Re: Chest compressions s/p open heart

This is a "dumb" question: What would the surgeon do if the pt was coding and they had to reopen at the bedside? Meaning, what interventions are done after the chest is open and what is the rationale? I'm just starting in CCU and trying to learn about any and all possible very bad scenarios to better prepare myself

Re: Chest compressions s/p open heart

Originally Posted by carebearRN08

This is a "dumb" question: What would the surgeon do if the pt was coding and they had to reopen at the bedside? Meaning, what interventions are done after the chest is open and what is the rationale? I'm just starting in CCU and trying to learn about any and all possible very bad scenarios to better prepare myself

of course that is not a dumb question! Never be afraid to ask a question!! People who don't ask questions are the ones who end up killing someone! Well, if he is opening the chest for CPR, he would do an internal cardiac masssage (he would actually manually squeeze the heart) or use the internal cardiac defibrilator. This should be found in a sterile package on your crash cart. I have only seen this done on patients who come to the floor with an open chest...or partially closed.

If it is a bleed, and there is no time to get to the OR, or cardiac tamponde, a nurse would squirt betadine on the chest. We have a chest set on our crash cart along with sterile wire cutters. Make sure you know where it is. All of this should be available sterile on your unit. Sterile towels and a half sheet would drape off the pt if there is time, the Dr will need a sterile gown and gloves, a hat and mask. He will remove the staples with a sterile hemostat, unless you have a staple removal kit available. Or sutures, he will cut. He will need wire cutters to cut the sternal wires. Sterile suchion and Yaunker tip. He will need prayers. Hope this helps!!

Re: Chest compressions s/p open heart

Originally Posted by DNPstudent-Michigan

of course that is not a dumb question! Never be afraid to ask a question!! People who don't ask questions are the ones who end up killing someone! Well, if he is opening the chest for CPR, he would do an internal cardiac masssage (he would actually manually squeeze the heart) or use the internal cardiac defibrilator. This should be found in a sterile package on your crash cart. I have only seen this done on patients who come to the floor with an open chest...or partially closed.

If it is a bleed, and there is no time to get to the OR, or cardiac tamponde, a nurse would squirt betadine on the chest. We have a chest set on our crash cart along with sterile wire cutters. Make sure you know where it is. All of this should be available sterile on your unit. Sterile towels and a half sheet would drape off the pt if there is time, the Dr will need a sterile gown and gloves, a hat and mask. He will remove the staples with a sterile hemostat, unless you have a staple removal kit available. Or sutures, he will cut. He will need wire cutters to cut the sternal wires. Sterile suchion and Yaunker tip. He will need prayers. Hope this helps!!

Sorry, should have said, "he or she". My bad. I was picturing our CT surgeons, and they are all males.

Re: Chest compressions s/p open heart

I did compressions recently on a fresh post-op, about 1 hour out actually. Yes, you just start pumping away like normal. We got him back and 3 days later he was on the floor. Nice....so glad to hear when things go well after a lot of hard work.

Our surgeons/PAs will open at the bedside for bleeding, tamponade, things like that. No big deal, under a CONTROLLED environment.....in a code situation, that's a whole 'nother story!! Gets that heart rate up for sure!

Re: Chest compressions s/p open heart

every time i've done compressions on a sternotomy, old or new, the wires have broken.


With a fresh sternotomy if a surgeons available often they break open the chest and do open heart massage if its a refractory dysrrythmia.

Re: Chest compressions s/p open heart

On my unit we have a "open chest compression board": a taped-up padded board to use on post-op CABG patients to compress the sternum evenly so the sternal wires don't break and pierce the patient. Kind of like the bedpan theory, I guess.

Never used it, but looks like it would be hard to do CPR with.

Re: Chest compressions s/p open heart

Originally Posted by DNPstudent-Michigan

Believe it or not though, I was taught that if you have a fresh pump, and I mean very fresh, you should use a Bed Pan (clean of course) to do compressions. The reason for this is for the nurse doing the compressions...the sternal wires could break and pierce the person doing compressions....I am certainly not advocating this as the proper technique, I'm just saying...But I will say that I've never actually seen it done.

We had a pt, 10 days or so post CABG, sent to the ONC floor for a previously dx cancer, he coded and the nurse doing the compressions recieved a lac from the sternal wires.