Preparation of Equipment/Consent Forms

Step	Action
1	Ensure: Parents are kept informed by Cardiac Team/Paediatrician prior to surgery. Check Consent form has been completed for surgery and the administration of blood and blood products. Anaesthetic consent completed just prior to surgery. Check pre op blood results are available and blood is available for transfusion. Anaesthetist may require 4% albumin and/or packed RBC to be available on the unit (Dr/NS-ANP to confirm).
2	Equipment required for surgery is prepared: Radiant heat table (must be away from the wall). Diathermy pad, machine and cable (brought by theatre staff) Trolley and large sterile trolley covers (brought by theatre staff). Suture material (brought by theatre staff). Theatre hats. Separate suction bottle connected to wall suction (for Surgeon to use) [the Scrub Nurse brings packs and instruments from Starship Hospital]. Alcohol Povodine-Iodine solution
3	Equipment required by the Anaesthetist is prepared: Check resuscitation trolley. Ensure Neopuff and mask are working and easily accessible on heat table (the baby is usually kept on the ventilator during surgery). Check the following drugs are available in the room: Neostigmine 0.08mg/kg (reversal for Pancuronium). Adrenaline 1:10,000 Atropine 0.01mg/kg Fentanyl 0.9% NaCl Sodium bicarbonate

Preparation of Baby

Step	Action
1	Place baby on heat table (away from the wall).
2	Continuous monitoring (recorded hourly): cardiorespiratory SpO₂ blood pressure or Dinamap skin temperature
3	Ventilation as per orders. Suction ET tube immediately prior to surgery.
4	IV fluids as prescribed.
5	Baby is kept nil by mouth for 4 hours prior to surgery.
6	Ensure preoperative preparation check list has been completed.
7	Ensure two identification labels are on baby.
8	Ensure there is no metal touching the baby, e.g. metal splint.
9	Aspirate gastric tube (immediately pre-op).
10	Place the baby on right side.
11	Keep left chest clear (left chest electrode may be placed on left groin).
12	Close room to visitors/parents while procedure in progress (takes approximately 1 hour). Place notice on door re room closed, also ensure masks are available outside door.

Step	Action
1	Ensure continuous monitoring is maintained and recorded hourly.
2	Maintain ventilation as per orders.
3	Keep baby nil by mouth until further orders.
4	IV fluids as prescribed.
5	Observe wound site for bleeding.
6	Comfel dressing to be left insitu for one week (or as per surgeon's order).
7	Pain relief as prescribed.
8	6 hourly urine output totals - urinalysis every nappy change.
9	Keep parents informed of baby’s condition.
10	Pleural drain insitu - remove on surgeon's orders.