Procedures commonly seen at Vanderbilt Medical Center PACU s: Cervical, thoracic, lumbar, and sacral spine surgeries. Goes to 6N

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1 Procedures commonly seen at Vanderbilt Medical Center PACU s: Cervical, thoracic, lumbar, and sacral spine surgeries Goes to 6N Burr holes and Craniotomies for hemorrhage, tumors, trauma, debulking Goes to 6T Ventricular/peritoneal shunts for hydrocephalus usually goes to 6N although sometimes goes home External ventricular drains for hydrocephalus, trauma, and increased intracranial pressure goes to 6T Neurostimulators for tremors, pain 6N or home Deep brain stimulators for Parkinson s 6N or home Catheterization for coiling of aneurysms, stenosis, clots 6N Hypophysectomy for tumors, treatment of Cushing s goes to 6T

2 Hypophysectomy Risks following surgery: Hypopituitarism. Following surgery, if the pituitary gland has normal activity, it may become underactive and the patient may require hormone replacement therapy. Diabetes insipidus (DI) (excessive thirst and excessive urine) is not uncommon in the first few days following surgery. The vast majority of cases clear but a small number of individuals need hormone replacement. Cerebrospinal fluid (CSF) leakage. CSF leakage from the nose can occur following hypophysectomy. If it happens during surgery, the surgeon will repair the leak immediately. If it occurs after the nasal pack is removed, it may require diversion of the CSF away from the site of surgery or repair. Infection of the pituitary gland is a serious risk as it may result in abscess formation or meningitis. The risk is very small and the vast majority of cases are treatable by antibiotics. Patients are usually given antibiotics during surgery and until the nasal pack is removed. Nasal bleeding or bleeding in the cavity of the tumor after removal may occur. If the latter occurs it may lead to deterioration of vision as the visual nerves are very close to the pituitary region. Nasal septal perforation. This may also occur during surgery, although it is very uncommon. Visual impairment. A very rare occurrence, but still a risk. (Double vision, loss of vision) Considerations: Labs and urine osmolality will need to be drawn on admission and as ordered. Also fluids should be stopped as soon as possible and a pitcher of water provided at bedside. The patient should not blow their nose or sneeze with their mouth closed.

3 Monitor urine output hourly. Call endocrinology with lab and urine results and neurosurgery for any other complications or questions. These patients go to 6 Neurocare tower Cervical, thoracic, lumbar and sacral spine surgery Risks of surgery: Risks of bleeding, no improvement in pain or function, and risks of functional loss. Things to assess: Decreased sensation or strength in upper or lower extremities, changes in neuro assessment. Call ortho spine or neurospine with any changes. These patients go to 6 north.

4 Burr holes and Craniotomies for hemorrhage, tumors, trauma, or debulkin ng of tumors: Risks of surgery: Bleeding, infection, swelling, brain damage. Considerations: Neuro assessments are of course the biggest assessments. Pupil reactions, size and accommodation, strength in upper and lower extremities, facial symmetry, tongue alignment. Document your findings and call neurosurgery with any changes. These patients go to Neurocare 6T. Ventriculoperitoneal shunts: Ventriculoperitoneal (VP) shunt placement is a proceduree that is performed to treat hydrocephalus, which is a condition wheree cerebrospinal fluid (CSF) is abnormally accumulated, primarily within chambers in the brain (called ventricles), causing pressuree on various structures within the brain. This can occur as a result of a variety of reasons, including brain tumors, bleeding inside of the brain, meningitis, and more. Such conditions lead to hydrocephalus through disruption of the delicate balance between production and absorption of CSF, which normally occurs in the healthy brain. These patients go to 6N. Risks: Bleeding, infection, clots, Considerations: Neuro asses.

5 Externa l Ventricular Drains: ( (1) Hydrocephalus from any cause; (2) brain hemorrhagee such as from an aneurysm or other lesion, particularly if the hemorrhage extends into the ventricles; (3) coma, particularly if associated with high ICP, in which case an EVD can be used to continually measure the ICP as well as to remove CSFF periodically to lessen ICP; and (4) shunt infection, where the infected must be removed. Neurocare only. Deep Brain Stimulators: Uses include Parkinson s and seizures. DBS has stages I III, we see II and III. At stage II the patientt has to go for a head CT prior to discharge to 6N. Stage III is when the generator is placed. Sometimes the device is turned on and sometimes they wait until follow up. Call Neuro surgery with any changes in neuro status.

6 Neurostimulators for tremors, pain, weakness Neurostimulators and drug pumps are surgically placed devices that interrupt pain signals before they reach the brain. Neurostimulators send mild electrical impulses to the spine. These impulses replace pain with a tingling sensation. Drug pumps (also called intrathecal drug delivery systems ) deliver pain medication directly to the fluid around the spinal cord, providing pain relief with a small fraction of the medication needed if taken orally. These patients go home or 6 N Coiling or clipping for aneurysms Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of the skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it. Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in the groin, and threads it through to the aneurysm. He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and causes blood to clot. This clotting essentially seals off the aneurysm from the artery. Rupture of the aneurysm during coiling, clot formation in a normal blood vessel during the procedure or coils occluding a normal vessel.

7 This packet is an overview of procedures that are seen in PACU heree at Vanderbilt. This is not all inclusive, I am sure there are things I missed something. If you have requests or suggestions for education please let me know. Thanks, Jamie Adams, RN References oclinic.org/ /neurology Manual/Hpolicy.nsf /index

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