Development of a checklist for neonatal perioperative care in cardiac surgery

Oliveira, Mariele Gobo de; Santos, Mariana Aparecida de Jesus Castro; Carvalho, Nyara Coelho; Barboza, Ana Lúcia Monaro; Morais, José Fausto de; Meneguin, Silmara

doi:10.37689/acta-ape/2024AO00026644

Mariele Gobo de Oliveira

collaborated with study design

data analysis and interpretation

writing of the article

critical review of relevant intellectual content

and approval of the final version to be published

Department of Nursing, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, SP, Brazil.

https://orcid.org/0000-0002-0780-965X

Mariana Aparecida de Jesus Castro Santos

collaborated with study design

data analysis and interpretation

writing of the article,

critical review of relevant intellectual content

and approval of the final version to be published

Department of Nursing, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, SP, Brazil.

https://orcid.org/0000-0001-9205-4644

Nyara Coelho Carvalho

collaborated with study design

data analysis and interpretation

writing of the article

critical review of relevant intellectual content

and approval of the final version to be published

Department of Nursing, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, SP, Brazil.

https://orcid.org/0000-0002-2551-4265

Ana Lúcia Monaro Barboza

collaborated with study design

data analysis and interpretation

writing of the article

critical review of relevant intellectual content

and approval of the final version to be published

Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, SP, Brazil.

https://orcid.org/0000-0001-7196-8957

José Fausto de Morais

collaborated with study design

data analysis and interpretation

writing of the article

critical review of relevant intellectual content

and approval of the final version to be published

School of Mathmatics, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.

https://orcid.org/0000-0002-0808-0477

Silmara Meneguin

collaborated with study design

data analysis and interpretation

writing of the article

critical review of relevant intellectual content

and approval of the final version to be published

Department of Nursing, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, SP, Brazil.

https://orcid.org/0000-0003-3853-5134

Corresponding author: Mariele Gobo de Oliveira E-mail: mariele.gobo@unesp.br

Associate Editor: Denise Myuki Kusahara (https://orcid.org/0000-0002-9498-0868) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Conflicts of interest: nothing to declare.

