ratio for fresh CABG pts

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  1. This is a discussion on ratio for fresh CABG pts in MICU / SICU Nursing, part of Critical Care Nursing ... I have a quick question. I recently started working in a busy 25 bed SICU that recovers aprox 1000...

    by Nov 3, '11
    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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    by bhrusa09 Nov 3, '11 4:26 pm
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  3. 12 Comments so far...

  4. Nov 3, '11 by
    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.
    nursenotamaid likes this.
  5. Nov 3, '11 by
    That's ridiculous and unsafe, no question about it.
    nursenotamaid and PMFB-RN like this.
  6. Nov 4, '11 by
    At our facility, fresh CABGs are actually 2:1 (2 RNs to one patient).
  7. Nov 4, '11 by
    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.
  8. Nov 5, '11 by
    Stupid and ridiculous. Needs to be 1 on 1 for at least 4-6 hrs
  9. Nov 5, '11 by
    My old CVICU has recently been admitting fresh hearts paired with LVADs. Talk about a recipe for disaster.
  10. Nov 6, '11 by
    Our fresh hearts, whether a simple CABG or valve replacement, or more complicated by IABP or nitro, are always 1:1.
  11. Nov 7, '11 by
    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
  12. Nov 19, '11 by
    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.