Check

Nutrition

Keep patient NPO

Tubes

NGT on intermittent low wall suction

Flush NGT with 20 cc water TID (once per shift)

Feeding jejunostomy to straight drainage. Flush with 20cc water once daily.

Drain (Jackson-Pratt or Blake) to bulb suction

Chest tube to under water seal (no suction)

Foley catheter to straight drainage

Labs

CBC, U+E, Mg in PACU/HD/ICU

Imaging

CXR in PACU/HD/ICU

Nursing

Vital signs in HD: continuous telemetry, continuous O2 saturations, BP Q2 hours for 8 hours then Q4 hours.

Strict input and output monitoring and recording

• Record chest tube output Q15 mins for 1^st hour then Q30 minutes for 2^nd hour then Q2 hours for 8 hours then Q8 hours

• Record urine output Q1 hour for 4 hours then Q2 hours for 4 hours then Q8 hours

Call MD if:

• HR <60 or > 100 bpm

• SBP <90

• MAP <65

• SpO2 <88% or O2 requirements >5L

• Temp <35*C or >38*C

• UO <0.5 ml/kg/min

• Chest tube output >200 ml/hour