I work on a 48 bed cardiac floor. We may have on any given day 10-17 cabg's. Along with post MI, post HC,Stent etc. My question is what is the pt. to nurse ratio on your floors and what are the ages for your cabg's. In the last year or 2 our age has increased, we now do alot of late 70's and 80's. And another thing, do you find A-fib to be a problem and what do your doc's do about it.
Oct 9, '02
Mind you I only pick up a few days a month on post-cabg unit. (and I've only started that a few months back)
We get all sort of ages back. Mostly 50-80's.
The nurse patient ratio on days / afternoons is 1:5. Midnights is 1:6-7. Our patients "usually" come back 2nd day post-op but some patients have complications and don't come back for several days post op.
I would say a-fib is the #1 complication on our unit. (also I've seen a few infections) I've done different things....one Dr. requested heparin be started....another dr. wanted me to digitalize the patient and another Dr. hmmm I forgot what he requested...I can picture the patient but don't remember what he ordered. I do remember though by the time I got the RX. the patient converted back over to NSR.
Oct 9, '02
A-FIB=Cardizem gtt on our unit.
Oct 15, '02
I work on an 8 bed cardiac surgical stepdown and 4 bed cardiac surgical ICU unit. On our cardiac surgical stepdown, we have the same pt populations you mentioned. If the stepdown is full, one RN has 4 pts along with an LPN assisting with 2 of each of the RNs 4 pts. The LPN opens their pts chart and the RN checks behind. The LPN also gives their 4 pts po meds, and does their pts VS, I&Os, and dressing changes. The ICU ratio varies from 1:1 to 1:2 depending on pt accuity and the freshness of cardiac surgical pts. Generally, post op surgical pts stay 1:1 through their 1st night. This may sound favorable to some, but considering the size and set up of our unit, and that the charge nurse takes a pt assignment, and we have no float nurses, this works out good if we have an unstable pt and considering the problems that can be encountered with these pts . Most of our pts are 55 to 75 yrs old, but we do have our share of 40s and low 80s yo. A-fib is the most common post cardiac surgical complication and this is true on our unit. I would say 15 to 25% of our pts have transient post op afib that is usually treated with either or both cardizem and digoxin. Sometimes a cardizem drip is used. I have never had a unstable a-fib pt that has had to be cardioverted. I would be interested to know the nurse pt ratios on other cardiac surgical units around the country.
Oct 15, '02
Hi, I work on a cardiac surgical step down unit. A majority of the patients come to us the day after their surgery, a few the same day as their surgery. Day nurse to patient ratio is 1:2-3, evenings is 1:4 and nights 1:5. A-fib is a common post-op complications in CABG's and even more common in valve procedures thanks to the swelling and irritability to the heart post-op. Our unit uses cardizem gtts, Corvert, sometime amiodarone gtts. The ages of our patients mainly ranges from 50's to 80's, with some in the 40's (some valve patients as young as 20's) and once in a while a patient in their 90's (not often, thank goodness!) We can hold 20 patients, usually have about 15-20 heart patients, and the others are usually vascular or overflow patients.
Last edit by Dazedgiggle on May 10, '03
Oct 15, '02
Sorry, just re-read my reply, some typos up there!! LOL I don't know where that smiley came from, but it's supposed to say nurse to patient! And we hold 29 beds, not 20. LOL
Oct 22, '02
I am sitting here at work at 3:30am and my 82yo patient (12hrs post op CABG) is doing great and sleeping like a babe.
We have an A-fib protocol and have had very good results. Happen to have the order set right in front of me.
1. Atrial pacing x 72 hours.
Native HR Pacing HR
2. Lopressor 50mg po BID
3. Do not give Lopressor if HR <60 (pause pacemaker to check underlying rate and rhythm); 2nd or 3rd degree HB; junctional rhythm, SBP < 100, titrating up on inotropics
For onset afib and HR >100, we have a cardiazem bolus/gtt protocol.
Oct 23, '02
AFIB is so common post cabg I'm almost surprised when they don't go into it. Our ratio is usually 4-5:1. We try not to give more than 2 CABG patients per nurse. Sometimes it can't be helped. My youngest was in the 30's. My oldest was 97.
Oct 23, '02
OUR ICU ratios for CABG/transplants/LVADS/ABIOMEDs is generally 1:2 and sometimes 1:1 for the first 12 hours of CABG especially.
The stepdown unit has 1:4/5 ratio with some CABG pts directly brought to stepdown as soon as extubated and Swan out. We also have 4 bed cluster with 1 RN, all postop CABG/valve,etc. also.
The stepdown unit can run Amiodarone, Cardizem, Lidocaine, Pronestyl drips although the last 2 are becoming rarer to see.
Our postop transplants generally stay in the ICU for at least 4-5 days, then go to special heart failure/transplant tele floor.
May 6, '03
wow, I can't believe you guys start atrial pacing when they go into atrial fib. That's definitely different. I'm not saying it's wrong. Doesn't it seem a little rash? Does it work? Just curious. We simply give PO amiodarone if they're able to take po that is. Otherwise we will probably start an amio. drip. but we do check electrolytes very commonly so we usually have up to date potassium and mag levels. very rarely will we use cardizem unless they took it previously. Amiodarone is our chief substance for atrial fib though. It seems to work in most cases. Our patients also get an amio. bolus when they return from OR for postop afib prevention. We have never paced any patient for atrial fib. however.
May 9, '03
We don't atrial pace with they go into afib, they are being atrial paced when they come out of surgery for the first 72 hours. As soon as they are extubated and can take po, they are given the lopressor. This actually works for us because our instances of post cabg afib have definitely decreased. In fact, it's very rare.
May 10, '03
I work in CCU....OUr standing orders state that we can give four doses digoxin (if pt not on pre-op/currently) and they are in afib or having frequent pacs rate 90-140, if on dig already straight to cardizem...if rate is >140, we go straight for the cardizem (and i think that dig too but can't remember offhand....) we also use amiodarone occassionally...
May 13, '03
Do you guys atrial pace only if the patient is in AFIB in the OR or has a history of AFIB, or does everyone get paced for the first 72 hours? Just curious. It does
sound like a good way to prevent post operative atrial fib.
It's interesting to find out what other heart units are doing to prevent post op complications, cuz we know there are many. The surgeons here don't like digoxin, I think mostly because of the potassium effect. Plus you have to do dig. levels and all that. So they just use the amiodarone. They used to use cardizem, but when they came out with amiodarone, they always use that now. Many times a patient will be on cardizem for days until they finally hit sinus rhythm. we've had better effect with amiodarone I believe.
They don't like lopressor either, mostly because of the bradycardia I think.
Thanks for your info.