Pre Operative Cardiac
|Reviewed by Ana Kennedy
Approved by Clinical Practice Committee
2015 with minor update April 2018
Cardiac Patients: Preparation Pre-operatively
Cardiac Surgery-Pre-Operative Skin preparation
Pre-operative anti -Staphylococcal Bundle
- All children undergoing cardiac surgery will have a total body wipe with
chlorhexidine 2% wash cloths the night before and morning of surgery.
- Mupirocin 2% nasal,(topical preparation not approved for neonatal use)
ointment to be applied to both nostrils the night before and on the morning
- The ointment is to be charted BD for 5 days and the tube should go into
a plastic bag attached to the baby’s notes so that it can be continued in
- Nasal swabs to be done on admission to NICU and if results available and
negative for Staphylococcus, the mupirocin steps can be omitted.’
Investigations Required Prior to Cardiac Catheter:
- Group and Cross match
- Urea and Creatinine
- Gas and lactate if intubated or unwell
Investigations Required Prior to Surgery:
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.
- Urea & Creatinine
- 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
- Send for known 22q11 deletion
- Within 1 month of surgery or if respiratory status has changed since
- Within 2 weeks of surgery. Pager for ECG tech 93 5367
- Renal & Head ultrasounds required on any infant undergoing aortic
arch surgery e.g. Norwood or Coarctation of the Aorta.
- Surgical consent is obtained by the surgeon.
- Anaesthetic consent is obtained by the anaesthetist or anaesthetic
- Consent for Blood Transfusion must be obtained prior to surgery -
infants with known or possible immune deficiency (22q11 possible DiGeorge)
should receive irradiated blood.
Ongoing Care in NICU:
Questions about the care of babies in NICU should be directed to the consult
cell phone (0211808238) 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 booking
clerk at ext 23619
If the parents of cardiac surgical patients have questions
about the process around surgery or what will happen post-op, please call the
Nurse Practitioners, Ana Kennedy on 021332861 or Marion Hamer on 021 983986 who
will be happy to come up and speak to the parents.