Experience in Training ICU Nurses to Perform Free Flap Monitoring to Accommodate Work Hour Restrictions

Abstract

Objectives:

(1) Understand difficulties associated with free flap monitoring and duty hour restrictions. (2) Describe techniques used to train intensive care unit (ICU) nurses to conduct free flap monitoring. The implementation of resident duty hour restrictions has resulted in a variety of modifications to residency training programs in otolaryngology–head and neck surgery. In those programs using a home call system, monitoring of free flaps in the postoperative period can be associated with difficulties in resident duty hour compliance. We sought to use a carefully constructed training program to transition a portion of free flap monitoring to a skilled group of ICU nurses.

Methods:

A written reference manual describing the basic concepts behind free tissue transfer and normal free flap physiology was distributed. Nurses received a PowerPoint presentation and completed an online module designed to consolidate the didactic training. Finally, the responsibility of on-the-job training of the nurses was given to the otolaryngology house staff such that each nurse logged and documented 10 flap checks in the presence of a resident.

Results:

Thirty patients receiving free flaps were monitored by the ICU nursing team resulting in 100% flap survival.

Conclusions:

Transitioning the monitoring of free flaps in the perioperative period to ICU nurses can be accomplished through the following principles: (1) Leadership and participation by the microvascular surgeons at a given institution. (2) Faculty-led didactic and web-based training modules prior to actual training. (3) Significant involvement of the otolaryngology house staff, allowing the ICU nurses to gain proficiency.