ratio for fresh CABG pts

  1. I have a quick question. I recently started working in a busy 25 bed SICU that recovers aprox 1000 CABG's a year. I have previously worked in a CCU where a CABG was 1:1 for the first 6 hours, however at my new job a fresh CABG is frequently my second,and in yesterdays case, my third.... Is this ridiculous to anyone else? These aren't "easy" hearts, pts all come out on epi, neo, nitro, dobutrex, require lyte and blood replacement frequently. I'm supposed to manage this pt, two others (one on vent with drips) and extubate my heart in 6 hours? Some input would be appreciated here guys, tell me if I just need to suck it up and become super nurse. Thanks
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  2. 12 Comments

  3. by   meandragonbrett
    A snowball has a better chance in Hell than me taking a 3rd patient with a fresh CABG. Anything other than a patient with Tele Orders just waiting on a bed assignment isn't going to happen with a CABG or Valve.
  4. by   Biffbradford
    That's ridiculous and unsafe, no question about it.
  5. by   Always_Learning
    At our facility, fresh CABGs are actually 2:1 (2 RNs to one patient).
  6. by   Sun0408
    I would run.. We have a separate CVICU for fresh hearts, caths etc.. and a SICU for fresh surgeries/traumas. At my facility fresh hearts are 1:1 period. Our SI pts are 2:1 max unless they are step down/floor pts waiting on a bed. Sounds very unsafe for you, the pt and the hospital.
  7. by   aCRNAhopeful
    Stupid and ridiculous. Needs to be 1 on 1 for at least 4-6 hrs
  8. by   Biffbradford
    My old CVICU has recently been admitting fresh hearts paired with LVADs. Talk about a recipe for disaster.
  9. by   esie
    Our fresh hearts, whether a simple CABG or valve replacement, or more complicated by IABP or nitro, are always 1:1.
  10. by   NickiLaughs
    Are these surgeons aware? I think they would even have a fit about their patients having this load. It's 1:1 the first 8 hours the two hospitals I worked at
  11. by   scrapqueen
    In our SICU, our fresh CABGs and valves are 1:1 for at least the first 12 hours. Doesn't matter if they are on pressors or not. Usually, we also get a few hours to set up the room too. Sometimes we will have a floor patient awaiting a bed, or a low acuity patient while we set up, but when the CABG arrives, he/she is always a 1:1, no exceptions. Our policy states that cardiac surgery patients can be 1:1 for up to 24 hours, or longer if hemodynamically unstable. Balloon pump patients are always 1:1 per our policy.

    If stable and uncomplicated, they are extubated within 6 hours. A couple of times recently, we have had CABGs come out of the OR already extubated. We have our CABGs delined (swan-ganz out, a-line out) and up in a recliner chair early morning of post op day 1, and walking in the hallway by the afternoon.
  12. by   Biffbradford
    Quote from NickiLaughs
    Are these surgeons aware? I think they would even have a fit about their patients having this load. It's 1:1 the first 8 hours the two hospitals I worked at
    It's all about bed space. Early morning conference calls between all surgeons and charge nurse to move patients OUT if they want to get their new cases IN that day. It's a factory, it's all about $$$. Gotta crank 'em out. On some days you're lucky if your surgery wasn't canceled for lack of ICU space. Seriously.
  13. by   nyrn5125
    at my hospital the LVAD are 2:1.
    fresh post op 1:1
    pt awaiting transfer to stepdown and 1 critical then 1:2
    Let your surgeons know about this as another post stated. They would not be happy. They can do something about it. Get the MD on your side
  14. by   sweetspirit
    Are you serious? Fresh CABG's should always be 1:1....Your facility should be ashamed to have their nurse tied to another patient! Wow...don't think I'd be working there long, what a liability!

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ratio for fresh CABG pts