What's CVICU like, really?

  1. Hi, cardiac nurses!

    I am looking to learn new things and expand my skills as a RN, so I have two CVICU interviews at large teaching hospitals coming up within the next nine days! I am excited about these opportunities, but I am also a little apprehensive about this patient population. Both of these units specify that their primary patient population is open hearts.

    I have some questions. As a current MICU RN, my absolute favorite patients are sedated, ventilated, and unstable, and I am even happier when they stay that way the entire three nights I work with them. I know hearts are that way at first, but I also know that the recommendation is to pull the ETT as soon as possible and even have the patients up and walking the next day if able, so it doesn't seem like they stay critically unstable for long, at least when things go as planned.

    How sick is the average patient where you work, and for how long do they stay that sick? What is the patient turnover like - are you more likely to have the same patient three days in a row, or is it more common to send them on their way to tele/stepdown quickly? How long does the average patient stay on the vent? Is there a pretty even mix of scheduled and emergent procedures? What do you see the most of, anyway? Valve replacement? CABG? Cath that turned into a CABG? Aortic aneurysms? Something else?

    I know all of this is very subjective and experiences vary a lot from one shift to the next, but I am looking for what you experience most often as I am trying to figure out if I am really going to like working in the CVICU, and also what I should familiarize myself with before the interviews. Thanks so much for your help.
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  2. 12 Comments

  3. by   Biffbradford
    Every case is different. The easy cheesy patients are becoming a thing of the past because of advances in heart cath procedures. They can easily stent patients that used to require surgery. So, it's less likely you'll get the 44 yo with one graft who get's extubated in 30 minutes and is up in a chair in 2 hours. We used to have a whole unit devoted to the quick wean and extubate patients. They were all transferred to the floor by the next day, and a whole new set would be admitted. Great factory work!

    More likely today, it's someone who's 58, diabetic, smoker, who was on Plavix pre-op and bleeds like a _______ for 6 hours post op and has uncontrollable pain issues. Then you get yelled at for not getting him extubated within 6 hours. Never mind the bleeding and his PCO2 that was through the roof. Not because he smoked for 30 years, naturally, but because YOU kept him too sedated (to keep him from ripping out all his lines).

    Then there's always the classic cardiac tamponade that develops despite your best efforts, or their blood pressure gets TOO high and they blow a clip. That's when you've got someone straddling the patient doing CPR as they're whisked back into the O.R. "DOOR! DUCK! "

    Then there's the LONG termers. 1 month - 6 months - 12 months. Trached, infected. You get 'em all tuned up, send them to LTAC and they either bounce right back in a week, or they die.

    The types of cases can vary widely depending on how big of a program your place has. Could be mostly CABGs or everything under the sun including heart and/or lung transplants, VADs and Total Artificial Hearts.

    Oh, it's a gas man. Every day is a challenge from one thing or another. LOL

    It ain't for everybody, or sometimes good for a while then it wears on 'ya.

    Good luck on the interviews!
    Last edit by Biffbradford on Jul 20, '14
  4. by   EricaLee12
    Hi there!

    I agree with you. My favorites are sedated with paralytics, lemme tell ya.

    But when I have a patient that I admit, they are (for the most part) extubated within 5-6 hours post-op, then they are Swanned until the next day (about half the time), then we get them up. Our patient population can vary from that to patients on ECMO that are not moving very much at all for a lot of their stay. It all depends on how stable or unstable they are.

    Usually my patients have the same type of history: type II diabetics with CAD, CHF, sedentary, overweight, smokers, sometimes illegal drug users (those are our vascular messes). They can be easy or hard to get up, as all attitudes vary. I think it really just depends on what type of a unit you are planning on working on, and how acute they can be. My hospital is a Level One trauma center and a referral center that does transplants and LVADs, so we get more sick patients, when compared to the first hospital that I worked at, which was commonly valves and vessels.
  5. by   calivianya
    Thanks for the responses, guys! Feel free to keep 'em coming!

    One of the places I'm interviewing states they are one of the largest heart transplant programs in the country on their website, and the other claims that they have advanced specialty certification in VADs and transplant. Apparently, there are only three facilities in the state that offer ECMO and they are two of them, so... they sound pretty comparable on the surface. I am getting more excited by the minute, for sure!
  6. by   Biffbradford
    VADs and transplants are amazing, no doubt. The thing that bothered me is that we (read: "I" being on nights), never found out how the successful one's ever did. "Hows Joe Schmo doing." - "Oh fine". HIPPA you know. So, we only saw the bounce backs. The transplant rejections, the VADs making grinding noises. The VADs that stroked. Definitely a feeling of accomplishment to work at a level of nursing like that, however.
  7. by   aprilkimberly
    Yes, the goal is to get the patient extubated as soon as possible if stable. Most people like taking care of immediate post-op patients because they are 1:1 and you stay pretty busy. I think there is a mix of stable and unstable situations. Some patients might come out on every drip under the sun, and some only on insulin and some fluids. Lines are usually taken out the next day and transferred later post op day 1 or 2 if stable. The morning of post op day 1 is usually pretty busy with getting the patient up to the chair for every meal and walks 4x/day. We have our share of unstable hearts as well, even had a couple come back with open chests. Obviously everyone likes an intubated/sedated patient better, but I also like when my patients progress like they should. It means we have awesome surgeons and great post-op care. It sucks when everyone works so hard for a week straight trying to keep a patient alive and then the family decides to withdrawal. I'd much more prefer them progress, even if they do use their call light continuously. Most of our patients are CABG and valves or a combination of the two. We also do TAVRs and unstable cardiac stented patients. We take care of a wide range of vascular patients as well with all sorts of post-bypassed vessels, ELG's, CEAs, AAAs. We also take care of post code/induced hypothermia patients which are 1:1 while cooling and re-warming. I'd say most of our surgeries are scheduled, we have the occasional emergent heart come through.

