Clinical Guideline

GENERAL PRE AND POST OPERATIVE CARE

SETTING Bristol Royal Hospital for Children
FOR STAFF Registered Nurses/Practitioners and Non-Registered Nurses/Practitioners
under direct supervision of a Registered Practitioner
PATIENTS Paediatric patients
_____________________________________________________________________________
Guidance
Patients requiring surgery will require specific nursing management as described below. This
document should be used in conjunction with specialised clinical/nursing guidelines.

Pre-operative care

• Complete all relevant sections of pre-operative surgical care plan.

• Ensure MRSA swabs are taken (refer to guideline).
• Ensure correct fasting times followed (refer to guideline). Consider Intravenous fluids (IV)
if fasting time exceeds 4 hours. Also discuss with theatre co-ordinator/anaesthetist.
• Ensure local anaesthetic, premedication and regular medication given as required.
• Consider Venous Thromboembolism (VTE) prophylaxis complete risk assessment.
• If intravenous fluids required check patient has patent intravenous access and administer
as prescribed.
• All fluid input and output to be accurately recorded on fluid balance chart.
• Check relevant medical investigations have been performed, documented and results
reviewed by medical staff.
• Ensure consent has been obtained and patient has been seen by anaesthetist.
• Prepare family and child for theatre, ensure patient has appropriate clothing (ideally a
gown) and take a pillow. Only one parent to accompany child to theatre (unless agreed by
anaesthetist).
• On arrival to anaesthetic room – confirm patient identity, discuss surgical care plan and
drug chart, following the World Health Organisation (WHO) checklist.
• Covid testing see recent guidance

Post-operative care

• Ensure bedspace checklist is complete. Ensure relevant equipment is accessible.

• On collection from recovery ensure Recovery discharge criteria met (refer to guideline).
• Monitor and record vital signs as detailed below or as per procedure specific guideline.
• Identify appropriate physiological parameters with surgical team. Calculate Paediatric
Early Warning Score (PEWS) and action as per the escalation guidance on the
observation chart.

Every 30 minutes For 2 hours

Hourly For 2 hours
General Surgery
2 Hourly For 4 hours
then 4 hourly or as condition dictates

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 Every 15minutes for 1 hour
Opioid/Epidural Infusions Every 30 minutes for 1 hour
1 hourly for 24 hours

• Check all catheters and drains are secure and patent

• If intravenous fluids/medication required check patient has patent intravenous access and
administer as prescribed. Refer to the peripheral cannula nursing guideline.
• Assess the patient for nausea and/or vomiting and administer anti-emetic as prescribed
as per Trust policy. Monitor and document effectiveness.
• If indicated place enteral tubes on free drainage and aspirate as directed by surgical
team.
• All fluid input and output to be accurately recorded on fluid balance chart.
• Observe and assess for any signs of bleeding, oozing, redness or swelling from wound
site(s). Document and inform surgical team.
Assess for signs of pain using appropriate pain assessment tool, give analgesia as prescribed as
per Trust policy. If prescribed analgesia is ineffective refer to pain team/on call anaesthetist.

Table A
REFERENCES None

RELATED Paediatric Core Care Plans

DOCUMENTS Nurse led discharge times
AND PAGES http://nww.avon.nhs.uk/dms/download.aspx?did=18741
Surgical Care Plan
Peripheral Cannula Nursing Guideline & Record of Care
Epidural/Opioid Nursing Guideline
Intravenous Fluid Administration Clinical Guideline
http://nww.avon.nhs.uk/dms/download.aspx?did=13477
Pain Assessment and Management Policy
http://nww.avon.nhs.uk/dms/download.aspx?did=11156
Policy for Insertion, Confirmation Of Position And Removal Of Naso Gastric
And Oro Gastric Feeding Tubes
http://nww.avon.nhs.uk/dms/download.aspx?did=7761
Medicines Code. Chapter M9: Administration of Medicines
http://nww.avon.nhs.uk/dms/download.aspx?did=3485
Screening for MRSA & MSSA
http://nww.avon.nhs.uk/dms/download.aspx?did=9367
Fasting guidelines for children having an anaesthetic
http://nww.avon.nhs.uk/dms/download.aspx?did=11087
Recovery discharge criteria
http://nww.avon.nhs.uk/dms/download.aspx?did=20817
FLAP guideline (hyperlink to follow)
Renal biopsy http://nww.avon.nhs.uk/dms/download.aspx?did=15638
AUTHORISING Nurse Practice Group
BODY

SAFETY None
QUERIES AND Surgical Team
CONTACT Children’s Critical Care Outreach Nurse Bleep 2968
Clinical Site Team Bleep 3217

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