Delayed Sternal Closure?
- 0Does anyone have sort of experience with delayed closure following open chest procedures? I just have a few questions. Is the retractor from surgery still left in place? Is there some sort of chest binder used? Can I get some knowledge?
- 2Feb 24, '13 by Rose_Queen, MSN, RN GuideNot sure how other facilities do it, but we most certainly do not leave the retractor in there (we need it for the next day, plus it would equate to a wrong count- sentinel event report required). What we do is protect the edges of the incision (material varies from surgeon to surgeon but must be x-ray detectable), splint the sternum open, and cover it with x-ray detectable towels and a sterile, impervious adhesive drape that fully seals the incision from the outside world. Between the chest tubes to suction and the full seal, it's almost like a VAC dressing without actually being a VAC dressing. Signs are posted above the bed that state no compressions. We only do this for patients who become hemodynamically unstable when we try to close their chest and we can't in any way get them stabilized without reopening (mostly our trauma patients).
- 0Feb 24, '13 by ndsrnQuote from TX911That last patient I had with delayed sternal closing did not have the retractor in place or a binder. There was an ioban dressing with another dry dressing on top of that. The patient ended up tamponading, but was asymptomatic because the ioban had some give to it. The dressing started expanding a little and the patient was brought back to the OR to fix the bleed. The patient ended up with a pressure ulcer because turning was an issue, so a specialty bed is something to consider. Other than the bleed, my experience was pretty uneventful and the management was very similar to a normal post open heart. sorry I do not have much else to offer.Does anyone have sort of experience with delayed closure following open chest procedures? I just have a few questions. Is the retractor from surgery still left in place? Is there some sort of chest binder used? Can I get some knowledge?
- 0Adhesive drape? Is there a (manufacturer) name for these or are they just something that's put together? Someone has mentioned something called an I-Band? Have you ever heard of this? Thanks for the response
edit* I bet the "I-Band" is actually the ioban that ndsrn just mentioned. Thanks!
- 0This is common in the PICU esp. with hypoplasic left heart initial Norwood procedure. The only thing covering the heart is an occlusive transparent dressing. It FREAKS the parents out, so we cover it with a cloth diaper while they are at bedside. It is not uncommon to have a chest left open for 2-4 days.
We also sometimes have open chests on our ECMO kids who are centrally cannulated.
- 0Quote from TX911Just another reason why PICU rocks! (PLUS, you need a background in plumbing to figure out the many hundreds of ways a baby can be born with a jacked up heart!)Lol, I can definitely see how walking in and seeing your kid's chest open after surgery might be a little off-putting. Also, that Norwood procedure is pretty wild. Well, all three (Glenn, Fontan) are actually, my goodness....
- 0Quote from marycarneyYeah, I got to write a paper on ToF which I know is one of the simpler "plumbing issues" that a kid can have. I wish I had the patience for children, it all seems pretty interestingPLUS, you need a background in plumbing to figure out the many hundreds of ways a baby can be born with a jacked up heart!)
- 0Feb 24, '13 by umcRNI also work in a peds cardiac ICU so we have many open chests, and usually if the kids code after surgery (and their chest is closed) the surgeons will come open it right at the bedside to put them on ecmo.
As far as the "no compressions" rule that someone mentioned previously we do not have that...well we don't do compressions per say but cardiac massage. I can distinctly remember asking when I was on orientation what to do if my open chest patient coded and my instructor told us "you do compressions, preferably with gloves!". In other words some circulation is better than no circulation, you better believe it though that the nurse is hitting that code button for a doc because most of us would rather a doc do cardiac massage, and of course we're all holding our breath for the surgeons to get there because really, that's their territory!