Inpatient Pathway for Post-Operative Care after Repair of Tetralogy of Fallot
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  • POST-OPERATIVE COMPLICATIONS
  • Junctional Ectopic Tachycardia (JET)
  • Dx: EKG including Atrial EKG
  • Rx: Per CICU/EP Team
  • Post-Operative Bleeding
  • See Hemostasis
  • Low Cardiac Output Syndrome
  • Causes include:
  • Tamponade
  • Systolic Dysfunction
  • Diastolic Dysfunction
    • Not uncommon with TOF
    • May slow recovery and may contribute to ileus, poor oral intake
  • Arrhythmia such as JET
  • Residual Lesions
    • Branch PA Stenosis
    • Residual RVOT Obstruction
      • Including RV Muscle Bundle
    • Residual or New VSD
  • Common Post-Operative Issues
  • Ileus
  • Poor oral intake
  • Pain, Irritability
  • Criteria for CCU Transfer
  • Stable off milrinone for 4-6 hours
  • Stable in RA or supplemental oxygen
  • Stable off dexmedetomidine for 4 hrs
  • No Pentobarbitol for at least 4 hrs prior to transfer
  • Hemodynamics
  • Respiratory Support
  • Pain Management
  • Fluid and Diuresis
  • Nutrition
  • Hemostasis
  • Temperature Control
  • Infectious Disease
  • Family Education
  • Social Work
  • GOALS FOR DAY 0
  • Early Extubation
  • Monitor for Low Cardiac Output Syndrome
  • Hemodynamics
  • Respiratory Support
  • Pain Management
  • Fluid and Diuresis
  • Nutrition
  • Lab, Radiology
  • Lines and Drains
  • Infectious Disease
  • Family Education
  • Discharge Needs
  • GOALS FOR DAY 1
  • Wean off Vasoactive Medications
  • Assure Adequate Analgesia
  • Maintain Adequate Hydration
  • Initiate Patient/Family Education
  • Transfer to the CCU if Clinical Criteria Met
  • Hemodynamics
  • Respiratory Support
  • Pain Management
  • Fluid and Diuresis
  • Nutrition
  • Lab, Radiology
  • Infectious Disease
  • Family Education
  • Disposition
  • GOALS FOR DAY 2 - Discharge
  • Transition to Enternal Medications
  • Preparations for Discharge
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Discharge Home
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Posted: July 2014
Authors: C. Ravishankar MD, A. Patton RN, S. Sheils, PNP, H. Meldrum, RN, M. Gibbons PNP, G. Bird MD, R. Ghosh MD, S. Fuller MD