VEPTR/Spine Growing Instrumentation Procedures Clinical Pathway, ICU and Inpatient – Implantation/Major Revision Post-Operative Day 3 Through Discharge

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

Implantation/Major Revision Post-Operative Day 3 Through Discharge

Goals for Day 3

  • Maintain analgesia, begin transition to PO pain medication
  • Advance mobility
  • Maintain wound integrity
  • Discharge planning
Pain Management
  • Start
    • Ibuprofen PO q6hr PRN mild pain, 2nd line
  • Continue
    • Acetaminophen PO q4hr PRN mild pain 1st line
    • Oxycodone PO q4hr PRN moderate pain 1st line
    • Hydromorphone IV q3hr PRN severe pain
    • Nalbuphine IV q4hr PRN itching
    • Diazepam PO q6hr PRN spasms
  • Discontinue After 8 Doses
    • Ketorolac IV q6hr
Activity/PT
  • Allow to self-position as able
  • Continue PT, OT
  • Review optimal positioning to avoid direct pressure on wound
  • OOB as tolerated
    • No lifting under axillae
    • No pulling arms
    • No lifting arms bilaterally overhead
    • No hip flexion past 90 degrees
Nutrition
  • Advance to home diet as tolerated
Tubes/Drains
  • Surgical drain
    • Nursing strip drains PRN
    • Discontinue per clinical team
  • Record surgical drain output q8hr
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
Imaging
  • XR Scoliosis 2 VW Frontal/lat no brace
    • Ortho resident, APP, or attending must check prior to d/c
Discharge Planning
  • Assess home health and transportation needs
  • Finalize discharge planning
  • APP/MD provides prescriptions for family once medication regimen is determined
  • First surgical incision dressing change as determined by orthopedics
  • Discharge to home when tolerating:
    • Oral pain medication
    • Oral liquids/solids or GT feeds
    • Baseline mobility
  • Discharge Instructions