Once the surgery is complete, the patient transitions into the Post-Anaesthesia Care Unit (PACU) which is the first part of the post-operative phase. In these notes, we’ll be going over the general idea of the PACU, the PACU Nursing Handover, and the PACU Admission process.
Introduction to the Post Anaesthesia Care Unit
The PACU (commonly called the Recovery Area) is an area where patients are temporarily admitted for observation and care following any surgical intervention. This means that the PACU caters for patients who received general anaesthesia, local or regional anaesthesia. This unit aims to monitor the patient and identify any complications that might arise from the surgery or anaesthesia.
The time spent in the PACU largely depends on the type of surgery performed and the type of anaesthesia that was given. Patients who would have had a major surgery requiring general anaesthesia would have to remain at the PACU for a longer period than those who had a minor surgical intervention with local or no anaesthesia. It also depends a lot on the patient’s overall condition, as both chronic and acute illnesses play a major role in determining the patient’s recovery.
The anaesthesia provider (Anaesthetist or Certified Nurse Anaesthetist) would typically be the one who coordinates the patient’s transfer and admission into the PACU. Especially in patients who would have had general anaesthesia, as they are at high risk of having airway obstruction after they are extubated. This happens because even though the patient is somewhat “awake” they still wouldn’t have regained total control over their body. Which means that their neck and jaw muscles relax, allowing the tongue to fall backwards and obstruct the airway.
In fact, during transfer, the anaesthesia provider would remain close to the patient’s head to continuously assess the patient’s breathing and intervene as necessary.
The Nursing Handover in the Post Anaesthesia Care Unit
Before the patient arrives at the PACU, the anaesthesia provider would typically contact the PACU nurses to inform them about the admission and the patient’s status. When and how it’s done depends mainly on the practices of each hospital. But in most cases, a brief handover is first given over the phone to allow the PACU to prepare for the patient’s arrival and ensure that all necessary equipment is available. Following that, a thorough and detailed handover is given to the admitting nurse in person.
The handover should contain the following information:
Patient’s name, ID number, gender and age
Known allergies
Name of the surgical intervention performed
Patient’s position during the surgery
Length of the procedure and any additional time spent in the operating room
Type of anaesthesia
Name and dose of anaesthetic agents and reversal agents
Name and dose of any treatment given during the procedure
Estimated blood and fluid loss
The volume of IV fluids administered
Any complications that might have occurred during the procedure
Any presenting complaints (pain, nausea, vomiting)
Last set of vital signs
Chronic or Acute illnesses that the patient might have
Admitting a Patient into the Post Anaesthesia Care Unit
Once the patient arrives at the PACU, the nurse assists the anaesthesia provider and surgical team to transfer the patient safely onto a PACU bed/stretcher. If the patient is still unconscious or not mobile a pat slide can be used to facilitate an easier and safer transfer. Unless indicated otherwise, most patients will be placed in a recovery position (on their side) or slightly elevated, both of which help to reduce the chance of airway obstruction.
Assuming that you’re the PACU nurse in this scenario, you should:
Assess the patient’s breathing
Ensure that the incision site does not have any additional pressure or strain
Safely secure all external devices (NG Tubes, IV lines, Urine catheters etc.) to avoid any obstructions or injuries to the patient
Apply an oxygen mask to the patient and administer the flow as prescribed
Attach the monitoring device and immediately conduct a physiology assessment (i.e. Check the patient’s vital signs).
Replace the soiled gown and bedsheets with a new warm set and place a lightweight blanket to maintain the patient’s normal temperature.
Once the patient is settled in you’ll want to perform a detailed nursing assessment to identify the patient’s needs and any signs of potential complications. Click here to read about the PACU Nursing Assessment.