Nursing care for giant sacrococcygeal teratoma resection in infants and young children

Experts say that sacrococcygeal teratoma is the most common true tumor in newborns and infants, with a higher incidence in women than in men. More than 90% of neonatal teratomas are benign, and the possibility of tumor malignancy increases with age. Therefore, once diagnosed, surgical treatment should be performed as soon as possible. So what should be paid attention to in the care of infants and young children undergoing sacrococcygeal giant teratoma resection?

Preoperative care

(1) Psychological care: Due to the low incidence of this disease, parents are relatively lacking in knowledge about the disease. In addition, the children are relatively young and worried about the prognosis of their children. Parents of children are prone to negative emotions such as anxiety, tension, and fear. To this end, nursing staff actively introduce the cure of this disease in our hospital, disease-related knowledge and surgical treatment methods, possible problems, and postoperative complications to parents, so that they have a comprehensive understanding of the disease and its treatment, thereby obtaining the understanding and active cooperation of the family members of the children. (2) Prevent tumor compression and control infection. Because the tumor is large and soft, some are even cystic and only wrapped in one layer of capsule. In order to prevent the tumor from twisting or squeezing, causing internal bleeding and worsening the condition, the child should be placed in a prone or lateral position. When changing the position, two people should cooperate, one person holds the tumor, and the other person changes the position. For children whose tumor epidermis has ruptured and is accompanied by infection, antibiotics are dripped intravenously throughout the body according to the doctor's instructions to control infection. Local washing or wet compresses are performed with 80,000 U of gentamicin + 100 mL of normal saline solution, followed by iodine disinfection. The tumor is wrapped with a sterile dressing, and attention is paid to keeping the sacral and perianal skin clean to prevent contamination of the tumor. (3) Preoperative preparation. Fasting is required for 1 day before surgery. The required nutrients are supplied intravenously. Normal saline is used for cleansing enema the night before surgery and on the morning of surgery to ensure intestinal cleanliness, inhibit bacterial growth, and prevent infection. No water is allowed for 4 hours before surgery. A gastric tube is placed in the morning of surgery, and electrolytes are supplemented intravenously to prevent electrolyte disorders.

Postoperative Care

(1) Closely monitor the patient's condition: All patients are admitted to the ICU after surgery. Because the temperature regulation and metabolic functions of newborns are not yet mature, they are placed on a radiation table or incubator to keep warm. Before waking up from anesthesia, a soft cushion is placed under the shoulders, the head is tilted back slightly, the airway is fully opened, the head is tilted to one side, and a suction device is prepared to promptly eliminate respiratory secretions and vomitus to keep the airway open to avoid complications such as suffocation and postoperative reflux. 24 hours after waking up from anesthesia, the patient is placed alternately in the prone and lateral positions, and turned over once every 2 hours to prevent pressure on the wound. The patient is placed prone, facing one side, with both arms naturally bent and placed on both sides of the body, knees bent toward the chest, and a soft pillow placed on the hips to make the patient's posture comfortable and not affecting breathing [2], so as to prevent urine and feces from contaminating the wound and reduce wound tension, which is conducive to wound healing. When the patient is in the prone position, the bed sheet may cover the mouth and nose of the child. If it is not discovered in time, the consequences will be disastrous, so frequent inspections are required to prevent suffocation. At the same time, continuous ECG monitoring is performed. Since urine volume during fasting can reflect whether the child's blood volume is adequate, the catheter must be kept open and changes in urine volume must be closely monitored.

Closely observe the blood circulation and activities of the lower limbs, observe urination and defecation after removing the catheter, and prevent incontinence. Since its inception, China Paper Service Network has been committed to providing clinical medicine paper downloads, nursing medicine paper rapid publication, surgical medicine professional title paper writing guidance and other services for professional title evaluation customers in various industries.

(2) Wound care. Because the surgical dissection is extensive, the residual cavity is large, the fluid is much, the wound surface is deep after excision, and the skin flap itself is prone to ischemic necrosis. In addition, the incision is close to the perineum and is easily contaminated by urine and feces. Therefore, the wound is prone to infection and rupture after surgery. Therefore, timely and effective perianal and perineal care will effectively reduce the chance of wound contamination in children. After surgery, the incision dressing is closely observed for bleeding, exudate, and contamination by urine and feces. After each bowel movement, the perianal skin is scrubbed with 0.05% iodine cotton balls, and the scrubbing method is from the peripheral skin to the anus. The incision that is drained with a drainage strip should be removed within 48 hours after surgery. When changing the dressing every day, a sterile gauze ball is used to gently squeeze to remove the blood or fluid until no fluid flows out. On average, the dressing is removed on the third day after surgery to expose the incision, and microwave irradiation local physical therapy is given for 20 minutes each time, twice a day, to promote local blood circulation, eliminate inflammatory reactions, and effectively promote wound healing.

(3) Reasonable nutritional support: Due to the young age of the children, the surgical wound is large and deep, the sacrococcygeal muscles and fat are not abundant, and the blood circulation is poor, which often leads to poor wound healing. During the fasting period, the amount of fluid replacement is strictly calculated according to the weight, blood sugar changes and drainage fluid, and attention is paid to maintaining the balance of water and electrolytes. Intravenous infusion of fat emulsion, albumin, plasma, etc. is used to improve the resistance of the children and promote wound healing. Antibiotics are given in time for anti-infection treatment. Because the children use intravenous nutrition for a long time, which causes great damage to the blood vessels, deep vein catheters such as internal jugular vein or PICC are placed as much as possible during infusion to maintain 24-hour fluid replacement and maintain smooth infusion and blood transfusion to relieve the pain of the children. The children in this group underwent non-intestinal surgery, but in order to reduce the contamination of the wound by stool discharge, the feeding time was delayed until the 3rd to 4th day after surgery. Newborns are fed with breast milk or formula milk. The side-lying position is selected for feeding. The nurse is required to monitor the child's sucking during feeding. The bottle should not be placed next to the child and allowed to suck by himself to prevent the milk from choking into the trachea and suffocating.