Vascular Surgery Rundown
Who to call
On-call Vascular Registrar: there is a Vascular Registrar on call at all hours, contactable via the Vascular On-Call phone.
On-call Vascular Consultant: via operator – in some emergency situations when the Vascular Registrar is tied up in the operating theatre the Consultant should be contacted directly. If the Consultant is also in the operating theatre it may be necessary to physically come to the operating theatre to directly discuss your case with the Consultant.
Vascular Nurse Specialist: a useful resource who provides an ABI service and wound advice management during working hours. Another Vascular Nurse Specialist is also available during working hours to assist with the ward management of vascular surgery patients.
Outpatient referrals: send e-referral via RCP.
Critical Care Input: most major vascular surgical cases go to level 8 DCCM post-operatively as do any readmissions.
Note: the above contact details apply to the Auckland Regional Vascular Service which is based at Auckland City Hospital and provides vascular coverage for Auckland, Waitemata, and Northland Hospitals.
Daily routine
0715-0730: arrive to update the list manually. You can also view these patients by searching ‘Vascular Service’ on the inpatient view in Clinical Portal.
0745: meet with registrars in handover room ward 41
0800: ward round After the ward round and jobs you’re usually quite quiet. Usually one team is busier than the other but it varies, help your colleagues out if you’re quiet and they’ll return the favour!
1600: At the end of the day you will run the list with the registrar or fellow. This can usually be a text if nothing complicated, or a phone call if you have any concerns. Some registrars prefer a face to face handover so ask them in the morning. You can find them in theatre for handover if required.
Patient list
Yellow team list: P drive >Everyone > Vascular house officer > Yellow team patients Purple/Blue team list: L drive > Everyone > Vascular Purple > Purple team lists.
When patients come in who are known to the service, they will go to the team that knows them, not to the on call team. Your registrars should inform you of this.
Ward rounds
SMOs round every day. Ward rounds are extremely fast-paced. Alternate with your off-sider with one person writing notes for one patient while the other HO gets the notes ready for the next patient.
Weekends
Weekend ward rounds are formally rostered. It’s usually ok to leave once you have completed the jobs from the ward round. These are probably the best weekend shifts you’ll ever do in terms of workload - look forward to them! On Friday, prep discharges for the weekend and ensure medication charts have enough space to get through to Monday to help your colleagues on-call as the general surgery weekends can be hectic.
General
You will need to chart the regular medications for the post angios that come to the ward in the afternoons, they usually go home the next morning so you could also prep the DC if time allows.
The phlebotomists come at very variable times - sometimes at 0800, sometimes bloods will not be back until 1500. Put up the bloods the night before (in the cubby hole slots on the ward) in case they come early as there is only one round a day.
Nurses should be able to take bloods for you on the ward, however many are not trained to do IV lines. If you miss the phlebotomists round or your patient needs an IV line you will likely be asked to do this.
Use this run as an opportunity to learn how to insert ultrasound guided IV lines. The USS is in the CNS office and you are more than welcome to use it.
Admissions
All acute admissions are done by the registrars, however if they are really busy they will occasionally ask you to see the patient in ED and/or chart the medications/request scans.
All elective admissions are done by you. Pre-admissions tend to arrive on the ward between 1-3pm, so put in an IVL and take bloods as soon as they arrive on the ward to enable you to check the bloods before you leave that day.
Elective AV fistula patients come under Renal preoperatively and Vascular post operatively. This means that the renal HO admit these patients, but occasionally you may be accidentally called about these patients. Kindly inform your renal colleagues if this happens. They will also do these patients' discharges.
Radiology meetings
Radiology meetings occur on Friday and generally delay the ward round until 1000hrs. HOs do not need to go to these meetings but they can for interests sake.
0800 Aorta meeting on level 8, Neurology Conference Room
0900 Peripheral Vascular meeting on level 5 in the main radiology conference room.
Occasionally the aorta meeting does not occur and the round will occur at 0800 as usual. Speak to your Nurse Specialist to find out what the plan is.
Nurse specialists
Jim Richardson is GOLD. He usually works with the Purple team but will help with the Yellow patients if needed. He does a pre-admit clinic that is so thorough you really only need to quickly see the patient (when they actually come in for their procedure) and chart their regular meds. Also amazing at lines, getting blood, dressings, follow up, booking scans, etc. Jim will provide you with an orientation booklet and you can also ask him anything. Jim takes on a large work-load so when it comes to IVL’s try to only ask him if you are really stuck.
Alicia Sutton is the Diabetic Foot CNS and is a fountain of knowledge for all things related to Diabetic Foot Wounds. Works across both teams.
Pearls of Wisdom
Angio patients should have IV fluids to reduce harm on the kidneys. Follow the protocol, which will be put in the front of the notes by the Radiology Department.
Pre-Op Bloods: Group and Hold requirements are on a chart on the wall on ward 41.
A buzz phrase for requesting USS follow-up is “duplex doppler ultrasound to assess vessel/stent patency and flow velocity”.
A buzz phrase for MRA is “to assess infrapopliteal disease”. MR-angiograms are requested with interventional radiology and will be prioritised within 48 hours. Ensure you know the eGFR/CrCl as you will be asked.
Some patients will require Heparin/Iloprost infusions. There are protocolised forms for both of these and the nurses are very experienced so it requires minimal effort from you.
Often the consultants will know the plan very clearly in their mind but will not articulate it as well. Just ask them to clarify and they’re always fine with this. It’s best to do this on the ward round as the consultants disperse following this, common questions are: What type of scan did you want and what is it looking for? When do you want to see them in clinic? How long should the aspirin continue? If you’re interested in theatre then the registrars and SMOS are super keen to teach and have you involved. You’ll likely be able to get pretty hands on with some cases like toe and leg amputations. But there’s also not much pressure to go if surgery is not your thing