Author, year, country	Study design	Main objectives	Relevant topics analyzed
Grebinski⁽¹⁵15. Grebinski A, Biederman F, Berte C, Barreto G, Oliveira J, Santos E. Workload and sizing of therapy in nursing staff intensive newborn. Enferm foco. 2019;10(1):24-28. Accessed October 20, 2020. http://revista.cofen.gov.br/index.php/enfermagem/article/view/1468/488. http://revista.cofen.gov.br/index.php/en... ⁾, 2019, Brazil	Cross-sectional study	Measure the nursing team workload and size the staff.	Nursing schedule sizing.
Hoffmeister⁽¹⁶16. Hoffmeister LV, Moura GMSS de, Macedo APM de C. Learning from mistakes: analyzing incidents in a neonatal care unit. Rev Lat Am Enfermagem. 2019;27. doi:10.1590/1518-8345.2795.3121. https://doi.org/10.1590/1518-8345.2795.3... ⁾, 2019, Brazil	Cross-sectional study	Analyze reported incidents in a neonatal care unit.	Care in patient identification, use of medications and devices.
Ribeiro⁽¹⁷17. Ribeiro G da SR, Silva RC da, Ferreira M de A, Silva GR da, Campos JF, Andrade BRP de. Equipment failure: conducts of nurses and implications for patient safety. Rev Bras Enferm. 2018;71(4):1832-1840. doi:10.1590/0034-7167-2016-0547.⁾, 2018, Brazil	Exploratory descriptive study	Identify equipment failures during handling and conduct by nurses.	Assembly and checking of technological equipment to avoid incidents.
Chaves⁽¹⁸18. Chaves LDP, Mininel VA, Silva JAM da, Alves LR, Silva MF da, Camelo SHH. Nursing supervision for care comprehensiveness. Rev Bras Enferm. 2017;70(5):1106-1111. doi:10.1590/0034-7167-2016-0491.⁾, 2017, Brazil	Reflective study	Reflect on nursing supervision as a nurse’s management tool for comprehensive care.	Nurse’s care and supervisor role on the team.
Schena⁽¹⁹19. Schena F, Picciolli I, Agosti M, et al. Perfusion Index and Pulse Oximetry Screening for Congenital Heart Defects. J Pediatr. 2017;183:74-79.e1. doi:10.1016/j.jpeds.2016.12.076.⁾, 2017, Italy	Multicenter clinical study	Assess the effectiveness of newborn screening combined with pulse oximetry and perfusion index for severe congenital heart defects.	Verification of pre- and post-cordial oximetry in cyanotic heart disease.
Pimenta⁽²⁰20. Pimenta P, Alves V. O transporte Inter hospitalar do recém-nascido de alto risco, um desafio para a enfermagem. Revista Cogitare. 2016;21:01-09. Accessed October 20, 2020. https://docs.bvsalud.org/biblioref/2016/08/1491/45047-184733-1-pb.pdf. https://docs.bvsalud.org/biblioref/2016/... ⁾, 2016, Brazil	Exploratory descriptive study	Know the conditions under which the inter-hospital transport of high-risk newborns takes place.	Safe conditions for neonatal transport.
Silva⁽²¹21. Silva MF da, Anders JC, Rocha PK, Souza AIJ de, Burciaga VB. Communication in nursing shift handover: pediatric patient safety. Texto & Contexto - Enfermagem. 2016;25(3). doi:10.1590/0104-07072016003600015. https://doi.org/10.1590/0104-07072016003... ⁾, 2016, Brazil	Exploratory descriptive study	Understand professionals’ perception of communication during shift changes and its impact on patient safety.	Use of clear and structured language when changing shifts.
Justice⁽²²22. Justice L, Ellis M, St George-Hyslop C, et al. Utilizing the PCICS Nursing Guidelines in Managing the CICU Patient. World J Pediatr Congenit Heart Surg. 2015;6(4):604-615. doi:10.1177/2150135115593131.⁾, 2015, USA	Guideline	Guidelines to be used as a bedside resource to assist in treating complications of congenital heart disease.	Postoperative monitoring.
Piggott⁽²³23. Piggott KD, Soni M, Decampli WM, et al. Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease. World J Pediatr Congenit Heart Surg. 2015;6(3):401-406. doi:10.1177/2150135115586814.⁾, 2015, USA	Retrospective cross-sectional study	Assess the incidence and risk factors for the development of AKI in newborns after surgery for congenital heart disease.	Carrying out water balance in the first hours after surgery.
DeSena⁽²⁴24. DeSena HC, Nelson DP, Cooper DS. Cardiac intensive care for the neonate and child after cardiac surgery. Curr Opin Cardiol. 2015;30(1):81-88. doi:10.1097/HCO.0000000000000127.⁾, 2015, USA	Review study	Discuss strategies for reducing length of stay in postoperative care for congenital heart disease.	Control of blood glucose and fluid balance in the postoperative period.
Melo⁽²⁵25. Melo HC de, Araújo SEG de, Veríssimo AVR, Santos VEFA dos, Alves ERP, Souza MHN do. O ser-enfermeiro em face do cuidado à criança no pós-operatório imediato de cirurgia cardíaca. Escola Anna Nery. 2012;16(3):473-479. doi:10.1590/S1414-81452012000300007 https://doi.org/10.1590/S1414-8145201200... ⁾, 2012, Brazil	Qualitative study	Understand care in the immediate postoperative period of cardiac surgery from the perception of being a nurse.	Cross-functional role of nurses pre-, intra- and postoperatively, with support from family members.
