Tetralogy of Fallot (TOF), Post-Operative Clinical Pathway — CICU

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Tetralogy of Fallot

Immediate Post-Operative CICU CARE
Post-Operative Day 0

POST-OPERATIVE COMPLICATIONS
Junctional Ectopic Tachycardia (JET)
Dx: EKG including Atrial EKG
Rx: Per CICU/EP Team
Post-Operative Bleeding
See Hemostasis
Low Cardiac Output Syndrome
Causes include:
Tamponade
Systolic Dysfunction
Diastolic Dysfunction
- Not uncommon with TOF
- May slow recovery and may contribute to ileus, poor oral intake
Arrhythmia such as JET
Residual Lesions
- Branch PA Stenosis
- Residual RVOT Obstruction
  - Including RV Muscle Bundle
- Residual or New VSD

Common Post-Operative Issues
Ileus
Poor oral intake
Pain, Irritability

Criteria for CCU Transfer
Stable off milrinone for 4-6 hours
Stable in RA or supplemental oxygen
Stable off dexmedetomidine for 4 hrs
No Pentobarbitol for at least 4 hrs prior to transfer

Hemodynamics
Respiratory Support
Pain Management
Fluid and Diuresis
Nutrition
Hemostasis
Temperature Control
Infectious Disease
Family Education
Social Work

GOALS FOR DAY 0
Early Extubation
Monitor for Low Cardiac Output Syndrome

Hemodynamics
Respiratory Support
Pain Management
Fluid and Diuresis
Nutrition
Lab, Radiology
Lines and Drains
Infectious Disease
Family Education
Discharge Needs

GOALS FOR DAY 1
Wean off Vasoactive Medications
Assure Adequate Analgesia
Maintain Adequate Hydration
Initiate Patient/Family Education
Transfer to the CCU if Clinical Criteria Met

Hemodynamics
Respiratory Support
Pain Management
Fluid and Diuresis
Nutrition
Lab, Radiology
Infectious Disease
Family Education
Disposition

GOALS FOR DAY 2 - Discharge
Transition to Enteral Medications
Preparations for Discharge

Post-Operative Day 1

Post-Operative Day 2 to Discharge

Discharge Home

Posted: July 2014
Revised: November 2021
Authors: C. Ravishankar, MD; M. Gibbons, PNP; G. Bird, MD; R. Ghosh, MD; S. Fuller, MD

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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CICU Clinical Pathway for Post-Operative CareAfter Repair of Tetralogy of Fallot

Evidence

CICU Clinical Pathway for Post-Operative Care
After Repair of Tetralogy of Fallot