PDA Ligation
Clinical Procedure
 
Aliases:
Duct closure
PDA Closure
Duct ligation

Topic aliases are alternate phrasings for a particular topic.


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Often performed in a location away from theater. Considerations as for
remote anaesthesia

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Know the anatomy of the aortic arch and branches before starting to understand which peripheral artery (if any) will reliably reflect cerebral perfusion-pressure.

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Place at least two pulse oximeters.

1. One preductal (right arm)
2. One post ductal (preferably on the feet as the left arm may still be preductal)

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An arterial line is not crucial if you have reliable pre and post-ductal sats and NIBP readings.

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If you're inserting an arterial line, the right radial (that is preductal) will better reflect cerebral perfusion pressure than a left sided line, and will not be lost in the event the aorta is inadvertantly clamped.

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Antibiotics as per surgeons

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Consider having an inotrope infusion ( eg dobutamine ) running and primed in case it is needed as the lung is retracted.

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Lateral position.
Most frequently a left thoracotomy with a right lateral position will be used, although in patients with a right sided-aortic-arch a right thoracotomy in a left lateral position will be required.

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Frequently after a few hours of increased afterload post-procedure the left ventricle begins to fail requiring inotrope (eg dobutamine ) support

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On clamping of the PDA expect an immediate rise in the diastolic and systolic blood pressure

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