Solberg⁽²⁶26. Solberg MT, Tandberg BS, Lerdal A. Using a didactic model to improve patient observation skills in neonatal intensive care nurse trainees - A pilot study. Intensive Crit Care Nurs. 2012;28(4):208-214. doi:10.1016/j.iccn.2011.12.005.⁾, 2012, Norway	Pilot study, with pre and post testing	Implement a didactic model and assess nurses’ self-assessments after observing children with heart disease, before and after participating in the program.	Clinical characteristics to be assessed by nurses.
Monteiro⁽²⁷27. Monteiro F, Melo R, Souza G, Araujo T, Lima F, Lopes M. Condutas de enfermagem à criança no pós-operatório de cirurgia cardíaca: análise das pesquisas.. Rev Eletr Enf. 2012;14(4):957-964. Accessed October 20, 2020. http://www.fen.ufg.br/revista/v14/n4/v14n4a25.htm > http://www.fen.ufg.br/revista/v14/n4/v14... ⁾, 2012, Brazil	Review study	Analyze nursing practices in the literature in the postoperative period of cardiac surgery.	Hemodynamic monitoring.
Torowicz⁽²⁸28. Torowicz D, Lisanti AJ, Rim JS, Medoff-Cooper B. A Developmental Care Framework for a Cardiac Intensive Care Unit. Advances in Neonatal Care. 2012;12(5S):S28-S32. doi:10.1097/ANC.0b013e318265aeef.⁾, 2012, USA	Review study	Review the process of implementing a care model in a cardiac ICU.	Patient positioning in the postoperative period.
Pagowska-Klimek⁽²⁹29. Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, Moll JJ. Predictors of long intensive care unit stay following cardiac surgery in children. European Journal of Cardio-Thoracic Surgery. 2011;40(1):179-184. doi:10.1016/j.ejcts.2010.11.038.⁾, 2011, Poland	Retrospective observational study	Examine the perioperative determinants of prolonged intensive care length of stay after cardiac surgery.	Warning signs in the pre, intra and postoperative periods.
Sadowski⁽³⁰30. Sadowski SL. Congenital Cardiac Disease in the Newborn Infant: Past, Present, and Future. Crit Care Nurs Clin North Am. 2009;21(1):37-48. doi:10.1016/j.ccell.2008.10.001.⁾, 2009, USA	Review study	Cover everything from pathogenesis to congenital heart disease management.	Postoperative implications: warning signs, use of invasive blood pressure, device positioning.
Méllo⁽³¹31. Méllo DC, Rodrigues BMRD. O acompanhante de criança submetida à cirúrgia cardíaca: contribuição para a enfermagem. Escola Anna Nery. 2008;12(2):237-242. doi:10.1590/S1414-81452008000200006.⁾, 2008, Brazil	Qualitative study	Understand the typical actions of companions during cardiac surgery outpatient care.	Communication with the family member/companion.
Bueno^/32), 2008, Brazil	Retrospective cross-sectional study	Check the frequency of pharmacological analgesic coverage and the occurrence of postoperative pain after heart disease.	Administration of drugs correctly in the postoperative period.
Ascenzi⁽³³33. Ascenzi JA, Kane PL. Update on Complications of Pediatric Cardiac Surgery. Crit Care Nurs Clin North Am. 2007;19(4):361-369. doi:10.1016/j.ccell.2007.08.003.⁾, 2007, USA	Review study	Discuss the current options available for postoperative complications seen after complex congenital heart disease surgery.	Use of nitric oxide in the postoperative period, in cases of pulmonary hypertension.
Ireland⁽³⁴34. Ireland D. Unique Concerns of the Pediatric Surgical Patient: Pre-, Intra-, and Postoperatively. Nursing Clinics of North America. 2006;41(2):265-298. doi:10.1016/j.cnur.2006.01.007. https://doi.org/10.1016/j.cnur.2006.01.0... ⁾, 2006, USA	Review study	Address pediatric surgical patients’ specific concerns.	Preoperative routine: fasting, laboratory tests, medications.
Beke⁽³⁵35. Beke DM, Braudis NJ, Lincoln P. Management of the Pediatric Postoperative Cardiac Surgery Patient. Crit Care Nurs Clin North Am. 2005;17(4):405-416. doi:10.1016/j.ccell.2005.08.006 https://doi.org/10.1016/j.ccell.2005.08.... ⁾, 2005, USA	Review study	Discuss multisystemic risk factors and consequences associated with cardiopulmonary bypass and cardiac surgery, and postoperative management.	Thermoregulation.
Parkman⁽³⁶36. Parkman SE, Woods SL. Infants Who Have Undergone Cardiac Surgery: What Can We Learn About Lengths of Stay in the Hospital and Presence of Complications? J Pediatr Nurs. 2005;20(6):430-440. doi:10.1016/j.pedn.2005.03.013 https://doi.org/10.1016/j.pedn.2005.03.0... ⁾, 2005, USA	Exploratory descriptive study	Describe a population of infants undergoing cardiac surgery and the relationship between the presence of complications and other variables.	Expected postoperative outcomes.
Andrade⁽³⁷37. Andrade J, Vieira M, Santana M, Lima D. A comunicação entre enfermeiros na passagem de plantão. Acta Paul Enferm. 2004;17(3):311-315. Accessed October 19, 2020. https://acta-ape.org/article/a-comunicacao-entre-enfermeiros-na-passagem-de-plantao. https://acta-ape.org/article/a-comunicac... ⁾, 2004, Brazil	Qualitative study	Identify the factors that interfere with communication, and its lack, during shift change.	Need to systematize shift handovers.

