CABG tips?

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I 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.

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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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Hello. 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!

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Specializes in Tele, ICU, ED, Nurse Instructor,.

My mother had open heart surgery this year. She was on q1h accuchecks with an insulin drip. She is a diabetic.

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Specializes in ICU, CVICU.

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.

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Specializes in Family Practice, Urgent Care, Cardiac Ca.

Definitely 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!

:)

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Specializes in Telemetry, IMCU, s/p Open Heart surgery.
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.

on 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).

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Specializes in ..

Can someone explain the rationale behind the insulin drip post-op for both diabetics and non-diabetics? (I'm a student and curious.)

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It's stress. Stress messes with blood sugar. CABG, if open and bypass especially, is very, very stressful to go through. This stress can shoot your sugar up. Best for you to have it managed in order for you to heal.

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Specializes in Critical Care.

ETOH 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.

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Specializes in CVICU.
ETOH withdrawal can be difficult to detect at first in OHS patients due to "pump head", which is similar to initial W/D symptoms.
I have read several articles that claim "Pump Head" is a myth. I'd like those writers to come and work in my unit for a year and then tell me it's a myth.
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Specializes in Cardiac care/Ortho/LTC/Education/Psych.

I have never heard about pump head and I do not really care about it . I know that there are many CABGs with alcohol withdrawal that do not make it good on the end. We even had one family threatening to sue us for allegations but it was clear as day what was going on . If you are a new nurse on the floor where there are CABG patients good idea is to educate them about everything especially that "exercise " does not mean going home and starting to pull weights and body building because they will come back with open chest ( we had that case), also that chest tube should be there to help patients ( some are very unhappy with those tubes) , that sometimes after surgery people are just tired and they do not want to "entertain" their family and you need to ask your patient if you need to play "tough policy oriented nurse" and escort them to a waiting room ( I always make some secret sign that they can use to let me know to kick their family out - they can be upset with me because grempa does not want to see them upset with him) , also sex , yes you need to mention that and talk about it as it is " what did you eat last night" because if they see you comfortable talking about it they will ask you questions that bother them otherwise they could think it is over.. Yes, temporary pacers - DO NOT PUT it close to their hand , I can prove it to you that it will become their call bell or tv remote control and then you have an issue ( I had it :)) it was scary and hilarious (later) because the pacer was off and suddenly my patient is going all around with EKG and there are pacing spikes ??!! how on the earth??! .. he turned it on and crank it up to the sky high ... good lord .. that I only could say and put it off.... They made fun of me later , "so, your patient is watching what channel, you said?? and what did you tell him to do it with his pacer"... you must joke sometimes I am sure you know that..:)) good luck to you -

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Specializes in Medsurg/ICU, Mental Health, Home Health.
It's stress. Stress messes with blood sugar. CABG, if open and bypass especially, is very, very stressful to go through. This stress can shoot your sugar up. Best for you to have it managed in order for you to heal.

That and tight blood sugar control is essential for faster and less complication incisional healing.

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