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 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. Monitor urine outtput hourlyy. docrinologyy with lab and urine results andd neurosurgery for aany other Call end
compliccations or q
questions. These p
patients go
o to 6 Neurrocare tower Cervical, tho
oracic, lumbar and saccral spine surggery Risks o
of surgeryy: Risks off bleedingg, no improvemen
nt in pain or functio
on, and rissks of functional lo
oss. Things to assesss: Decreased sensaation or sstrength iin upper o
or lower mities, chaanges in n
neuro asssessment. Call orth
ho spine o
or extrem
neurosspine with
h any chaanges. The
ese patieents go to
o 6 north. Burr h
holes and Cran
niotomies for h
hemorrrhage, ttumors,, traum
ma, or d
debulkin
ng of tu
umors:
Risks off surgery: B
Bleeding, in
nfection, swelling, brrain damagge. Conside
erations: N
Neuro assesssments arre of coursse the bigggest assessments. Pupil reaction
ns, size and
d accommodation, sttrength in upper and
d lower exttremities, facial syymmetry, ttongue aliggnment. Do
ocument yyour findings and call neurosurrgery with any changes.. These pattients go to
o Neurocare 6T. Ventrriculope
eritoneal shun
nts: Ventricculoperitonneal (VP) sshunt placeement is a proceduree that is peerformed to treat hyydrocephalus, which is a condittion wheree cerebrosp
pinal fluid (CSF) is abnorm
mally accum
mulated, prrimarily within chambers in thee brain (called ventricles), causin
ng pressure
e on variou
us structurres within tthe brain. TThis can occcur as a result of a variety of reaasons, including brain tumors, bleeding inside of th
he brain, m
meningitis, and more. Such conditions leaad to hydro
ocephalus through disruptiion of the d
delicate baalance betw
ween prodduction and absorption of CSF, which n
normally occcurs in the healthy b
brain. Thesse patientss go to 6N.. Risks: Bleeding, in
nfection, clots, Consid
derations: Neuro assses. Externa
E
l Ventriicular D
Drains: ((1) Hydroccephalus frrom any caause; (2
2) brain he
emorrhage
e such as frrom an aneeurysm or other lesio
on, particularly iff the hemo
orrhage exttends into the ventricles; (3) co
oma, particcularly if associated w
with high IICP, in which case ann EVD can b
be used to
o continually measure th
m
he ICP as w
well as to re
emove CSFF periodically to lesseen ICP; and
d (4) shunt infecttion, wherre the infeccted must be removeed. Neuroccare only.
Deep Brrain Stimulators: Use
es include P
Parkinson’’s and seizu
ures. DBS hass stages I‐III, we see III and III. A
At stage II tthe patientt has to go for a head
d CT prior to discharge
e to 6N. Staage III is wh
hen the geenerator is placed. So
ometimes tthe device is turned o
on and som
metimes they wait unntil follow u
up. uro surgeryy with any changes in
n neuro staatus. Call Neu
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. overview o
of procedures that arre seen in PPACU heree at This paccket is an o
Vanderb
bilt. This iss not all incclusive, I am
m sure theere are thin
ngs I misseed somethiing. If you have requests or sugggestions fo
or educatio
on please leet me know
w. Thanks,, Jamie A
Adams, RN References www.mayo
w
oclinic.org//neurologyy https://mcaapps.mc.vaanderbilt.e
edu/E‐Mannual/Hpoliccy.nsf http://www
w.nursingconsult.com
m/nursing//index