Transcript CHEO routine

CHEO Residents
Manual
Amy Rodgers 2008
Anesthesia Lounge
Your file
folder
Coffee
machine!
Microwave
APS binder
and folder
APS
papers
APS board on this
wall
In this chair at
7:30am for pain
rounds!
Main OR organization board
(entrance to main OR)
Nurse in charge
Anesthesia staff
in charge
Anesthesia staff
on call
Anesthesia
resident on-call
Parental presence
induction volunteer
Interview Room
(entrance to main OR)
OR booking
If schedule not printed
for following day, it is
organized at this desk, you
can take a peek if you ask
nicely!
Patient’s charts
kept on this
ledge after they
arrive
Main OR hallway
Conference room for
teaching and grand rounds
Anesthesia
assistants office
Entrance to anesthesia offices
and lounge-code needed to
unlock door
Anesthesia resident
call room
These are the doors just past the main OR entrance
This part usually
filled out in PAU by
anesthesiologist in
clinic
Signed a.m. of OR by
anesthetist, verify if
any changes since PAU
and fasting status
Usually difficult to
assess in young
children
Filled out by
nurses in
day care
Filled out by nurses
in day care
Anesthesia Record
Anesthesia Record
Fill out the
admission recovery
score in PACU
Currently
no dilaudid
PCA
APS order sheet, it should go in patient’s chart
Be sure to write time and
date of each visit.
Mark if patient was in
ICU
Place this sheet in the APS binder in anesthesia lounge
Write patient info on APS board in lounge
Place in APS billing folder in anesthesia lounge
Anesthesia Bill
Patient’s hospital
card info here
Write
anesthesia staff
Write the
surgical
procedure here
Mark the
date
Anesthesia staff
will calculate
codes
If a trauma code or
a case, mark the
duration
Patient’s
surgical
diagnosis
A bill is required for every case, every APS patient, every PAU
Patient, every trauma, every post-op ICU patient that we are
following (only if not ventilated) and every consult
Place bill in APS folder for Carrie along with a copy of the consult.
Anesthesia Supplies in
Sterile Corridor
Anesthesia Supplies
Anesthesia Supplies
Anesthesia Supplies
Anesthesia Supply
Drawers
Use supplies with white clip first. When the slot is empty,
remove the white clip and place it on the board to show it
needs to be ordered. Then start using the slots with the red clips
at the back of the drawer.
Anesthesia Supply
Drawers
Use the slots with the white clips first, remove this clip when
drawer empty.
Anesthesia Supply
Drawers
Use supplies from this part of the drawer after finishing the
supplies from the drawer with white clip. Place the red clip
on the board to be ordered when this part of the drawer
is empty.
To Be Ordered Board
Place the clips from empty drawers on this board.
Drug Cart in Sterile
Corridor
Drug Cart in Sterile
Corridor
Pentaspan and
Voluven
Blood Gas Machine in
Sterile Corridor
Anesthesia Carts
Ventolin
Tape
Handy
reference
guide
ECG stickers
Medication labels on top
of anesthesia cart
Handy Reference Card on
all Carts
Handy Reference Guide
ETT sizes,
blades, vitals for
all ages
Anesthesia Cart Organization
This sheet is attached to every cart
Anesthesia Cart Top
Drawer
Emergency
drugs
NS flush bags
Blunt
needles
Lip smackers
for face masks
Second drawer
Tourniquets
Angiocaths
Tegaderm
Alcohol swabs
needles
Third drawer-syringes
Infusion tubing
stopcocks
Fourth drawer
Steri-strips
Arterial
catheters
Calculator
Neuromuscular
twitch monitor
IV arm boards
Caps for
stopcocks
Arm boards
(to protect IV)
Nurses will generally secure the IV on the board
while anesthesia is securing the airway
Fifth drawer
Blood set
IV tubing
T-pieces
for IV
Sixth drawer
NG tubes
NS
flushes
(10cc)
Volatiles
Bags to cover
neonates head
to prevent
heat loss
NS 500cc
bags
RL and 1L bags are kept in corridor.
PS and Voluven are kept on the anesthesia drug cart.
Top drawer of ventilator
Laryngoscope
Blades: each room
has a specific colour
of tape around it, to
be kept in that room
Stylets
Stylets
small
medium
Oral Airways
Oral Airways
•
•
•
•
•
•
•
•
3cm-pink
4cm-orange
5cm-blue
6cm-purple
7cn-white
8cm-green
9cm-yellow
10cm-red
Second drawer
Breathing bags
2L
bag
500ml
bag
1L bag
Third drawer
Face Masks
Small
adult/child
Infant
Neonate
Medium
adult
Toddler
Fourth drawer- ETT
Head rests for patients
(donuts)
Usually kept on top of the anesthesia machine
Lip Smackers
Apply sparingly to the face mask prior to inhalational induction.
