Pectus Excavatum Management Pathway

Pathway for Pectus Excavatum Repair (see pectus excavatum orderset) •SCDs•Type and Screen•Ancef or Vanc(+ORSA) prior to incision•Pre-op wash (Dynahexof HIbiclens) in SDS •Continuous pulse oximetry•Clears, advance as tolerated•OOB to chair and then ambulate (if first case of the day)•Incentive spirometry 10x/hour•mIVFD5 ½ NS + 20 meqKCL @ maintenance•SCDs•Ancef x 3 doses (Clindaif +ORSA) •Pain management per pain team: Epidural, valium, robaxin, toradol, IV Tylenol, methadone x1, scheduled Zofran •Chewing gum 5 separate times for 20 min (if fully awake post-op)•Senna/miralaxBID and Movantik•Foley catheter Initiate POD1•OOB (up to chair and ambulate) TID•Remove foleycatheter •Pain management per pain team: Continue Epidural, valium, robaxin, toradol, IV Tylenol, start oxycodoneContinue from POD0•Regular diet•Incentive spirometry 10x/hour•mIVFuntil drinking well and urinates after foleyremoval•SCDs •Chewing gum 5 separate times for 20 min •Zofran Q8H (changes to prn) •Senna/miralaxBID and Movantik Initiate POD2•Stop IVF (if still running) •Stop epidural at 0600•Epidural removed when pain team rounds•Transition to all PO pain medication: oxycodone, valium, robaxin, motrin, Tylenol•2V CXR to evaluate bar location(s) and for pleural effusion/pneumothorax•Remove dressings and wash chest daily Continue from POD0/1•Regular diet•Ambulate TID•Incentive spirometry 10x/hour•SCDs •Chewing gum 5 separate times for 20 min •Zofran Q8H prn•Senna/miralaxBID and Movantik Pre-OperativelyPOD 0 POD 1 POD 2 Initiate POD3•PT/OT will sign off on walking stairs•Prescriptions filled and medication schedule givenContinue from POD0/1/2•Regular diet•Ambulate TID•Incentive spirometry 10x/hour•SCDs•Chewing gum 5 separate times for 20 min •Wash chest daily•PO pain medication •Senna/miralaxBIDDischarge home if pain well controlled, tolerating PO intake POD 3 v2 Updated 11/2019