Crazy days when I take a CABG

  1. 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????????
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    About cabgnurse

    Joined: Jun '13; Posts: 11; Likes: 4
    Heart Nurse and ID doc's nurse; from US
    Specialty: CVICU, Infectious Disease


  3. by   Stormy8
    Yes! I can relate. That's pretty much what my days are comprised of. It's exhausting.
  4. by   RNforLongTime
    So you have two patients AND a fresh-post op CABG? That doesn't sound safe. I don't do CABG anymore but when I did, the fresh post-op CABG pt's were 1:1 for AT LEAST 4 hrs. They came right out of the OR to us. No stop in PACU. If they were unstable, they stayed 1:1 for 8 hrs sometimes 12. Usually by 11pm, depending on what time they came out of the OR, they were doubled up with another pt. We tried to have them extubated within 6 hrs of surgery. I sometimes came in at 11am and worked till 7pm with just the one patient. If the heart was stable at 3pm, they'd give me another pt. But that was rare.

    Your ratio sounds unsafe.
  5. by   LNRN11
    Sounds very similar to the facility where I work. That's part of the reason why I'm on night shift. I have a year of CV experience under my belt, and I know I couldn't handle the pace of day shift yet.
  6. by   MunoRN
    Sounds like you transfer your day 1 or more post-op's before getting your fresh heart. If this is the case that sounds pretty normal where I work.

    On post-op day 1 or 2 nearly all hearts transfer to the tele/progressive care floor where the Nurse will have up to 5 patients and up to 3 of those might be post-op hearts. Fresh hearts are 1:1 until extubated which is usually 4 hours after arrival.
  7. by   cabgnurse
    Yes. I transfer out two 2nd day patients just in the nick of time to pick up a new cabg. Sorry if I didn't state it very well.
  8. by   Esme12
    Welcome to AN! The largest online nursing community!

    Yup pretty long as the heart is 1:1 upon arrival
  9. by   CritCareUkNurse
    Yeah, sounds the same as on our unit. I had one patient who was still getting paced & a discharge one day..that was not a fun day!

    Does the surgeon actually come on the unit & pulls the drains himself?! Do you not do that?!
  10. by   cabgnurse
    Quote from CritCareUkNurse
    Yeah, sounds the same as on our unit. I had one patient who was still getting paced & a discharge one day..that was not a fun day!

    Does the surgeon actually come on the unit & pulls the drains himself?! Do you not do that?!
    Our facility doesn't allow us to pull chest tubes or pacer wires. I set up and take the dressings down, but my surgeons do the actual pulling.
  11. by   Biffbradford
    Transfer - admit. Working at the factory!

    Back about 10 years ago, we had a separate 8 bed unit that was designed just for that. Only cases that were expected to do well and would transfer to the floor POD#1 would be assigned there. They were typically extubated quickly, dragged out of bed numerous times, then in the morning around 0500 we'd get orders to D/C swan, d/c chest tubes, maybe some blood along with lasix. Days would come in, finish up whatever orders we didn't get to on NOCs, transfer them out before 0900, and admit a new set of fresh hearts. There were only curtains separating the beds so in a way it worked out well. Each patient heard that the others were doing, so they knew what was about to happen. We'd work as a team and go right down the line. Midnoc and 0400: 1,2,3,4 up in the chair, then 30 mins later 1,2,3,4 back to bed. 0600 we're all pulling swans and chest tubes together. It was actually fun. None of this 'do I have to get up NOW?' stuff. NO! Everybody is getting up now, so let's go! Ahhh, those were the days. Now, those cases are pretty much handled in the cath lab and they don't even do surgery on them. Pitty. (also, now you can see the beauty of a stable CVVH or IABP patient!)
    Last edit by Biffbradford on Jun 14, '13
  12. by   marilynbaker
    I am in the same boat as you! I feel exhausted after all my work but at the end of the day I feel like I accomplished a ton! I'd say it is normal...
  13. by   ICUPrincessNurse
    1:1 for six hours at my facility! Our first case usually starts at 7 and depending on which surgeon dose the case, if it's a cabg or valve and how things go downstairs they pretty reliably come out around 10-11. That makes our six our time until 4 or 5 pm, but usually our charge takes pity on us and keeps us 1:1 for the rest of the shift!! It's a pretty good day unless you have a patient who becomes a bear post anesthesia and you're told to "not give him any drugs and just tie him down!!"

    That day I had wine and cake for dinner.
  14. by   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.