Landing Surgical Patients
What does it mean to "land" a surgical patient? Simply put, landing a patient from the OR refers to settling a patient into their room after their operation has been completed. I like to refer to it as "landing" because there are a lot of similarities between setting down an airplane on a runway and settling in a patient post-op. If one mistake is made or things are done out of sequence there could be major consequences in both scenarios.
This is going to vary from place to place but in general you should receive a call from the OR nurse about an hour or so before the patient is set to arrive to the unit. These reports are usually very brief in nature and not anything that you would expect from a change of shift report.
The main takeaways from this report include:
What blood products have been given.
What lines does the patient have (if a Swan was inserted the proper equipment must be prepared).
What drips the patient is currently on.
Estimated time of arrival for the patient.
After this report, the next time you hear from the OR should be when the team is getting ready to bring the patient up.
Getting the Room Ready
The patient's room should be prepared well before the patient arrives. Room preparation will vary from patient to patient and from surgery to surgery. However, some essential items include:
Several suction set-ups (more if the patient is still intubated or has multiple chest tubes or BOTH).
Any equipment deemed necessary from initial report (hemodynamic monitoring system).
All appropriate cables.
New set of linens.
In addition to these, sometimes it is appropriate to have some fluid or albumin present at bedside to bolus into the patient once they arrive.
Once you get word that the OR team is on their way up you should let your charge nurse know as well as the nurses situated closest to you. You can not land a surgical patient by yourself effectively or safely.
If you are the primary nurse for the patient your sole job while landing the patient is to get report from anesthesia and/or the surgery team. This report will give you some insight as to how the patient should be managed from here. This information should include any complications during surgery, medications currently being infused, medications that were previously infused (is the patient still paralyzed?) and target hemodynamic parameters such as CVP, BP, and HR.
If you are not the primary nurse then your job is to get the patient hooked up to the room's monitor and situate the patient quickly and efficiently. What this usually boils down to is 2-3 nurses grabbing randomly at the patients lines and hooking up the patient to the monitor in no particularly thought out manner.
There is a certain order that I go by and prioritize when hooking up a new OR patient to the monitor and it is as follows:
Hook up the arterial line if present- This will give you blood pressure and heart rate. I don't care what the patient's rhythm is at this point. All I need to know is they have a pulse and that pulse is generating a sufficient BP. This does require you to zero the line before getting any meaningful information.
Attach the SPO2 probe- This is much like the arterial line, although it will not give you a blood pressure. This will tell you if the patient has a pulse and if the patient is oxygenating well. (Off subject, but if your patient is coding and has an SPO2 prob or Arterial line please check it during a rhythm check to see if a patient has a pulse instead of solely relying on your adrenaline filled fingers to fill the patients pulse and not your own).
Once you have established that your patient has a pulse and a BP you can begin hooking up the EKG leads. This usually takes the longest and is usually what people try to hook up first (heart = important, right?) which leads to valuable time lost. Your patient could be pulseless by the time you finished hooking them up to the EKG and even so have you ever heard of PEA?
Lastly, attached a noninvasive BP cuff to the patient, preferably on the arm that does not have the arterial line. Cycle the cuff and see if it correlates.
Do not take these as steps but rather a list of priorities. These can be done all at the same time if enough staff is present and capable of helping. Just remember the arterial line should always be the first thing that you go for.
Once the patient is hooked up to the monitor and made comfortable most of the hard work is done. However, keep anesthesia's report in your mind. Did they push in vasopressors before leaving? Is the patient adequately sedated or are they still paralyzed? Was the patient anti-coagulated? Did the patient get lasixs or manitol before coming up? These thoughts should be in the back of your mind so that you can respond appropriately if/when issues arise.