VEPTR/Spine Growing Instrumentation Procedures Clinical Pathway, ICU and Inpatient – Implantation/Major Revision Post-Operative Day 1

VEPTR/Spine Growing Instrumentation Procedures Clinical Pathway — ICU and Inpatient

Implantation/Major Revision Post-Operative Day 1

Goals for Day 1

  • Maintain analgesia
  • Advance diet and mobility
Pain Management
Managed by the
Acute Pain Service
  • Start
    • Ketorolac IV q6hr at 0800 max 8 doses
  • Transition to enteral pain regimen if nutrition tolerated:
    • Acetaminophen q4hr PRN mild pain
    • Oxycodone q4hr PRN moderate pain
    • Diazepam q6hr PRN muscle spasms
  • Continue
    • Hydromorphone PCA until oxycodone tolerated, then discontinue
    • Hydromorphone IV q3hr PRN severe pain
    • Nalbuphine IV q4hr PRN itching
Activity/PT
  • Allow self-positioning or logroll q2hr
  • Start PT and OT
  • OOB TID
    • No lifting under axillae
    • No pulling arms
    • No lifting arms bilaterally overhead
    • No hip flexion past 90 degrees
Nutrition
  • Advance diet as tolerated
  • Saline lock PIV
Tubes/Drains
  • Remove Foley catheter if tolerating OOB
  • Surgical drain(s)
    • Record output q8hr
    • Strip tubing PRN or concerns for clogged tubing
Incisional Care
  • If surgical incision site dressing becomes saturated, soiled, or any vac problems occur, notify Ortho on call
  • See Incision Management
Respiratory
  • Incentive spirometry q2hr while awake if able
  • Identify preferred method of airway clearance:
    • Consider chest physiotherapy, cough assist, or IPV q4hr and PRN
      • No Vest therapy for 2 wks
Medication Management
  • Complete 3 doses post-operative antibiotic prophylaxis
  • Continue famotidine, transition to PO
  • Continue bowel regimen as ordered
Laboratory
  • 0600 CBC (no diff), type and screen
  • Consider PRBC transfusion if hemoglobin < 8 g/dL
Discharge Planning
  • Surgical recovery teaching with family