    Good luck! Hope you like it.
  8. by   calivianya
    So, one thing just occurred to me - it is probably common sense, but I can be a moron on occasion. I like working nights, and I had a great interview for nights at the first place I am I interviewing yesterday. However, if most CVICU surgeries are elective, they are probably going to happen in the morning, right? By the time I get there, most of them are going to be already stable and extubated. So, if I really want the full CVICU experience, I am going to have to take a pay cut, ruin my sleep schedule, and work days, right? I hate day shift so much. Nights fit so much better with my body's natural rhythm and the pay difference is substantial, but I don't want to potentially make this transition to a unit and minimize the experience I will get because the unstable patients are on the other shift. Yikes.
  9. by   aprilkimberly
    Not necessarily. The last surgery of the day might come out the the beginning of your shift or later. Also, earlier, less stable surgeries might not be ready to extubate. If you do work days, you will land more fresh hearts but we have our share of middle of the night STEMIS and an emergent here and there. Day shift does a lot of transferring of patients to telemetry and discharging the stable vascular surgeries.
  10. by   calivianya
    That is true. I guess I don't need to stress before I even get an offer, too. Thanks for the reassurance.
  11. by   Lovelymo79
    Quote from calivianya
    So, one thing just occurred to me - it is probably common sense, but I can be a moron on occasion. I like working nights, and I had a great interview for nights at the first place I am I interviewing yesterday. However, if most CVICU surgeries are elective, they are probably going to happen in the morning, right? By the time I get there, most of them are going to be already stable and extubated. So, if I really want the full CVICU experience, I am going to have to take a pay cut, ruin my sleep schedule, and work days, right? I hate day shift so much. Nights fit so much better with my body's natural rhythm and the pay difference is substantial, but I don't want to potentially make this transition to a unit and minimize the experience I will get because the unstable patients are on the other shift. Yikes.
    Definitely not true. I've been a CVICU nurse only on nights for the past 3 years. My unit does CABGs, AVRs, TAVRs, Aortic dissections, heart and lung tranplants, as well as different types of VADS and ECMO as well. We see a lot of action on nights. A lot of our cases come out between 1 and 4pm so we are hitting those first crucial 6-12 hours on nights. Also, we've had many cases that have run 12+ hours due to crazy sick patients (my surgeons like to operate on cases that other hospitals have said no to) so they may not be coming out until 9, 10pm or even 1, 2am. And remember, all are not elective. You could have the random one on the floor that decides to code or have a MI in the middle of the afternoon and is going into the OR as you are coming in to night shift. We have many cases that are urgent or emergent.

    I love CVICU and I can't imagine working anywhere else! Trust me, you will get great experience at night!
  12. by   cinlou
    I have worked in all kinds of ICU's, after about 2 years I would get board with the tedious same ole same ole. You have to Love what you do. It wasn't that I didn't have more to learn but the routine would get to me. No matter where you work it can get this way, but if you truly Love what you do you will flourish. I have to be on the move, and my favorite ICU job was when I was per Diem ICU and floated to them all in a Level I University trauma center, then I got to keep my hands involved in all types of patients.
  13. by   StayLost
    Quote from calivianya
    ...I can be a moron on occasion...most [ patients ] are going to be already stable and extubated. So, if I really want the full CVICU experience, I am going to have to take a pay cut, ruin my sleep schedule, and work days, right ?

    CT patients can go to sh** on you faster than any patient - extubated and sitting up one 1 minute & bleeding with a MAP in the 40's the next. I had a patient completely exsanguinate in less than 10 second through the chest tubes, with blood overflowing all over the floor. Some go back to the OR, but usually there is no time & we crack open chests at the bedside. Place bedside ECMO or IABP.

    The cases that come out of the OR at night shift are usually the sickest. The later cases the non-elective, emergent cases. For us, a typical 3AM admission is a train wreck: bleeding with REALLY long bypass times, vasodiolated, high-dose pressers/inatropes, multiple devices (i.e. BiVAD, ECMO), Nitric Oxide, open chest, and now.. not making any urine.
  14. by   calivianya
    Quote from StayLost
    CT patients can go to sh** on you faster than any patient - extubated and sitting up one 1 minute & bleeding with a MAP in the 40's the next. I had a patient completely exsanguinate in less than 10 second through the chest tubes, with blood overflowing all over the floor. Some go back to the OR, but usually there is no time & we crack open chests at the bedside. Place bedside ECMO or IABP.

    The cases that come out of the OR at night shift are usually the sickest. The later cases the non-elective, emergent cases. For us, a typical 3AM admission is a train wreck: bleeding with REALLY long bypass times, vasodiolated, high-dose pressers/inatropes, multiple devices (i.e. BiVAD, ECMO), Nitric Oxide, open chest, and now.. not making any urine.
    That is an incredibly exciting thought! My second interview is today - I needed some fresh enthusiasm. Thanks!

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