From the Guidelines
Post-operative orders for a pericardial window procedure should prioritize cardiac monitoring for at least 48 to 72 hours to detect arrhythmias or hemodynamic changes, as recommended by the American Heart Association 1.
Key Considerations
- Pain management with scheduled acetaminophen and as-needed opioids
- Vital sign monitoring every 4 hours for the first 24 hours
- Chest tube management with documentation of drainage amount and character
- DVT prophylaxis with subcutaneous heparin or enoxaparin
- Early ambulation within 24 hours of surgery
- Laboratory tests, including daily CBC, basic metabolic panel, and cardiac enzymes
- Fluid management to maintain euvolemia
- Respiratory care with incentive spirometry and supplemental oxygen
Cardiac Monitoring
- Cardiac monitoring should continue for at least 48 to 72 hours post-operatively, as recommended by the American Heart Association 1
- Monitoring should focus on detecting arrhythmias or hemodynamic changes
- Patients at high risk for atrial fibrillation (AF) should be monitored for the duration of their hospitalization in an acute care unit 1
Follow-up and Surveillance
- Patients should be evaluated for possible postpericardiotomy syndrome with tamponade, which may present with symptoms such as fever, fatigue, vomiting, chest pain, or abdominal pain 1
- Echocardiographic surveillance should be performed to evaluate device position, residual shunting, and complications such as thrombus formation or pericardial effusion 1
- Clinical and ECG surveillance for recurrent or new-onset arrhythmia is an important feature of postoperative evaluation 1
From the Research
Pericardial Window Post-Operative Orders
- Post-operative management of pericardial window procedures involves careful monitoring and pain management, as discussed in 2 and 3.
- The choice of surgical approach, such as subxiphoid or thoracotomy, can impact post-operative outcomes, including pain and recurrence of pericardial effusion, as noted in 4.
- The use of a pericardial window technique can help prevent pericardial tamponade after cardiac surgery, as shown in 5.
- Effective pain management is crucial in the post-operative period, and can be achieved through a combination of pharmacological and non-pharmacological strategies, as discussed in 3.
- In patients with penetrating cardiac injuries, pericardial window techniques can be used for both diagnosis and treatment, and may be associated with decreased hospital stay and intensive care unit stay, as noted in 6.
Key Considerations
- Monitoring for signs of pericardial tamponade, such as cardiac arrest or moderate-to-large pericardial effusion, is essential in the post-operative period, as discussed in 4 and 5.
- Pain management should be tailored to the individual patient's needs, and may involve a range of strategies, including analgesia and non-pharmacological interventions, as discussed in 3.
- The choice of surgical approach and post-operative management strategy should be based on the individual patient's condition and medical history, as noted in 2 and 6.