When is it okay to leave after an SAB?

[ucsfgaspain]

So I've been having a debate with colleagues about when we can leave after placing a SAB in a remote site. We do prostate and cervical brachytherapy in a remote site from the main hospital. We do the SAB they placed the needles, we go to a ct scanner, they make adjustments, then they formulate a treatment plan and then they treat them and then pull out the needles. There is an RN with the patient that assists the radiation oncologists. We are getting pressure to leave the patient after 2-3 hours so that we can do other remote sedations. I am unsure as to whether it is kosher to leave them after say 2 or 3 hours when they've been stable. By this time all that really needs to be done is to remove the needles at the end. What do you think? When is it okay to leave?

My colleagues say that by this time are anesthetic is done and we are okay to leave. I am unsure. Thanks!

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[IlDestriero]

How many times have you done a 2 hour case under regional, moved the patient from the OR table to stretcher, had the patient complain of nausea and be hypotensive?

If you have a PACU RN stay with the patient after 2 hours that would be one thing. But a radiation oncology RN? Our discharge criteria from the PACU after regional anesthesia is receding sensory level of at least two dermatomes (same observer documenting). I think that is the minimum that you should consider acceptable if transferring care to a radiation onc RN.

That's what we used to do with the OB patients. Evidence of receding block, and no hypotension with head of bed up to 30 degrees. Our c/s were only about 30 min back then, so I had to wait. Now they take at least an hour, so by the time I've finished tucking them in, I leave. No need to wait 3 hours.

 

[urge]

So I've been having a debate with colleagues about when we can leave after placing a SAB in a remote site. We do prostate and cervical brachytherapy in a remote site from the main hospital. We do the SAB they placed the needles, we go to a ct scanner, they make adjustments, then they formulate a treatment plan and then they treat them and then pull out the needles. There is an RN with the patient that assists the radiation oncologists. We are getting pressure to leave the patient after 2-3 hours so that we can do other remote sedations. I am unsure as to whether it is kosher to leave them after say 2 or 3 hours when they've been stable. By this time all that really needs to be done is to remove the needles at the end. What do you think? When is it okay to leave?

Do not understand.

 

[lushmd]

Do not understand.

He's referring to the brachytherapy needles, not a spinal needle.

 

[ucsfgaspain]

Thanks for the replies. My main concern is medicolegal responsibility and transfer of care i.e. what consititutes patient abandonment. I know that is a tough call, I just don't want to be venturing off the reservation.

 

[jwk]

Thanks for the replies. My main concern is medicolegal responsibility and transfer of care i.e. what consititutes patient abandonment. I know that is a tough call, I just don't want to be venturing off the reservation.

I don't understand why this is a tough call at all (except politically).

You've administered a spinal anesthetic. Whatever standard you would use in the OR for an SAB patient is the same one you must follow in this remote site. If they can't be transported back to your regular PACU (we bring our radiology patients to PACU all the time although it's not really remote), then they need to be attended and monitored appropriately by an RN with the same level of training as your PACU nurses (ACLS or whatever requirements you have), for however long it usually takes, and they need to satisfy whatever discharge criteria any SAB patient would have to be discharged from your PACU back to the floor. If that care can't be provided for whatever reason in your remote area, IMHO you need to come up with a better plan.