Pediatric Gastroenterology (Presby Tower)
Authors: Joseph Sisk MD, Tracye Carter, CRNA
Surgeons: Altaf, Grunow, Marshall, Palle, Shaukat, Steele, Talathi, Tung
ORs: Procedure Room #3
Last Update: 5.21.21
The Peds GI Pre-op and PACU is located in the back of the PNCU on the 1st floor of Presby Tower.
If you come off the skywalk, take a sharp right and you'll see the waiting room.
Continue through PNCU to the back and you will see bays 13-18.
This is GI Pre-OP and PACU.
The GI Suite is Procedure Room #3.
is a physician's workroom and a break room across from the GI suite.
The code for the doors is 9876#
There is a restroom across from the GI suite.
Pre-OP, patients will be brought back to a bay and checked in by a Peds Nurse. They will obtain an HCG at this time, if indicated.
If done at OSH, are in the patient folder at the nursing desk in pre-op.
Pre-op oral versed is available if ordered. The pre-op nursing is able to administer this.
Nurses may place pre-op PIVs, but I found myself offering nitrous oxide to those that needed awake IVs.
PNCU has a glucometer that may be used if needed
Centricity Pre-Ops will be skeletonized by our PAs but require completion by the attending.
At present, the only computer with Centricity on it is in the PNCU or Procedure room. They are working to get it installed in the Pre-Op/PACU area.
Centricity currently defaults to PNPTCLP006 which is in the back of PNCU.
This should be updated to print on the printer in pre-op/PACU (PNPTCLP005) soon.
There is a pipeline O2 supply.
Both Nitrous Oxide and Air supply comes from tanks on the back of the machine.
These must be turned on and off each day.
Monitor and Ventilator Defaults
Most of the monitors and anesthesia machines currently default to adult settings.
This means the secondary gas is air and the default vent setting is a TV of 500ml.
The procedure room setup has the same supplies as the GI Suite at OCH.
Locating the case in Centricity
For vitals to transmit, assign the case to:
Awake v Deep
Deep extubations can be done if indicated.
It is recommended that the attending anesthesiologist remain with the patient in PACU while the CRNA turns over over the room.
Do not roll back to the procedure room with the next patient until the previous emerges from Anesthesia and no longer has their oral airway in place.
Consider having both providers carry an emergency drug bag on them.
The patients are recovered by Peds nurses who are familiar with deep extubations
The Pre-Op and PACU bays are tight spaces.
Consider ordering IV fluids to be TKO or saline locked so the nurses do not need to use a pump.
Consider ordering acetaminophen for PACU as these patients will not receive Tylenol premedication.
Our pediatric anesthesia techs have done a super job ensuring we have adequate supplies
It is helpful to have the circulator call the Presby anesthesia techs when they call report to PACU.
The adult techs did their best to arrive in a timely fashion but most of the turnover will fall on the CRNA.
The time it takes the attending to recover the child in PACU provides the extra time to get this done.
Because the adult techs are not made privy to the patient information on the tracker, they are unfamiliar with the age of the patient, the appropriate sized equipment.
Consider having the techs work to sanitize the anesthesia station and empty the trash while you perform a patient-appropriate set-up yourself.
For the older patients that require an adult circuit, the techs have pre-made packs filled with:
1. A Circuit
3. Blue towels
5. Tongue depressor
6. Oxygen facemasks for transport
7. BP cuff, pulse ox, electrodes
8. Trash bag
9. Some miscellaneous items
· These packets are located outside the GI suite and have proved to be quite helpful. You will still have to set out your own airway equipment and pediatric monitors.
Please deposit used blades in the designated biohazard labeled bin.
o The GI nurses will return them to the peds side for sterile processing.
The procedure room Pyxis has our standard peds medications including precedex
There is a central pyxis in PNCU which contains dilute epinephrine
The Peds-to-Adult Code cart is in Pre-Op/PACU
PACU Airway Cart
There is a pediatric basic airway cart in Pre-Op/PACU
This contains Mapleson Circuits, OPAs, LMAs, etc.
These are located in the Pre-Op/PACU Airway Cart
Individual PACU bays also have Mapleson circuits at bedside
Malignant Hyperthermia Cart
The MH Cart is in PNCU
Presby Anesthesia techs can quickly bring us an ultrasound or video laryngoscope if requested
There is a Glidescope on this floor which is shared with Cath Lab
Cell service in the Peds GI area appears adequate
Replacement Nitrous Oxide/Air cylinders
The Techs told can quickly provide new Nitrous Oxide and Air cylinders if called.
There are adult Anesthesia providers working in the Adult GI section of the PNCU
Important Phone Numbers
OUMC Airway Phone
Presby 24hr Anesth tech hotline
Anesthesia Tech on Duty
Overall, the workflow is similar to MRI
The Anesthesia Attending should review the charts prior to the start of the day.
Update all COVID tests.
Nursing will room the patients and check them in.
Assess for pre-medication need early.
Tell nurse if it is ordered.
Identify IV plan ASAP.
Induce as you would in GI
Consider seeing the next patient as the case proceeds.
If not, it can be done after the case.
Extubate as you would in GI.
If deep, the attending should stay with the patient until the Oral Airway is out while the CRNA turns over the room.
Roll back with the next patient only after Oral Airway is out.
Work in Progress:
Centricity needs to be installed on computers in Pre-Op/PACU. Ideally on the nursing computer and a COW.
Procedure Room #3 needs a narcotics waste receptacle
The Anesthesia Machine Vent and Monitors need to be configured to Pediatric Settings as default
Pre-OP/PACU vitals monitors should be configured to Pediatric Settings as default