Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed if possible.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent as far as possible (NMC [152], C).
2. 2.Show
   Obtain a full handover from the surgical and anaesthetic team.
   To ensure effective communication of the patient's care and treatment and to aid the planning of subsequent care. E

Procedure

1. 3.Show
   Assess the patency of the airway by feeling for movement of expired air.
   To determine the presence of any respiratory depression or neuromuscular blockade. Observe chest and abdominal movement, respiratory rate, depth and pattern (Urbankowski and Przybyłowski [206], R).
2. 4.Show
   Listen for inspiration and expiration. Observe any use of accessory muscles of respiration and check for tracheal tug, which might indicate airway obstruction.
   To ensure the airway is clear and laryngeal spasm is not present. E
3. 5.Show
   If indicated, support the chin with the neck extended (head tilt, chin lift manoeuvre).
   In unconscious patients, the tongue is liable to fall back and obstruct the airway, and protective reflexes are absent. E
4. 6.Show
   Suctioning of the upper airway is indicated if:

   • gurgling sounds are present on respiration
   • blood secretions or vomitus are evident or suspected
   • the patient is unable to swallow
   • the patient is unable to cough adequately or at all.

   Suction must be applied with care to avoid damage to mucosal surfaces and further irritation or initiation of a gag reflex or laryngeal spasm.
   Foreign matter can obstruct the airway or cause laryngeal spasm during induction of or emergence from anaesthesia. Foreign matter can also be inhaled when protective laryngeal reflexes are absent (Gavel and Walker [67], E).
5. 7.Show
   1. Apply a face‐mask and administer oxygen at the rate prescribed by the anaesthetist.
   2. If an endotracheal tube or laryngeal mask is in position, check whether the cuff or mask is inflated and administer oxygen by means of a T‐piece system.
   To maintain adequate oxygenation. Oxygen should be administered to all patients in the recovery room (AAGBI [3], C).
6. 8.Show
   Check the colour of the lips and conjunctiva, then peripheral colour and perfusion (skin temperature and peripheral pulse).
   Central cyanosis indicates impaired gaseous exchange between the alveoli and pulmonary capillaries. Peripheral cyanosis indicates low cardiac output (Adeyinka and Kondamundi [8], E).
7. 9.Show
   Record blood pressure, pulse and respiratory rate measurements on admission to the PACU and at a minimum of 5‐minute intervals unless the patient's condition dictates otherwise.
   To enable any fluctuations or gross abnormalities in cardiovascular and respiratory functions to be detected immediately (AAGBI [3], C).
8. 10.Show
   Check the temperature of the patient.
   Peri‐ and post‐operative hypothermia is common and preventable (NICE [143], C).
9. 11.Show
   Check and observe wound site(s), dressings and drains on admission to the PACU and at regular intervals. Note and record leakage/drainage on the post‐operative chart and also on the drain bottle/bag.
   To assess and monitor for signs of haemorrhage (RCoA [174], R).
10. 12.Show
    Check that intravenous infusions are running at the correct prescribed rate in accordance with local policy and that the site of the venous access device is assessed as patent in accordance with local protocol.
    Care of venous devices and sites prevents complications and ensures that fluid replacement and balance are achieved safely. E
11. 13.Show
    Check the prescription chart for medications to be administered during the immediate post‐operative period, e.g. analgesia and antiemetics.
    To treat and prevent symptoms such as pain and nausea swiftly and appropriately and further monitor their effectiveness. E
12. 14.Show
    Orientate the patient to time and place as frequently as is necessary.
    To alleviate anxiety, provide reassurance, and gain the patient's confidence and co‐operation. Pre‐medication and anaesthesia can induce a degree of amnesia and disorientation. C
13. 15.Show
    Give mouth care including moistened mouth swabs, sips of water and petroleum jelly for the lips.
    Pre‐operative fasting, drying gases, manipulation of lips, etc. leave mucosa vulnerable, sore and foul tasting. E
14. 16.Show
    After regional and/or spinal anaesthesia, assess the return of sensation and mobility of limbs. Check that the limbs are anatomically aligned.
    To prevent inadvertent injury following sensory loss (AAGBI [5], C).