Chest compressions s/p open heart

[mcknis]

Just curious if a pt is a fresh CABG what risks do we encounter when performing manual compressions with CPR? Reason for the question is my grandfather jsut went througha valvuloplasty and CABG so his incision is fairly new, but would their be any complications if CPR was performed directly over the incision. I have been tossing these thoughts over and over in my mind for quite some time, but can't figure out the solution in my mind. Any help is much appreciated.

Thanks

[cruisin_woodward]

of course that is not a dumb question! Never be afraid to ask a question!! People who don't ask questions are the ones who end up killing someone! Well, if he is opening the chest for CPR, he would do an internal cardiac masssage (he would actually manually squeeze the heart) or use the internal cardiac defibrilator. This should be found in a sterile package on your crash cart. I have only seen this done on patients who come to the floor with an open chest...or partially closed.

If it is a bleed, and there is no time to get to the OR, or cardiac tamponde, a nurse would squirt betadine on the chest. We have a chest set on our crash cart along with sterile wire cutters. Make sure you know where it is. All of this should be available sterile on your unit. Sterile towels and a half sheet would drape off the pt if there is time, the Dr will need a sterile gown and gloves, a hat and mask. He will remove the staples with a sterile hemostat, unless you have a staple removal kit available. Or sutures, he will cut. He will need wire cutters to cut the sternal wires. Sterile suchion and Yaunker tip. He will need prayers. Hope this helps!!

Sorry, should have said, "he or she". My bad. I was picturing our CT surgeons, and they are all males.

[kelseybel]

I did compressions recently on a fresh post-op, about 1 hour out actually. Yes, you just start pumping away like normal. We got him back and 3 days later he was on the floor. Nice....so glad to hear when things go well after a lot of hard work.

Our surgeons/PAs will open at the bedside for bleeding, tamponade, things like that. No big deal, under a CONTROLLED environment.....in a code situation, that's a whole 'nother story!! Gets that heart rate up for sure! :)

[Sarcolemma]

every time i've done compressions on a sternotomy, old or new, the wires have broken.

With a fresh sternotomy if a surgeons available often they break open the chest and do open heart massage if its a refractory dysrrythmia.

[RoyalNurse]

On my unit we have a "open chest compression board": a taped-up padded board to use on post-op CABG patients to compress the sternum evenly so the sternal wires don't break and pierce the patient. Kind of like the bedpan theory, I guess.

Never used it, but looks like it would be hard to do CPR with.

[elthia]

Believe it or not though, I was taught that if you have a fresh pump, and I mean very fresh, you should use a Bed Pan (clean of course) to do compressions. The reason for this is for the nurse doing the compressions...the sternal wires could break and pierce the person doing compressions....I am certainly not advocating this as the proper technique, I'm just saying...But I will say that I've never actually seen it done.

We had a pt, 10 days or so post CABG, sent to the ONC floor for a previously dx cancer, he coded and the nurse doing the compressions recieved a lac from the sternal wires.