Still a newbie, but this was COOL

[Mommy_of_3_in_AL..RN]

Ok, so i know i am still a new nurse. Onlly had my license a little over a month, and been on my unit for 4 weeks. Already taking my own patients, but that is a different story..so the other day, i got to have thi patient who i was horrified of...but it was still the coolest thing to see!!

64 yo male, one month post triple bypass and aortic valve replacement. Apparantly there were some pulmonary problems post op (as we received him from another facility). Came to us after his incision had completely dehisced (excuse the spelling)...so, when i got him, he has an 8 inch long sternal incision that is completely open..and i mean completely. sternum itself is separated about 4 inches or so, and all the wires that were in place to close the sternum had completely burst, so he was WIDE open..you can see the heart and some of the lungs and all! Ofcourse he is vented, but still coughs, and when he does it all kinda pops out. The part i dont understand is why they have a WOUND VAC in it!!! i mean, i am NOT a cardiac nurse, nor do i want to be, but i do not understand why the man has suction to his OPEN CHEST,,,literally the wound vac is on his heart! Not to mention, there isnt a surgeon in the facilty that wants to try to fx it, as they have never dealt with such...its a messed up situation all around, and i know i shouldnt be so giddy about seeing someone in such bad shape, but as a new nurse, it was still exciting to see, and even more excited that i was able to have him as my patient!!!

[richard1980]

First open chest huh? Yeah it's pretty fun. If someone's having sternal dehiscence, no matter the reason, in my facility, it's standard procedure to place a vac over it. There's no negative effects on hemodynamics or respiratory mechanics. W. Vacs rock. It's fun when they just have a little hole and cough and blood/fluid squirts out all over the place. Welcome to SICU. Keep some extra scrubs handy. :-)

[tri-rn]

I saw something similar once, although there was no wound vac in place. I was hleping do a dressing change...I don't recall if the pt was vented but I DO remember he was awake...it creeped me out to look into his chest and see his heart beating, then shift my eyes up and look directly into his!

Incidentally, we did a project on wound vacs in school and if I remember correctly, they were the preferred tx for infected sternal wounds...my memory could be faulty though, that was a couple of years ago.

[Mommy_of_3_in_AL..RN]

well..its an MICU (although i do like SICU better)..and yea, first open chest..i have had a few open bellies and those were cool, but this was better. It makes me feel better to know that it is common to have wound vacs on them, knowing that it wasnt something that they just came up with because they couldnt think of anything else. This guy wasnt awake..he was maxed on diprovan, although we did decrease it some, and he started to arouse, but was very agitated and starting to be combative, so we incresed him right back. Kinda along the same subject..what is your policy in your facility about how high you can titrate diprovan?? Our policy is 50 mcg/kg/min, but we can go higher with a doctor order (which most wont order). I ask, becuase i had another patient this week who was maxxed and WIDE awake..i mean literally had not closed her eyes in two days, combative, sel extubated the previous shift, and still, noone would allow us to go up on her dose, nor give her anything else to calm her...made for a long day. just wondering...

[tri-rn]

I don't know that we have a policy, per se. Once we start getting up into the 40 mcg/kg/min range, usually our MDs will order something to go with it....most likely fentanyl (if that isn't already going), maybe versed - or change strategies entirely. there's another drug that's been popular the last couple of months, but I can't think of the name of it just now...