Kept in the top drawer of anesthesia cart.
IV Line Set-up
Buretrol
NS 500cc
bags unless
teen
T-piece
CHEO routine: place tegaderm over IV to secure prior
to hooking up to the line
-ensure no bubbles or air in ports especially in cardiac cases!
-needle free system, attach syringe to port to inject drugs
IV line
This clip needs to be closed to
place in the IV pump
IV pumps
Choose accept
“Yes”
Primary Infusion
Setting IV rate
VTBI: Volume to be
infused, set amount
smaller than size of bag
so bag doesn’t run dry.
VI: Volume
infused, look her
to record final
volume infused at
end of case
IV pump
Press one of these buttons to
change either the rate, VTBI
or VI.
When changing options press the hold button first.
Press the button either beside rate, VTBI or VI.
When finished making changes press the run button.
Oximeters
Infant (3-20kg)
on toe/finger
-Neonatal (<3kg)
on foot
-Adult (>40kg)
on finger
Always keep oximeter on at end of case, will be reused in PACU
Oximeters
Oximeters
Disconnect
oximeter here
for transfer to
PACU
Temperature probe
Usually placed in axilla, however in longer cases may be placed
in nasopharynx/esophagus for more accurate monitoring
Bair Hugger
Multi-use port
Multi-use port for
medication vials
Syringes will attach to port for withdrawal of drugs
Emergency drugs
Sux and atropine should be drawn up with a 25G needle
attached in case IM/SC injection required
Anesthesia Cupboard in
corner of OR
Oximeter
probes
Filters
Suction tubing
and yaunkers
Anesthesia
circuits-small
and large
Room beside the
changerooms
Stores refrigerator for blood products, BIS monitor,
Glidescope and ultrasound machine
BIS monitor
Portable ultrasound
machine
Glidescope
Glidescope blades
Central line kits
Blood line sets
Arterial line kits
Arterial line boards
Fluid warming set
Arterial pressure line kits
Neonatal Cart in Sterile
Corridor
Bring cart into OR when working on a neonate. Supplies should be quickly
accessible.
Neonatal cart-1st drawer
Magill forceps
Baby Yaunker
Oxyblades
Robert Shaw
blades size 0, 1
Miller blades size 00, 0, 1
Laryngoscope blades
Neonatal cart-1st drawer
Ett # 2.5, 3.0, 3.5
Oral airways
000, 00, 0
Nasal airways at
front: 12, 14,
16Fr
Neonatal cart 2nd drawer
Masks-neonatal
and infant sizes
ETT connectors
with Co2 ports#2.5, 3.0, 3.5
Neonatal cart-2nd drawer
Mastisol
Breathing bags
500mL
Neonatal cart-3rd drawer
IV boards
Infant tegaderms
Small gauge
needles
Infant sized
tourniquets
Mini blood
tubes
Caffeine
Citrate
Neonatal cart -3rd
drawer
Arterial line boards
Guidewires
Jelco’s 24, 26G
Short Insyte
Neonatal cart-4th drawer
Precordial
stethoscope
NG tubes-5Fr,
8Fr
Baby SpO2
probes
Neonatal
ECG
electrodes
Neonatal ECG package
Includes small stickers and wires
Precordial stethoscope
Remove bell from
stethoscope and
attach here
Ng Tube 14Fr
Sticker to place
on dome of
stethoscope
Precordial
stethscope
Tape stethoscope to L axilla to rule out R endobronchial
intubation intra-op
Neonatal cart-5th drawer
Bp Cuffs
BP cuffs
#4
Size
#1
#3
#2
#5
Temp probe
covers
Neonatal cart -5th
drawer
Hemacue
Neonatal cart-6th drawer
Shoulder rolls
Baby hats
Infant MIE
Neonatal Cart-6th drawer
D10W
D5W
Extension set
small bore
Infant nasal
cannulae
Infant
donut
Regional Cart in Sterile
Corridor
Regional cart-top drawer
Drugs: bupivacaine, lidocaine, tetracaine, ropivacaine
-also available on drug cart in sterile corridor
Regional Cart-top drawer
Emergency drugs
Regional Cart-2nd drawer
Spinal needles
Regional Cart-2nd drawer
Syringes, fluid
Regional cart-3rd drawer
Epidural kits
Epidural Kit
Contents: 19G catheter, 17G Tuohy needle, 10cc loss of
resistance syringe, filter
Epidural Kit
Contents: 20G catheter, 18G needle, 10cc loss of resistance
syringe, filter
Regional cart-3rd drawer
Steristrips, saline flushes, large tegaderms, drapes
Regional Cart-4th drawer
Nerve stimulator, Pajunk stimulating needles,
Regional anesthesia textbook
Crash cart
Located in the sterile corridor beside the
Neurosurgery OR
Difficult Airway cart beside it (not available when working
on this presentation)