Chest compressions on open heart pt/sternectomy?

CRNAStudent · May 9, 2004

I work in the CTICU in the biggest cardiac surgery program in the US, and we most definitely do chest compressions on fresh post-op OHS surgery patients. However, patients who have had a flap (sternectomy) are most often our long-term patients and usually have an order for no chest compressions. Makes sense too...you would smash the heart if you did compressions with no sternum:-) I have never seen a sternal flap patient who required compressions, but have seen many patients fresh post-op OHS patients who did.

When you think about it, what choice do you have? If your patient has a PEA/VF/VT arrest, you have to restore circulation, and chest compressions should be initiated immediately while you get the emergency meds/defib/etc.

psychomachia · May 10, 2004

Is there a consensus on whether to do chest compressions during a code on a fresh open heart patient??? Or one who has had a sternectomy and "flap grafts"? We have been arguing over this for a while now. The doc's are also not consistent in their answers.
Thanks,
Gracie V:nurse:

Just lighten up on the depth...

Dinith88 · May 10, 2004

I work in the CTICU in the biggest cardiac surgery program in the US, /etc.

Where's that? And what volume of OH/CABG pt's does your unit see in a day/week/month?

Just curious!

CRNAStudent · May 10, 2004

I work at the Cleveland Clinic in Cleveland OH. We routinely do anywhere from 20-25 OHS patients per day, with 5 CTICUs. Here is a link about the program:

http://www.clevelandclinic.org/heartcenter/pub/about/surgoutcomes/default.asp?firstCat=59&secondCat=440

When I said biggest, I was talking about surgical population, but after I did a little more research, it may be that their combined cardiac program (medical AND surgical combined) is the biggest. I just remember being told that our program was the biggest by the Dept Chairman. Hope that link helps!

heart queen · May 10, 2004

we do compressions until the surgeon arrives and usually cracks the chest.

zambezi, BSN, RN · May 10, 2004

We also so compressions if that is what the situation calls for...

my2sons · May 10, 2004

We have no set protocol, but use clinical judgement depending on the circumstance, on fresh or flapped hearts. For example, for a witnessed v-fib or pulseless v-tach, I'd hold off on compressions for the minute or two it would take to defibrillate. For a PEA, I would start compressions, while someone was dumping in fluids. They are most likely going to be re-opened anyways. What freaks me out is what do you do when your CABG with the open chest clearly needs compressions? This has come up several times this year. I feel that it is clearly out of the scope of nursing to put on a pair of sterile gloves, pull back the clear dressing and do internal massage. I had a CV surgeon told me to do this and to continue until he got back to the hospital! Thank goodness an anesthesia doc was walking by and he said he'd do it. He ended up popping a finger through his LV during massage, but the patient walked out a week later.

Nitecap · Jun 16, 2004

Iyeah

mandylyn30 · Dec 17, 2006

I work in the CTICU in the biggest cardiac surgery program in the US, and we most definitely do chest compressions on fresh post-op OHS surgery patients. However, patients who have had a flap (sternectomy) are most often our long-term patients and usually have an order for no chest compressions. Makes sense too...you would smash the heart if you did compressions with no sternum:-) I have never seen a sternal flap patient who required compressions, but have seen many patients fresh post-op OHS patients who did.
When you think about it, what choice do you have? If your patient has a PEA/VF/VT arrest, you have to restore circulation, and chest compressions should be initiated immediately while you get the emergency meds/defib/etc.

Hi, I am simply adding what I have learned at the hospital I work in in Miamisburg, Ohio. We had 3 sternectomy pts on the floor at one time and what we learned is that you would use a flattened, hard object, such as a bedpan to equalize pressure and reduce incidence of causing additional damage to the heart. I have been trying to find where this is written, but so far have come up with nothing.

muffie, RN · Dec 17, 2006

bedpan cpr- i like that

i've never heard of a flap pt receiving cpr, but when ever we hear of someone going for a flap, we always say 'oh, no cpr for you'

vanders8 · May 30, 2008

Hi! I read your post! I am in my 4th semester of nursing school. I encountered a patient during clinicals who had his sternum removed d/t infection from a CABG. The patient's family has him listed as a "FULL CODE". I have no idea if the doctor has explained this situation 'in full' to the family but... ? The nurses informed my instructor they were told to do CPR as if the patient were a child. We were given the "What if" question to find out 'facts' about this situation. Can you provide me any websites for more information on this topic! Any help would be much appreciated...

Txs:)