Pre Operative Cardiac Care

Reviewed by Ana Kennedy
Approved by Clinical Practice Committee

May
2008


Investigations prior to Surgery	Consents	Ongoing Care in NICU
	Parental Queries

Cardiac Surgical Patients: Preparation Pre-operatively

Investigations Required Prior to Cardiac Catheter:

Group and Cross match
CXR
ECHO
FBC
Electrolytes
Urea and Creatinine
Gas and lactate if intubated or unwell

Investigations Required Prior to Surgery:

Test	Details
Group & Cross Match	On the request form write clearly “pt is for cardiac surgery” and fill in transfusion history so sample will be valid for 7 days rather than 72 hours. If patient changes name the sample will no longer be valid so a repeat sample will need to be sent. Group and Crossmatch will be valid for child < 4 months even if transfused as long as they have not left the hospital. If 22q11 deletion and t-cell abnormalities or unsure of lymphocyte function you may need irradiated blood, please confirm this with the surgeon or anaesthetist before ordering.
Newborn Metabolic Screening	Needs to be sent prior to bypass so sample should be sent even if prior to 48 hours otherwise follow the NICU protocol. If missed and not done prior to bypass the first sample should be sent 48-72 hours after surgery and a repeat sample sent in 3 months.
Other Bloods	FBC Urea & Creatinine Electrolytes Gas & Lactate if intubated or unwell Coags as requested by anaethetist or surgeon
Fish for 22q11 deletion	Required on all infants who have Conotruncal abnormalities; Tetralogy of Fallot, Truncus, Interrupted Aortic Arch and on children with dysmorphisms or concern for chromosomal anomalies. As all bypass cases will be transfused any chromosomal testing needs to be done pre operatively.
T Cell (count & function)	To be sent on all children with Interrupted Aortic Arch
CXR	Within 1 month of surgery or if respiratory status has changed since last one.
ECG	Within 2 weeks of surgery. Pager for ECG tech 93 5367
Ultrasound	Renal & Head ultrasounds required on any infant undergoing aortic arch surgery e.g. Norwood or Coarctation of the Aorta.

Consents:

Surgical consent is obtained by the surgeon.
Anaesthetic consent is obtained by the anaesthetist or anaesthetic registrar.
Consent for Blood Transfusion must be obtained prior to surgery

Ongoing Care in NICU:

Questions about the care of babies in NICU should be directed to the consult pager (93-5508) Mon-Fri 8am to 5pm or the Cardiologist on call.

To refer new patients to the Cardiology Service the Neonatologist should call the Cardiologist on Call.

Questions about the scheduling of surgery can be answered by Cathy (booking clerk) at ext 23619

Parental Queries:

If the parents of cardiac surgical patients have questions about the process around surgery or what will happen post-op, please call the Nurse Practitioner, Ana Kennedy on 021332861 or Marion Hamer on 021 983986 who will be happy to come up and speak to the parents.