VEPTR/Spine Growing Instrumentation Procedures Clinical Pathway, ICU and Inpatient – Implantation/Major Revision Post-Operative Day 2

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

Implantation/Major Revision Post-Operative Day 2

Goals for Day 2

  • Maintain analgesia
  • Mobilization
  • Maintain wound integrity
Pain Management

Specific dosing managed by the Acute Pain Service

  • Continue enteral regimen, or transition today
    • Acetaminophen q4hr PRN mild pain 1st line
    • Oxycodone PO q4hr PRN moderate pain 1st line
    • Diazepam q6hr prn muscle spasms
    • Toradol q6hr scheduled
    • Hydromorphone IV q3hr PRN severe pain
    • Nalbuphine IV q4hr PRN itching
Activity/PT
  • Continue PT and OT
  • Self-regulated positioning
  • Logroll q2hr — discuss optimal positioning to avoid direct pressure on the wound as much as possible
  • OOB as tolerated
    • No lifting under axillae
    • No pulling arms
    • No lifting arms bilaterally overhead
    • No hip flexion past 90 degrees
Nutrition Advance diet as tolerated
Tubes/Drains
  • Surgical drain
    • Nursing empty q8hr, strip drains PRN
    • Discontinue per clinical team
  • Remove Foley catheter if not already done
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
  • Continue bowel regimen and famotidine
Laboratory
  • CBC (no diff) if prior value < 9 g/dL or as clinically indicated
Discharge Planning
  • Surgical recovery teaching with family