Hi, cardiac nurses!
I am looking to learn new things and expand my skills as a RN, so I have two CVICU interviews at large teaching hospitals coming up within the next nine days! I am excited about these opportunities, but I am also a little apprehensive about this patient population. Both of these units specify that their primary patient population is open hearts.
I have some questions. As a current MICU RN, my absolute favorite patients are sedated, ventilated, and unstable, and I am even happier when they stay that way the entire three nights I work with them. I know hearts are that way at first, but I also know that the recommendation is to pull the ETT as soon as possible and even have the patients up and walking the next day if able, so it doesn't seem like they stay critically unstable for long, at least when things go as planned.
How sick is the average patient where you work, and for how long do they stay that sick? What is the patient turnover like - are you more likely to have the same patient three days in a row, or is it more common to send them on their way to tele/stepdown quickly? How long does the average patient stay on the vent? Is there a pretty even mix of scheduled and emergent procedures? What do you see the most of, anyway? Valve replacement? CABG? Cath that turned into a CABG? Aortic aneurysms? Something else?
I know all of this is very subjective and experiences vary a lot from one shift to the next, but I am looking for what you experience most often as I am trying to figure out if I am really going to like working in the CVICU, and also what I should familiarize myself with before the interviews. Thanks so much for your help.
Jul 20, '14
Every case is different. The easy cheesy patients are becoming a thing of the past because of advances in heart cath procedures. They can easily stent patients that used to require surgery. So, it's less likely you'll get the 44 yo with one graft who get's extubated in 30 minutes and is up in a chair in 2 hours. We used to have a whole unit devoted to the quick wean and extubate patients. They were all transferred to the floor by the next day, and a whole new set would be admitted. Great factory work!
More likely today, it's someone who's 58, diabetic, smoker, who was on Plavix pre-op and bleeds like a _______ for 6 hours post op and has uncontrollable pain issues.
Then you get yelled at for not getting him extubated within 6 hours. Never mind the bleeding and his PCO2 that was through the roof. Not because he smoked for 30 years, naturally, but because YOU kept him too sedated (to keep him from ripping out all his lines).
Then there's always the classic cardiac tamponade that develops despite your best efforts, or their blood pressure gets TOO high and they blow a clip. That's when you've got someone straddling the patient doing CPR as they're whisked back into the O.R. "DOOR! DUCK! "
Then there's the LONG termers. 1 month - 6 months - 12 months. Trached, infected. You get 'em all tuned up, send them to LTAC and they either bounce right back in a week, or they die.
The types of cases can vary widely depending on how big of a program your place has. Could be mostly CABGs or everything under the sun including heart and/or lung transplants, VADs and Total Artificial Hearts.
Oh, it's a gas man. Every day is a challenge from one thing or another.
It ain't for everybody, or sometimes good for a while then it wears on 'ya.
Good luck on the interviews!
Last edit by Biffbradford on Jul 20, '14