CVICU settling post ops

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    I am new to the CVICU. I have settled two post off cardiac surgical patients.once they are settled in I feel good about monitoring etc but the chaos when they first arrive is something that i dont feel fully comfortable with. With so many healthcare professionals rushing in with the patient and focusing on their task at and (rt hooking up the vent, lvad coordinator hooking them up to the council) I was wondering if any experienced CVICU nurses could give me some information about what their priorities are and what the first things they do when their new surgical patient arrives. Your ideas will be much appreciated!
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    Got a good rhythm? Got a good blood pressure? Ventilating okay? Chest tubes to suction and draining? Wrist restraints on properly? Howz body temp? Need to warm 'em up? We usually send STAT labs right then. Organize lines (takes time!), make sure all at correct rates. Get pain under control, then call family in for first visit. Most of us have a plasmanate or two at the ready, some morphine or fentanyl ready to go. It's a whirl-wind no doubt about it.
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    I’m a new grad that just got hired into a CTICU. My only experience with taking post-op heart patients is from my senior practicum. Hopefully I didn’t forget anything, but I will write out how we handle our post-op patient.

    First and foremost, make sure all consent form is signed for plan surgeries. Gather all necessary pre/post op forms and follow the protocols. Depending on your facility, the patient would need to take a chlorhexidine bath twice before surgery, paying close attention the chest region. Provide any cardiac education (notes, videos, etc). OR will come and get the patient. This is the time to prep your room with post-op supplies for when your patient returns.

    The OR will call multiple times. The first call is the “off-pump” call if placed on the pump. After the “off-pump” call, 30min-1hr later they will call to give report. They will also provide us with vent settings. After receiving the vent settings, we call RT to relay the vent settings. After we get report, it will be another 30min-1hr later before the patient arrives. Once the patient is ready to return to us, OR will call and say they are “rolling.” Once we receive the rolling call, alert your other staff and RT that the patient is on their way.

    This is where the “controlled chaos” comes in The patient is rolled back into the room on the monitor with the OR nurses and the Anesthesiologist or CRNA. At this time, there are critical things that must occur first. The patient needs to be hooked up to the monitor (VSS), verify all drips and vent settings (make sure the drip and vent settings reported to you during report is the same setting your patient arrives to you with. If not, ask why they increase or decrease drip or vent settings), RT needs to connect patient to vent with resp. stable, need to know amount of OR fluids received/loss (NS, blood loss, blood products given, etc), and temperature of patient. Anest/CRNA need to know what the patient’s temp is. Anything less than 97 degrees, the patient’s body needs to be warm with blankets and such. Label drips and make sure all drips running together are compatible. Remember that your co-workers will be in the room to help you admit. You co-workers at the same time will write down on the board the patient’s TOA, Urine output, chest tube output, temp, and blood sugar and labs drawn from the arterial line once set up and zeroed. Insulin gtt may remain the same or increase/decrease based on result. Labs should be sent down immediately.

    Usually, OR places an OG tube and we verify placement using a toomey syringe. Once placement is verified, we can hook up to LIS. Tape OG to ETT securely leaving a tab. KUB is order for long term placements. Our patients are usually extubated within 6 hours. Uncover all Chest tubes because they need to be visible during the post-operatively. Chest tubs to -20 suction. Secure all chest tube connections with tape a leaving a tab. Prime your vamp if you haven’t already and zero out all your lines. STAT EKG ordered and performed.

    Perform your assessment. Neuro checks q1 Follow post-op protocol. Check labs asap. Follow ERP. Titrate drips to maintain SBP >90(to prevent vein from collapsing) and <120 (to prevent bleeding from graft site). Keep the patient on their back for 4-5 hours. RT will be in periodically to wean patient and check blood gases. Monitor for pain. Assess for responsiveness and ability to follow commands. With that establish, the extubation with RT may occur within that hour or next. Allow family to come in and answer questions. Hourly glucose check. Blah, blah, blah. I believe you wrote that you are comfortable from this point forward. Let me know if you have any questions. I hope this cover enough. It does take practice and you will get it in no time


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