Download PDF
J Reconstr Microsurg Open 2016; 01(01): 008-011
DOI: 10.1055/s-0035-1570534
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Creation and Validation of a Structured Training Program to Train ICU Nurses in Free Flap Monitoring

Samir S. Khariwala
1   Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
,
Sandra Alexander
2   Intensive Care Unit, University of Minnesota Medical Center, Minneapolis, Minnesota
,
Bevan Yueh
1   Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations
Further Information

Publication History

08 May 2015

23 August 2015

Publication Date:
21 January 2016 (online)

Also available at
   Permissions and Reprints

Abstract

Background Monitoring is an important part of the postoperative care of free flap patients. Because the burden of flap examinations often falls to the house staff, residents must make special trips to the hospital for flap examinations, which increases duty hours. We developed a training program designed to train intensive care unit (ICU) nurse to perform significant portion of free flap monitoring.

Methods First, ICU charge nurses received a slide presentation and completed an online module to consolidate the didactic training. Second, the nurses were given a written reference manual describing the basic concepts behind free tissue transfer and normal flap physiology. Finally, “on-the-job” training of the nurses was done by residents/house staff. Flap-related outcomes were analyzed.

Results The entire group of 24 ICU nurses targeted for this education were successfully trained and transitioned to nurse-led monitoring. For the first 50 patients monitored by ICU nurses following this educational effort, we had no adverse events and no signs of flap compromise were missed by ICU charge nurses. In one instance, an ICU nurse required a resident to personally examine a flap. There were no partial or total flap losses.

Conclusions Training of ICU nurses in free flap monitoring can be accomplished through the following principles: (1) leadership and support by the microsurgeons involved; (2) faculty-led didactic and web-based training modules; (3) significant involvement of the otolaryngology house staff; and (4) consistent and experienced ICU nurses in collaboration with nursing leadership. This is the first description of a successfully validated curriculum.

Keywords

free flap - monitoring - flap salvage - ICU nurse

This manuscript was presented as an oral paper on September 22, 2014, at the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting (Orlando, Florida, September 21–24, 2014).


Supplementary Material

 

  • References

  • 1 Suh JD, Sercarz JA, Abemayor E , et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004; 130 (8) 962-966
    CrossrefPubMedSearch in Google Scholar
  • 2 Spiegel JH, Polat JK. Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 2007; 117 (3) 485-490
    CrossrefPubMedSearch in Google Scholar
  • 3 Chubb D, Rozen WM, Whitaker IS, Acosta R, Grinsell D, Ashton MW. The efficacy of clinical assessment in the postoperative monitoring of free flaps: a review of 1140 consecutive cases. Plast Reconstr Surg 2010; 125 (4) 1157-1166
    CrossrefPubMedSearch in Google Scholar
  • 4 Cornejo A, Ivatury S, Crane CN, Myers JG, Wang HT. Analysis of free flap complications and utilization of intensive care unit monitoring. J Reconstr Microsurg 2013; 29 (7) 473-479
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Khan MA, Mohan A, Ahmed W, Rayatt S. Nursing monitoring and management of free and pedicled flaps—outcomes of teaching sessions on flap care. Plast Surg Nurs 2010; 30 (4) 213-216 , quiz 217–218
    CrossrefPubMedSearch in Google Scholar
  • 6 Jackson RS, Walker RJ, Varvares MA, Odell MJ. Postoperative monitoring in free tissue transfer patients: effective use of nursing and resident staff. Otolaryngol Head Neck Surg 2009; 141 (5) 621-625
    CrossrefPubMedSearch in Google Scholar
  • 7 Marsh M, Elliott S, Anand R, Brennan PA. Early postoperative care for free flap head & neck reconstructive surgery—a national survey of practice. Br J Oral Maxillofac Surg 2009; 47 (3) 182-185
    CrossrefPubMedSearch in Google Scholar
  • 8 Luu Q, Farwell DG. Advances in free flap monitoring: have we gone too far?. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (4) 267-269
    CrossrefPubMedSearch in Google Scholar
  • 9 Abdel-Galil K, Mitchell D. Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques—part I. Non-invasive techniques. Br J Oral Maxillofac Surg 2009; 47 (5) 351-355
    CrossrefPubMedSearch in Google Scholar
  • 10 Lohman RF, Langevin CJ, Bozkurt M, Kundu N, Djohan R. A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry. J Reconstr Microsurg 2013; 29 (1) 51-56
    PubMedSearch in Google Scholar
  • 11 Lin SJ, Nguyen MD, Chen C , et al. Tissue oximetry monitoring in microsurgical breast reconstruction decreases flap loss and improves rate of flap salvage. Plast Reconstr Surg 2011; 127 (3) 1080-1085
    CrossrefPubMedSearch in Google Scholar