articles on PACU computer terminal and on departmental educactional CD PACU file.
- Other required activities during rotation:
- Select and prepare brief (10-15 minute) presentation for PACU nurses on topic of your/their choosing and arrange time to give with PACU managers.
- Submit your PACU test question answers at the beginning and end of the rotation.
- The PACU RNs will be submitting evaluations regarding their experience.
- Select and prepare brief (10-15 minute) presentation for PACU nurses on topic of your/their choosing and arrange time to give with PACU managers.
GUIDELINES FOR EPIDURAL MANAGEMENT
In PACU:
• Start infusion only after assessing pt.status.(no instabilities, contraindications, motor block, or high block)
• Determine your level of confidence that the catheter is functional.
- MD report is helpful, depth?, was it tested?, Rx given intraop?
- If no sensory level try 3-5 ml 2 % lidocaine
- Draw back on catheter to check for blood,
- Possible intravascular placement? use, w/ epi 1/200k w/ test dose), wait 10 min
- Recheck level, if unilateral try pulling back 1-2 cm.
• If all fails, consider replacing the catheter
Do not send non-functional catheter to floor
• If necessary d/c it and replace or start PCA.
• If catheter ok, and pt. does not have motor block, determine level + start infusion.
• Please refer to the document: PACU Pain Guidelines document