Complications during transport from the OR

Transport from the OR to the ICU is a critical period. The patient is being disconnected and reconnected from various monitoring devices syringe pumps,ventilators etc. This can lead to errors and absence of monitoring if care is not taken. Post cardiac surgery the patient is disautonomic and is unable to mount appropriate vasomotor responses and so change in position (especially if compounded with hypovolemia). Serial transfer of all devices is the norm. One sign of life at all times is to be maintained for eg ECG is disconnected while arterial line is connected and so on and so forth. Inotropes are also transfered sequentially if syringe pumps are to be exchanged.

During shifting attention has to be taken to prevent disengagement of various liens, tubes and bottles. Bleeding patients (wet closures) should not have drainage bottles clamped as that can cause unrecognized tamponade.Patients with pulmonary hypertension need to have transport with 100 % oxygen and full sedation to prevent a pulmonary hypertensive crisis.

After shifting care has to be taken that the patient is ventilating,all monitoring lines are zeroed and working.The tubes are milked, checked for patency and connected to low pressure suction and all inotropes are properly connected. Importantly communication with the receiving team about operative and postoperative events and significant postoperative management issues and expectations are to be properly communicated.