N/IICU Pathway for the Management of PDA in High-risk Preterm Neonate — Off-site PDA Ligation — Clinical Pathway: ICU, Inpatient

Off-site PDA Ligation Protocol

Children’s Hospital of Philadelphia Off-site PDA Ligation Protocol

Contact Cardiology to determine who will notify cardiac anesthesia and CT surgery.

Phone Numbers

  • CT Anesthesia Office — Coordinator Eurrai Booth: 215-590-1867
  • Susan Nicolson — beeper: 215-363-0350 — this beeper is answered 24/7
  • Lisa Montenegro — beeper: 215-363-0353

Pre-procedure Preparation

  1. Two local hospital consent forms for surgery and anesthesia.
  2. Copy of echo report performed within 24h of procedure.
  3. CBC within 24h.
  4. Discussion with parents about their presence in unit 1h before scheduled procedure to meet with surgeon and anesthesiologist and sign consents.
  5. Blood requisition.
  6. Sample for type and screen.
  7. Notify blood bank of procedure time and need for PRBCs.
  8. Unit of blood must be 7 days old or less. Collection date must be on the label.
  9. Unit to be divided into 2 aliquots in 60ml syringes from blood bank.
  10. If platelet count < 100,000, discuss product needs with CT anesthesia.
  11. If patient is known/suspected to be coagulopathic, discuss with CT anesthesia.
  12. Warmer bed in designated space.
  13. All extra equipment removed from designated space.

Day of Procedure Preparation

  1. Two functioning access sites, at least one as a PIV for use by anesthesia.
  2. If on feeds, NPO for 3h if receiving exclusively breast milk (EBM); 4h if receiving formula — if breast milk is fortified, need to be NPO for 4 hours.
  3. Sedate and intubate infant.
  4. CXR confirming ETT location the AM of the procedure, available to be reviewed.
  5. ABG on current ventilator settings.
  6. Retrieve blood from blood bank before arrival of CT team — the team will call when they are 20-30 minutes from arrival; blood must be at bedside in cooler.

At Bedside

  1. Chest tube (CT may bring own pigtail catheter)
  2. Pleurovac collection system
  3. Overhead spotlight
  4. Resuscitation and airway supplies
  5. Mayo stand and table
  6. Suction x3, including suction catheters 6, 8 and 10F
  7. Large sharp container
  8. Light source and head set 2 pulse oximetry monitors and probes
  9. Blood warmer with cassette
  10. IV pumps on right side
  11. 2 bottles of warmed saline
  12. Cardio-respiratory electrodes
  13. Large infectious waste container
  14. Privacy screen

Equipment brought by CHOP CT Surgery Team

  1. Bovie machine
  2. Internal defibrillator paddles and adapters
  3. PDA surgical tray
  4. Physician head light and light source
  5. Medications to be utilized during procedure

During Procedure

  1. All caregivers in procedures designated areas wear hat and mask
  2. Respiratory therapy available
  3. Attending neonatologist present in unit
  4. At end of procedure connect chest tube to Pleurovac according to unit guidelines

Post Procedure

  1. Site specific pain protocol, usually for 24 hours or until chest tube removed
  2. Blood gas immediately after procedure and q2-3 hours until ventilator status is stable
  3. Hematocrit check based on pre-op hematocrit, clinical status and EBL
  4. CXR the following AM to confirm resolution of any pneumothorax; if no pneumothorax, neonatology can put chest tube to water seal and remove chest tube same day if clinically stable
  5. Restart feeds per attending discretion