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NICU guideline identifier

Surgery - pre-operative and post-operative care of the neonate

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Pre-operative care for neonatal surgery

  1. Ensure continuous monitoring is maintained and recorded hourly of:
    1. Cardiorespiratory
    2. Blood pressure
    3. SpO2
    4. Skin temperature
  2. Take and record temperature 4 hourly.
  3. Ensure arterial blood gas/capillary gas, FBC, group & cross-match, and U&E's are taken as ordered.
  4. Check that two correct identification bands are on the baby.
  5. Ensure baby is nil by mouth for prior to surgery:
    1. If formula fed, last feed 6 hours prior to surgery
    2. If breast fed, last feed 4 hours prior to surgery
    3. If receiving clear liquids, 2 hours prior to surgery
  6. Administer IV fluids as prescribed.
  7. Ensure Pre-operative Preparation Checklist is completed.
  8. Check consent form has been completed for surgery and the administration of blood and blood products.
  9. Explain all procedures and treatment to parents.
  10. Ensure a parent accompanies baby to Theatre. Anaesthetic consent is usually obtained just prior to surgery.
  11. Baby's notes, drug sheet are taken to Theatre with the baby.
    1. Offer karakia to tangata mauiui and whanau as appropriate.
    2. Baptism is discussed with the parents as appropriate.
    3. Ensure an interpreter (if required) has been arranged to be at Theatre.

Surgical transfers to Starship Theatres

  • When taking a baby to Theatre, at Starship Hospital, do not leave NICU until theatre have called for the baby.
  • Theatre will phone NICU when they are ready for the baby and will also offer to provide an escort with an orderly. This avoids unnecessary waiting time in Theatre reception.
  • The time that we are given when the baby is booked for surgery is an approximate time only.
  • This applies to surgery both during the day and at night.

Documentation

Prior to surgery, the following forms will need to be completed:

  • Anaesthesia Record (CR4018).
  • Preoperative Check List (CR4048). Theatre staff have provided a guide for filling this form in.
  • Babies requiring urgent surgery outside normal theatre hours also need an Acute Surgical Booking Form (CR 2789)
  • This must be completed by the Registrar and faxed to ext 5218.

Copies of these forms are in a Surgical Document file kept in the NICU work room (bottom of the stationary shelf, #16).

Post-operative care for neonatal surgery

  1. Ensure continuous monitoring is maintained and recorded hourly of:
    1. Cardiorespiratory
    2. Blood pressure
    3. SpO2
    4. Skin temperature
  2. Take and record temperature 4 hourly.
  3. Maintain ventilation as per orders.
  4. Ensure arterial blood gas/capillary gas, FBC, group & cross-match, and U&E's are taken as ordered.
  5. Administer IV fluids as prescribed. The baby remains nil by mouth until doctor/NS-ANP orders.
  6. Maintain accurate input and output record.
  7. Observe wounds for signs of bleeding. Report excessive bleeding.
  8. Ensure pain relief is administered as prescribed.
  9. Administer antibiotics as prescribed.
  10. Explain all procedures and treatment to parents.
  11. Ensure stress for the family is minimized:
    1. Parents are kept informed of baby's condition and progress.
    2. Parents are given the opportunity to speak with the surgeon/doctors/NS-ANP. 

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Document Control

  • Date last published: 01 May 2005
  • Document type: Clinical Guideline
  • Services responsible: Neonatology, Paediatric Surgery
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years