Originally Posted by Bruno Matos

You always have a Swan Ganz catheter on your CABG patients ?

Hi. I have worked at two different hospitals in the open heart unit and the patients always come out with Swan Gantz catheters. It is the only way we know for sure how the heart is functioning (cardiac outputs, SVR, PVR, etc.) following surgery.

Does anyone here work in the CCU? I posted internally at my hospital for a position in the CCU because I want off night shifts. Can someone give me a run down on what goes on in the CCU and whether or not you feel I can make the transition from the open heart unit?

Originally Posted by Bruno Matos

You always have a Swan Ganz catheter on your CABG patients ?

We still use swans on 99.9 % of our cabg patients...the only time we don't is if it is a young person (20's) with say a VSD or ASD repair...
We usually pull our swans out the next day or two days out if extubated but somewhat rocky or still requiring lots of pressors....If the patient remains intubated we usually leave it in for a couple of days (unless the patient is not on any pressors)...

Originally Posted by Bruno Matos

You always have a Swan Ganz catheter on your CABG patients ?

Our docs may end up swanning a cabg if there are issues or problems (or on epi and nipride for CO), but no, they do not routinely swan cabg's.

Sg - Cabg

In our cabg's we just have a left atrium cath and a CVP cath, that we pull out in the morning after surgery.
Almost of our patients stay at ICU just for 20 - 24 hours .
We only put SG if we have a non linear pos op like dependency of vasoactive drugs, low urinary output, prolonged mechanical ventilation...

With some MD's we always have a swan. With some of the other MD's we almost never do unless they are really really sick. This has just been a recent thing with them not putting in swans in some pts & we don't like it (no SvO2, CO, CI, etc.). It's good to know other places don't use them sometimes!

Re: post-op cabg care

First we give 2 Liters of NS (1 liter bolus at a time)
Then we give 2 albumins
Then we call the MD for more orders

Remember, it is important to worry about fluid overload...but we can always give them a diuretic!

Re: post-op cabg care

The thread you're replying to is several years old; remember practices may have changed by now.

Re: post-op cabg care

For the most part fluids are titrated to hemodynamic parameters. If the patients SVR is elevated and CI<2.1 then fluids are indicated- esp if PAP/CVP are lower than the patients pre-op values. Most of our patients end up 1.5-2.5L positive in the first 24hrs and are often 3+L positive by the time they transfer to the floor. Post op patients have poor protein stores and diminished vascular tone. They end up third spacing a lot of fluid. Even though they are "fliuid overloaded" by I&O if you don't fill the vascular space you are going to have a patient in renal failure -either from excessive dehydration in the vascular space, hemodynamic instability or excessive use of pressors to maintain VS. By the way, there have been studies that suggest excessive fluids post op CABG results in in increased rate of atrial ectopy. We usualy feel lucky to keep a patient <3L+ in the post-op period. As a rule we try to give colloid first followed by crystalliod. After 2-3 L of fluid load it us best to check an H&H in case you are due for cells.

Re: post-op cabg care

We used to routinely give our post CABG pts dex saline 1ml/kg/hr, although most surgeons do not want this.
Typically our patients end up being 2lts positive at end of day of surgery.
Usually the patient will recieve filling in the form of colloid inrelation to their heamodynamic status, we would give pts with a moderate- poor LV less filling and in those cases may be more likely to start inotropes rather than risk over filling them.
If they have a lot of bleeding they will recieve the appropriate blood products.
Typically we aim for pt's to be extubated and onto oral fluids within 6 hours.
In my experience most cardiac pt's are on diuetics anyway and have pre-existing problems with this. If the U/O tails off, or is mediocre they will get lasix or if found to be very positive next day will usually get 20mg IV to help off load them.
Hope that helps

Re: post-op cabg care

I think it depends on the program and how sick the patients are pre-op, nontheless post-op. The hospital I work at does 50 cases weekly...and we recover some sick patients. We use D5 1/3 NS for maintenance. We use 2-3 L of NS or LR for fluid resusciation. Colloids are used next up to 500cc with/without Calcium.
We use only Diprivan 30-50mcg/kg/min for the first day or two...then change to Fentanyl/Versed for sedation. Very typical to have one or two pressors, ie; Norepi and Dopa. 80% of the time we start an insulin gtt.A t least one patient a week will come out open chest and they have 1-2 LA lines and a CCO swan. We have all standing orders for vasoactive drugs. Very rare we call the attendings unless the patient needs to go back to the OR.