CABG recovery ratios?

Posted
by brook0224 (New) New

Hello all! I am a critical care RN with 10 years experience on a 32 bed adult MICU. I've taken all patients including Neuro/Trauma/Surgical but Cardiac has been unfamiliar. I recently moved to a new facility with a high cardiac focus and have become trained to take fresh CABG pts. Our fresh hearts come off of 1:1 status as soon as they are extubated per (I'm assuming) hospital policy. A recent request to our surgeon to keep his pt 1:1 prompted questions of our policy as he was unaware of this staffing policy. Frequently, the second patient we pick up after our CABG is extubated is a new admit. I personally am uncomfortable with a second patient immediately after extubation. I believe the pt to be potentially more unstable once an airway is removed.

What are the guidelines/policies within your facility? I'm asking in hopes to work with our surgeon and administration to develop new standards for the care of our CABG pts. Also, do you have any articles or references for CABG ratios?

Thank you for your input in advance.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,688 Posts

I don't think my facility even does 1:1 on fresh hearts unless it's a VAD, IABP, or seriously unstable patient (as in, chest is packed open or maxed out on multiple drips).

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 7,771 Posts

We do 1:1 only until extubated, same at a previous place I've worked. I don't really have a problem with that, they're certainly still busy after extubation but no more than any other ICU patient can be. They typically get transferred to the cardiac tele floor the day after surgery where they will be 4:1, so it wouldn't make much sense to keep them 1:1 until then.

MYSTICOOKIEBEAR

Specializes in Cardiac/Transplant ICU, Critical Care. Has 5 years experience. 144 Posts

I believe our policy is to keep them 1:1 for a minimum of 4 hours before we can get a new patient, whether they are extubated or not. More often than not, we keep them 1:1 on the shift they came out on and as long as they are stable-ish, after that they can be paired.

Just recently I had a 1:1 post op open heart that was stable-ish but then had to take a cardiac arrest from the ED at 04:30 since my pt was the most stable of all the 1:1s. The patient had received like 13mg of EPI and had compressions done on her for a solid 30 minutes between EMS and the ED. That was quite the cluster, the nice thing was that my coworkers tag teamed my guy for the last 3 hours and actually got him extubated and ready for day shift unbeknownst to me :woot:. Teamwork really does make the dream work :yes:.

Stratiotes

Specializes in Critical Care. Has 4 years experience. 54 Posts

We have the same policy, but as a charge nurse, I generally would try to let the nurse with the CABG take over someone else's patient and have the other nurse take the admit. This depending on the acuity of the new admit. We get a lot of not-so-critical stuff so sometimes it is no big deal to get a new admit.

eCCU

Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy.. Has 14 years experience. 215 Posts

1:1 only if they are on crrt, IABP and multiple pressors, otherwise we try to pair with a less acuity pt

Our CABG patients are 1:1 until 4 hrs after extubation. Intubated CABGs are never paired because we don't restrain them d/t sternal incision.

CindydH

3 Posts

I agree - keep them 1:1 until after extubation. Typically the first big hurdle is to get the patient extubated. If they are very sick and unstable - they're usually going to remain intubated. Maybe the compromise could be that the patient is paired an hour after extubation to ensure that they're stable.

RedInScrubs, ASN, RN

Specializes in Medical-Surgial, Cardiac, Pediatrics. Has 3 years experience. 136 Posts

Working both CVICU and cardiac, ours are 1:1 until extubated, then they're 2:1. I don't actually think that is asking too much, really, since they're usually transferred to the cardiac floor, where the staffing is 4:1 (5:1 on nights, more often than not, with new admissions for just about everyone) within the first day after being extubated, unless their pressures can't come up or something like that. Why keep a 1:1 when within that shift they're often transferred, and often even have their chest tubes removed prior to transfer? We have many of those walk to the cardiac floor down the hall, and barring some post-op anesthesia compilation, they're generally stable enough to handle a higher staffing ratio.

amandagracen

6 Posts

I've had three travel assignments in heart units in Phoenix, Charlotte and Idaho and all the hearts I've seen are 1:1 until extubated then they can take another patient, though like said earlier- kinder charges will have you take a settled patient and give someone else the new admit (;

jamst149

49 Posts

Had a pt once...1:1...extubated in like 3 hours...doing great. Tamponaded in the chair and was one of the worst codes I've ever encountered. It happenes!

Kssrn404

Specializes in Cardiovascular recovery unit/ICU. Has 9 years experience. 68 Posts

Had a pt once...1:1...extubated in like 3 hours...doing great. Tamponaded in the chair and was one of the worst codes I've ever encountered. It happenes!

I had a tamponade as a new grad. It was terrifying to say the least. But I was able to stay focused and order stat labs, CXR and page the surgeon. We cracked the pts chest at the bedside and the liver looking clots were removed and the patient was rushed back to surgery. Note: the patient was a first post op day CABG.

In our unit we are 1:1 until all pressers are off and of course weaned from the vent, then we can pick up a stable patient.