ABSTRACT
Thoracoabdominal aortic aneurysm repairs present many challenges, and the complication of paraplegia remains a concern for both the surgeon and the nurse caring for the patient in the postoperative period. Paraplegia can occur secondary to spinal cord ischemia from prolonged aortic clamping during the repair of the descending thoracic aorta. Paraplegia is a devastating complication for the patient and family. Multiple adjunct techniques have been instituted to prevent reduced spinal cord perfusion during and after the operation, including the use of shunts and cardiopulmonary bypass, femoral artery-femoral vein bypass, left atrial-femoral artery bypass, and selective revascularization of the dominant intercostal artery. Other methods, such as somatosensory evoked potential monitoring during the operation and regional spinal hypothermia techniques, have not reduced the incidence of paraplegia. Improved outcomes have been seen with the use of methods to reduce cerebrospinal fluid (CSF) pressure. One such method is the use of external CSF drainage during the operation, followed by use of a lumbar drain system for as long as 72 hours after the operation. This system setup uses a transducer to monitor CSF pressure and a drip chamber to drain CSF to maintain a normal pressure. This article describes thoracoabdominal aneurysms, surgical techniques to repair the aneurysm, and the use of external CSF drainage and related nursing care measures.
Subject(s)
Aortic Aneurysm/surgery , Drainage/methods , Drainage/nursing , Postoperative Care/methods , Postoperative Care/nursing , Spinal Puncture/methods , Spinal Puncture/nursing , Aortic Aneurysm/classification , Aortic Aneurysm/etiology , Cerebrospinal Fluid/physiology , Humans , Patient Care Planning , Perioperative Nursing/methodsABSTRACT
A brief pilot study has shown how efficient and effective an integrated one-page documentation tool can be in utilizing admissions data to facilitate discharge planning. This manual form makes immediate interdisciplinary documentation possible.
Subject(s)
Nursing Records , Patient Admission/statistics & numerical data , Patient Care Team , Patient Discharge , Forms and Records Control , Humans , Pilot ProjectsABSTRACT
Sophisticated practice modalities, advances in technology, and the increase of sicker and older patients undergoing surgery mandate an expansion of all PACU nurses' skill and knowledge base. Invasive hemodynamic monitoring, as well as the quantitative assessment of cardiovascular function that it provides, is both feasible and necessary as an adjunct tool in today's PACU. Hemodynamic monitoring should be used only when a specific management decision is being considered and when the physician is committed to act on the data obtained. Once instituted, it is the nurse's responsibility to care for the patient safely and provide accurate and reliable data for collaborative assessment.
