My moms CABG

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    Okay all you brilliant CCU RN's.. I need your wonderful words of wisdom. My mom who is 59 y/o just had an angiogram and was told she needs to have a triple bypass. Multiple 90% blockages in the RCA, 80% to the LAD and 60-70% circumflex. Besides being dyspneic with exertion, she has been asymptomatic. Her Parents both died of MI's in their 40's. She recently quit smoking, she is diabetic, overweight and has HTN. EF is 40%, kidney function is good. We meet with the surgeon next week and hope to have a CABG scheduled soon after. I am terrified, but am trying to put on a brave face for her. I want to be as prepared as possible. What questions do I need to ask this surgeon? What can we expect post op and what possible complications to we need to be aware of? I welcome and and all advice you have. I am a med/surg RN, but right now I am just a daughter who is not ready to lose her mom. Please HELP.
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    She has significant risk factors, but all things considered she should still be able to get through with a strong recovery. The general mortality for isolated CABG is ~1-3%, and her risk profile is typical to moderately elevated.

    Major worries after CABG are death, stroke, infection and renal failure. Normal kidneys are a help. Extent of atherosclerosis and technical factors influence stroke risk. Diabetes and obesity are risk factors for sternal wound infection. You can ask what their mortality rates are, this data is mandatory for all CTS practices.
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    Here in my Australian public hospital, we do 4 CABG per day, 5 days a week. They do well. Some bleed and go back to theatre, but after that they're OK. Some come back on aortic balloon pumps, but after a few days they are off them.

    There are a lot of things they can do for cardiac patients if they run into trouble. In intensive care, we deeply sedate them for a few days, support all major organs and then move forward after that.

    The worst ones are the patients that are sick before theatre. Then you are fighting a compromised patient before the really big stressor of surgery.

    CABG are a hospital's "bread-and-butter". We do a lot of them everyday, and they all go well. They really do! Be brave for your mum.
    resumecpr likes this.
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    As a nurse, you understand this, but just to reinforce - complications do happen during recovery, so don't be surprised if something does comes up. Just take the whole process one day at a time and I'm sure she'll do fine. Good luck!
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    Quote from flo136
    There are a lot of things they can do for cardiac patients if they run into trouble. In intensive care, we deeply sedate them for a few days, support all major organs and then move forward after that.
    Your hospital should look into fast track extubation. Negative outcomes with prolonged ventilation and sedation. ~75% of my pts are extubated within 6 hrs.
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    Extubate when they're ready, whenever that is ... 2 hours or 2 weeks.
    mmutk likes this.
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    Quote from Biffbradford
    Extubate when they're ready, whenever that is ... 2 hours or 2 weeks.
    That's my point.
    Most are ready on POD#0.
    Perfunctory "rest time" is a thing of the past and has proven worse outcomes. All stable pts with adequate gas exchange should get a breathing trial on the first day.
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    As another poster mentioned.....she does have some significant risk factors that could contribute to post-op complications but overall it's nothing that everybody else doesn't generally have. Keep her away from those ciggies before surgery and that will help her with being mechanically ventilated and extubation.

    The questions you asked us are all questions that should be asked of the CV Surgeon. How long does he anticipate her CVICU stay? How long on step-down? What does he do for pain control?

    You can expect her to likely be on an insulin gtt in the immediate post-op period. You might also run into issues with a-fib/flutter or ventricular arrhythmias........both are "Normal" and "common" in the post-CV surgical patient.

    Our goal is to extubate our CABGs and valves within 4 hours, up to the chair at 6am on POD#1, and pull the swan once any inotropes, pressors, or vasodilators are off for 2ish hours.
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    Thank you all so much. I truly apprieciate all the great advice. We are very anxious to meet with the surgeon next week!
  13. 0
    Quote from butterflie28
    Okay all you brilliant CCU RN's.. I need your wonderful words of wisdom. My mom who is 59 y/o just had an angiogram and was told she needs to have a triple bypass. Multiple 90% blockages in the RCA, 80% to the LAD and 60-70% circumflex. Besides being dyspneic with exertion, she has been asymptomatic. Her Parents both died of MI's in their 40's. She recently quit smoking, she is diabetic, overweight and has HTN. EF is 40%, kidney function is good. We meet with the surgeon next week and hope to have a CABG scheduled soon after. I am terrified, but am trying to put on a brave face for her. I want to be as prepared as possible. What questions do I need to ask this surgeon? What can we expect post op and what possible complications to we need to be aware of? I welcome and and all advice you have. I am a med/surg RN, but right now I am just a daughter who is not ready to lose her mom. Please HELP.
    How long did she smoke for before she quit? Any ETOH use?
    These seem to be tied to the most complications in our unit.


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