Crazy days when I take a CABG

[cabgnurse]

I would love to hear how my experience compares with my fellow nurses.

I take CABGs/Valves fresh from OR. Days (7A-7P) that I do this, I have two CV patients, often that are Two days post-CABG themselves.

I have normal nursing duties with the two, assessments, meds, plus d/c-ing all of their lines and drips (swan-ganz and introducer, drips weaned off, art line, and foley. )

Assist surgeon with DC of chest tubes and temp pacer wires bedside.

Put them on Step Down bed list, actually take patients to their new rooms, give bedside report.

*Somewhere* in there, find time to chart, 15 min vitals after the chest tubes and wires, set up my heart ICU room, hope like heck to get to eat, (which I usually don't) & then be all smiles for when the elevator opens from the basement and the CRNA and team is bringing me today's case.

Is this normal????????

[german_girl11]

Lucky you guys. It is very uncommon that we are able to do 1:1 with our CABG's. Most of the time, we already have another patient. I just think its very unsafe, since you barely have any time for the other patient after the CABG arrives.

[MendedHeart]

I work on a Intermediate floor. We recieve POD 2-3 CABG, valve,etc pts. We have 4 patients, dc CTs, and PW and mAnage Insulin gtts. We dont do the vent weaning, med weaning, and line dc's of courss.

[PatMac10,RN, RN]

Yes. At our hospital whoever has a Fresh CABG patient is 1-on-1, even in that first night shift. Now, if the pt. is stable on post op day 1, then nurse caring for the CABG pt can have another pt, but not another recent CABG.

[jssHeartNurse]

The assignments for heart nurses in the am are 1-2 pts, typically including a transfer. If we have a POD1 heart, the transfer and taking the fresh heart makes for a very busy day! If we have a patient not being discharged, we report off to another RN on the unit so we can take the heart. Our hearts are 1:1 for the entire shift and most times overnight. Very rarely do we get a stable enough heart to pair for the night shift. We are responsible for pulling chest tubes and removing lines, but pacer wires are done by the surgeon as they are usually capped when the pt is transferred to stepdown and pulled before discharge.

[thatoneguyRN]

Yeah pretty normal from what I have seen, though not always do you have two patients to transfer only sometimes. Its usually one to hurry up and get to step-down then a fresh admit... This is day shift to a "t". Having to d/c two and then get one back every day would wear me out! Annnd this is why I work nights We still get admissions on nights but just not as crazy of a pace as days. The factory analogy is pretty fitting for a dayshift in the CVICU I guess! I will say though I would love to do only valves and cabgs. We do VADs, Lung transplants, heart transplants, and other lung stuff and then there is the crazy ECMO stuff which I don't do yet but I digress. Of all the above give me a cabg or valve anyday!

By the way where are there stable IABP pts, I want to go work there! We see them put in because the pts EF is 15 and they couldn't get them off bypass now they are on rocket fuel maybe a RVAD and IABP...sicker than snot! I would love to learn-I am not IABP trained yet-on a stable balloon pt!

Also we have PAs and NPs that pull all chest tubes and temp pacing wires, oh yeah can't forget the 2nd year residents they do this too. Do nurses do this in other facilities? We dress them ect but thats all.

[Biffbradford]

"Sicker than snot."

You're not the first one I've heard say this. Where does this phrase come from?

Sometimes those balloon pumps go in at the cath lab (perhaps needed, perhaps as a precaution), and the surgeon leaves them in overnight after surgery. 1:3 at midnoc, coags in the AM, and out she comes by 9am.

Nurses pulled chest tubes in the two places I worked. I think I got to pull heart wires once. No biggie (I made SURE there was no resistance though!) I remember getting an order to d/c -something- that we NEVER d/c'd. I can't remember what. (Not a swan, or chest tube. A Hickman perhaps??) Again, no biggie, but one takes a deep breath before doing it!

(oh, I did pull an IABP once. But it was post-mortem. Still ... pretty cool.)

[thatoneguyRN]

I dunno but its the go to phrase for our really sick pts!

Thats pretty cool you could pull tubes, to be honest I have watched the mid-levels do it and it doesn't look too complicated, but then again its one less thing I have to do so I am not complaining that we dont. Pulling an IABP would be pretty interesting, even if it was post-mortem. I have seen them pulled, and they are longer than you would, or at least I thought.

Anyways thanks for the info. I guess I forget IABP is not something typically used to help get people off bypass but to help "cure" angina and usually given, like you said, post cath lab so after angioplasty or PCI stent ect? Maybe I need to go work in a CCU.