post-op cabg care

[jetty]

What type of care do your fresh cabg patient require that is routine. I am interested in seeing how much FLUID other hospitals give their patients related to starting of IV gtts. I think we fluid overload a lot of our patients post-op then have to give lasix/bumex pod #1. Typically Our patients receive 2 to 3 liters( sometimes more) in the first 6-8 hrs postop and I feel this causes an increased # of pulmonary complications. What do your facilities do? :rotfl:

[criticalHP, MSN, RN]

We use the hemodynamics as a guide to volume replacement, taking into consideration the pt's EF from preop ECHO. As a general rule though valves require much more fluid than CABG-in that case we use 250ml hespan once, then albumisol thereafter. Dumping LR or NS into a pt just causes third spacing, as it leaves the vascular system very quickly after administration whereas albumisol has the pull of the larger molecule. We did try to run the CABG a little on the dry side, by the way, ususally to a PAD of 12 (normal for average, but then we don't take care of the normal now do we?) Generally, our docs will order Lasix 10mg IV as a standard POD1 routine unless contraindicated. About 95% CVS pts are out of CVICU by 1100on POD1 with our routine.