Phases	CVI*				Items n(%)
Phases	C	R	P	S	Constructed	Modified	Excluded
Preoperative	0.98	0.98	0.96	0.96	23(40.3)	16(28.0)	-
Intraoperative	0.98	0.98	0.98	0.98	11(19.2)	4(7.0)	2(3.5)
Postoperative	0.98	0.98	0.98	0.98	23(40.3)	4(7.0)	2(3.5)
Overall	0.98	0.98	0.97	0.97	57(100)	24(42.1)	4(7.0)

Preoperative phase (Initial item)	Modified item
1. Check the date and time of the surgical procedure, through direct contact with the OR, to confirm the appointment and/or doctor in charge of the surgery.	Check the surgical procedure schedule with the medical team and wait for contact from the OR to transport it.
2. Guide family members/caregivers regarding the surgical procedure to be performed with patients, clarifying doubts relevant to their area of expertise and referring the family member to dialogue with the surgeon.	Inform family members/caregivers about the procedure that will be performed with patients.
3. Schedule a daily shift with two nursing technicians for the day of the heart surgery.	Schedule a daily shift with two nursing technicians and a nurse, when possible, to [...]
5. Check fasting time, paying attention to signs of hypoglycemia (sweating, paleness and tachycardia) using the hemoglycotest (HGT).	Check fasting time and perform the blood glucose test (HGT) as prescribed by your doctor.
9. Check the functionality of the transport incubator, keeping it plugged in to check its temperature, which will be indicated on the side panel, ideally between 36.5 and 37ºC.	Check the heated crib functionality, keeping [...]
10. Check the need to refill the O₂ torpedo for transport, requiring replacement with a pressure gauge indicating less than or equal to 50mmHg	Check the need to refill the oxygen torpedo for transport, giving preference to the full torpedo (> or = 150mmHg).
11. Prepare transport incubator with mattress, swaddle, pillow, support for infusion pumps, transport monitor and transport fan.	Prepare a heated crib with [...] and transport ventilator/manual resuscitator.
12. Accommodate patients in the transport incubator, maintaining multiparametric monitoring, continuous infusion pumps positioned safely and offering oxygen when necessary.	Accommodate patients in a heated crib while [...]
13. Transport patients to the OR accompanied by the doctor, a nurse and a nursing technician.	Transport patients to the OR accompanied by at least a doctor and a nurse.
14. Pass patients’ clinical conditions to the operating room nurse, informing patients’ name, age, vital signs, breathing pattern, devices present and medications in continuous infusion pumps.	Pass patients’ clinical conditions [...] medications on continuous infusion pump and voltage of the heated crib.
15. Perform routine multiparametric monitoring, control of vital signs every two hours and care with dressings.	Perform routine multiparametric monitoring, control of vital signs and other care according to the unit’s routine
16. Organize the bed by arranging hospital medical equipment in an organized and easy-to-handle manner.	Organize the bed by arranging hospital medical equipment in an organized and easy-to-handle manner, preferably in an exclusive room, with double bed rails (for installing all equipment and medical gases).
20. Fasting according to medical prescription, paying attention to hypoglycemia.	Fasting according to medical prescription, observing the occurrence of changes in blood glucose.
21. Assist in preparing the transport incubator.	Assist in preparing the heated crib.
22. Position the transport case at the bottom of the incubator.	Position the carrying case [...] of the heated crib.
23. Assist in transporting patients to the OR.	Assist in transporting [...] if necessary.
Intraoperative phase
4. Supervise the head of the bed, which must contain: O₂ flowmeter, O₂ reducing valve, compressed air flowmeter, compressed air reducing valve, suction valve with complete circuit and previously tested bag-valve-mask.	Check the head of the bed, which must contain O₂ and compressed air flow meters, O₂ and compressed air reducing valves, a suction bottle with a complete circuit and a valve-mask bag previously tested and connected to the flow meter.
5. Prepare the invasive blood pressure (IBP) circuit.	Separate the invasive blood pressure (IBP) circuit for use, if necessary.
6. Prepare the nitric oxide (NO) circuit, if necessary.	Check availability of the nitric oxide (NO) torpedo and separate the circuit for use, if necessary
9. Connect a multiparametric monitor, 3 standard continuous infusion pumps, 1 continuous syringe infusion pump and 1 continuous blood component infusion pump to the electrical network, as directed.	Separate for use multiparameter monitor, three standard continuous infusion pumps, three continuous syringe infusion pumps installed on the electrical network, as per guidance.
Postoperative phase
5. Receive patients, observe identification using the identification bracelet and carry out a brief assessment while still in the transport incubator/heated crib.	Receive patients [...] still in the heated crib.
19. Change medications, one at a time, in a continuous infusion pump from the OR to those in the NICU, taking care not to interrupt the flow of medication.	Change medications, if necessary, one at a time, in a continuous infusion pump from the OR to those in the neonatal ICU, with the help of nurses.
20. Assist in multiparametric monitoring, connecting 2 monitors to patients (pre-cordial and post-cordial) to assess O₂ saturation.	Assist in multiparametric monitoring, connecting patients to two pulse oximeters (precordial position: right hand and postcordial: feet) to assess oxygen saturation, in cases of cyanotic heart disease.
22. Change position following medical instructions.	Relieve pressure points, following medical advice.

[1] Corresponding author: Mariele Gobo de Oliveira E-mail: mariele.gobo@unesp.br

Brasil

Brasil

Development of a checklist for neonatal perioperative care in cardiac surgery

Abstract

Objective

Methods

Results

Conclusion