Crazy days when I take a CABG
- 0Jun 10, '13 by cabgnurseI would love to hear how my experience compares with my fellow nurses.
I take CABGs/Valves fresh from OR. Days (7A-7P) that I do this, I have two CV patients, often that are Two days post-CABG themselves.
I have normal nursing duties with the two, assessments, meds, plus d/c-ing all of their lines and drips (swan-ganz and introducer, drips weaned off, art line, and foley. )
Assist surgeon with DC of chest tubes and temp pacer wires bedside.
Put them on Step Down bed list, actually take patients to their new rooms, give bedside report.
*Somewhere* in there, find time to chart, 15 min vitals after the chest tubes and wires, set up my heart ICU room, hope like heck to get to eat, (which I usually don't) & then be all smiles for when the elevator opens from the basement and the CRNA and team is bringing me today's case.
Is this normal????????
- 0Jun 10, '13 by RNforLongTime, BSNSo you have two patients AND a fresh-post op CABG? That doesn't sound safe. I don't do CABG anymore but when I did, the fresh post-op CABG pt's were 1:1 for AT LEAST 4 hrs. They came right out of the OR to us. No stop in PACU. If they were unstable, they stayed 1:1 for 8 hrs sometimes 12. Usually by 11pm, depending on what time they came out of the OR, they were doubled up with another pt. We tried to have them extubated within 6 hrs of surgery. I sometimes came in at 11am and worked till 7pm with just the one patient. If the heart was stable at 3pm, they'd give me another pt. But that was rare.
Your ratio sounds unsafe.
- 0Jun 11, '13 by MunoRNSounds like you transfer your day 1 or more post-op's before getting your fresh heart. If this is the case that sounds pretty normal where I work.
On post-op day 1 or 2 nearly all hearts transfer to the tele/progressive care floor where the Nurse will have up to 5 patients and up to 3 of those might be post-op hearts. Fresh hearts are 1:1 until extubated which is usually 4 hours after arrival.
- 0Jun 14, '13 by cabgnurseQuote from CritCareUkNurseOur facility doesn't allow us to pull chest tubes or pacer wires. I set up and take the dressings down, but my surgeons do the actual pulling.Yeah, sounds the same as on our unit. I had one patient who was still getting paced & a discharge one day..that was not a fun day!
Does the surgeon actually come on the unit & pulls the drains himself?! Do you not do that?!
- 2Jun 14, '13 by BiffbradfordTransfer - admit. Working at the factory!
Back about 10 years ago, we had a separate 8 bed unit that was designed just for that. Only cases that were expected to do well and would transfer to the floor POD#1 would be assigned there. They were typically extubated quickly, dragged out of bed numerous times, then in the morning around 0500 we'd get orders to D/C swan, d/c chest tubes, maybe some blood along with lasix. Days would come in, finish up whatever orders we didn't get to on NOCs, transfer them out before 0900, and admit a new set of fresh hearts. There were only curtains separating the beds so in a way it worked out well. Each patient heard that the others were doing, so they knew what was about to happen. We'd work as a team and go right down the line. Midnoc and 0400: 1,2,3,4 up in the chair, then 30 mins later 1,2,3,4 back to bed. 0600 we're all pulling swans and chest tubes together. It was actually fun. None of this 'do I have to get up NOW?' stuff. NO! Everybody is getting up now, so let's go! Ahhh, those were the days. Now, those cases are pretty much handled in the cath lab and they don't even do surgery on them. Pitty. (also, now you can see the beauty of a stable CVVH or IABP patient!)Last edit by Biffbradford on Jun 14, '13