Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Preoperative Preparation for CDH Repair

Review

Day Prior to Procedure

Anesthesia	Review Medical history Pediatric Anesthesiology — Congenital Diaphragmatic Hernia Repair Guidelines Communicate Neonatal Attending to Anesthesia Attending Discuss ETT size and determine need to change to a Microcuff ETT to minimize leak Confirm Appropriate blood products ordered Order Equipment using level II form in the preoperative navigator Medications using Anesthesia PHL General Requisitions Order Set
N/IICU Bedside OR	Neonatal Attending to work with Anesthesia Attending at bedside during case Review Discuss ETT size and determine need to change to a Microcuff ETT if large leak Neonatal Surgical Nursing Care Checklist: Set up for Surgical Cases in the N/IICU Vascular access — Umbilical lines for OR as per surgical attending Arterial UAC or PAL, pre-ductal is preferred Central venous DL PICC, lower extremity preferred Peripheral venous PIV x 1 for anesthesia access and blood product administration Order Use Neonatology Perioperative Pathway Order Set Blood products IV fluids Perioperative Antibiotics Stress dose steroids, if indicated Neuromuscular blocking agent dose may be administered to reduce bowel gas and ensure ventilation is adequate once muscle relaxed for OR
Repair on ECMO	Reference the ECMO Anticoagulation Guidelines Procedures in the N/IICU for Guidance

Anesthesia

Review
- Medical history
- Pediatric Anesthesiology — Congenital Diaphragmatic Hernia Repair Guidelines
Communicate
- Neonatal Attending to Anesthesia Attending
- Discuss ETT size and determine need to change to a Microcuff ETT to minimize leak
Confirm
- Appropriate blood products ordered
Order
- Equipment using level II form in the preoperative navigator
- Medications using Anesthesia PHL General Requisitions Order Set

N/IICU Bedside OR

Neonatal Attending to work with Anesthesia Attending at bedside during case
Review
- Discuss ETT size and determine need to change to a Microcuff ETT if large leak
- Neonatal Surgical Nursing Care Checklist: Set up for Surgical Cases in the N/IICU

Vascular access — Umbilical lines for OR as per surgical attending
- Arterial
  - UAC or PAL, pre-ductal is preferred
- Central venous
  - DL PICC, lower extremity preferred
- Peripheral venous
  - PIV x 1 for anesthesia access and blood product administration

Order
- Use Neonatology Perioperative Pathway Order Set
- Blood products
- IV fluids
- Perioperative Antibiotics
- Stress dose steroids, if indicated
- Neuromuscular blocking agent dose may be administered to reduce bowel gas and ensure ventilation is adequate once muscle relaxed for OR

Repair on ECMO

Reference the ECMO Anticoagulation Guidelines Procedures in the N/IICU for Guidance

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Preoperative Preparation for CDH Repair

Review

Day Prior to Procedure

Find a research study

Innovation and your child

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Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Preoperative Preparation for CDH Repair — Clinical Pathway: Inpatient and ICU

Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Preoperative Preparation for CDH Repair

Review

Day Prior to Procedure