- 1Dec 25, '10 by Rise AgainstI wanted to hear some of the nursing care that experienced nurses can provide for the care of a CABG patient. Not everything can be learned in books and some information is passed on from nurse to nurse. Can you give maybe horror stories of CABG's gone wrong or helpful tips you have picked up while caring for open heart patients.
Ex. Usually when the chest tube dressings become saturated around the chest tube this can sometimes mean that the chest tube is clotted and needs to be milked or suctioned. But only the mid chest tube can be suctioned. Other times this can just mean the puncture site of the chest tube is oozing. Important to monitor drainage of each chest tube every hour to make sure something is coming out.
Horror story- all open heart surgery patients on withdrawal from alcohol. They can either be crazy or extremely lethargic. Had a pt that had all the vitals normal on the monitor but was extremely lethargic post extubation, diaphoretic and would not speak or follow commands. Extreme change in mentation. Kept thinking it was the anesthesia and maybe he was extubated too early. Gave some narcan and he would wake up instantly and then 5 min later drift back to the way he was. Gave narcan twice that night. Also thought he may have stroked but ct was negative. In the am after worrying all night the surgeon believed it to be alcohol withdrawal. never have seen alcohol withdrawal like that.
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- 0Dec 25, '10 by ocean wavesHello. A new development (to me) in the nursing care of open heart surgery patients is the pre-op and post-op finger sticks with assessment of blood sugar levels in all patients, not just diabetics. A fellow nurse told me nurses are doing these blood sugar checks at the hospital in Michigan where he personally had a cardiac bypass surgery--he said he was glad of this assessment plan because, even though he was not pre-op diabetic, the nurses detected a high abnormal blood sugar level post-op and quickly got a doctor's order for oral diabetic meds for him. Best wishes!
- 4Dec 25, '10 by SHURNall of our open hearts come out on an insulin gtt. Non-diabetics have it turned off and turned to Q4hr accuchecks morning of POD1 while diabetics will stay on the gtt for 24 hrs. We monitor glucose very carefully - any glucose over 200 at 0600 POD1 or POD2 is considered a "fall out" for our post op patients.
- 1Dec 25, '10 by LuxCalidaNPDefinitely review your vaso-active drips if they come back with epi, norepi, etc running, insulin gtt as well, unit policy for propofol/sedation titration, and I would also recommend talking with PT (if you have them) about why sternotomy patients have limits on arm movement: fascinating stuff. If your facility uses them, review IA balloon pumps and pacing wires.
I only had 2 patients that went horribly wrong, and it was usually due to small bleeders that caused some serious pericardial hematomas and tamponade.
Hope this helps!
- 2Dec 25, '10 by NurseStephRNQuote from ddml06on my open heart unit we keep everyone (diabetic or not) on an insulin gtt through POD 2 then we start them on a sliding scale. We've used to d/c the gtt on POD 1, but we had a few fallouts, so the surgeons changed the protocol and now we keep it through an extra night. Q4 hrs if they are above 120, ac/hs if they are below. many non-diabetics get a little concerned and ask if they are diabetic now (and some patients find out they are diabetic as a result of preop labs, etc).all of our open hearts come out on an insulin gtt. Non-diabetics have it turned off and turned to Q4hr accuchecks morning of POD1 while diabetics will stay on the gtt for 24 hrs. We monitor glucose very carefully - any glucose over 200 at 0600 POD1 or POD2 is considered a "fall out" for our post op patients.
- 0Dec 26, '10 by MunoRNETOH withdrawal can be difficult to detect at first in OHS patients due to "pump head", which is similar to initial W/D symptoms. One of our PA's told me once that the mortality rate for post OHS patients who go into significant withdrawal is around 50%, so it's important to catch and treat early if that's the case.
We keep our OHS patients on intensive BG control (BG goal of 80-110) for 24 hours and then a goal of 80-150 for the next day 48 hours, so they are on an insulin gtt until POD 3 regardless of DM hx or not. We used to use the tight control target for all ICU patients, but now we know that tight control is only beneficial to patients who have had thoracic surgery, and that it actually causes more harm than good in all other patients.
- 0Dec 26, '10 by JulieCVICURNETOH withdrawal can be difficult to detect at first in OHS patients due to "pump head", which is similar to initial W/D symptoms.