CTICU for Beginners

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Hello everyone!

I am a new grad nurse starting my first job in a CTICU next week. I had a capstone in the CTICU and loved it, but am slightly worried about being rusty after a couple months away.

Does anyone have any tips for working in the CTICU, things to keep in mind during a typical day, or even any good resources I can look over to prepare myself?

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Specializes in Critical Care.

CTICU - cardiothoracic ICU? What are your patient populations? More surgical like post CABG/Valve replacements&repairs/Transplants, or more medical like STEMI, heart failure, resp failure, pulmonary htn... Im at a large hospital that divides these patient populations. You might have both. I know more medical than surgical & nursing care can be different. Depends on the hospital but both would likely expose you to vents, pulmonary artery catheters, art lines, CVP & advance therapies such as intraaortic balloon pump, continuous renal replacement therapy, Impella, therapeutic hypothermia... maybe ECMO or LVADs.

It's a steep learning curve... my advice is to be a sponge, write down everything that you can, learn to review and organize your notes (I kept many of mine as reference so I wasn't repeating questions).

First things to learn: Know what to do in an emergency - first actions and who to call (codes like to happen when you least expect them). Telemetry strips: sinus/brady/tachy/heart blocks/ lethal rhythms such as vtach vfib asystole... Learn drips (used for, starting dose, how much to titrate by and frequency of titration, side effects), there are many but most common for my unit are: Norepinephrine, Vasopressin, Dopamine, Fentanyl, Propofol, Cardene, Heparin, Nitroglycerin, Amiodarone, Milrinone, Integrilin... Offer help to everyone on the unit. Be nosey. Take opportunities to see and do as much as possible. During orientation you should never have a "I'm bored" moment. Use the time wisely. Get familiar with orders and protocols and where to find the info if you don't know something.

Also, create an ICU report sheet for yourself. This will help you organize your day, remember what tasks need to be completed, be able to answer questions about your patients, receive and give report, ect. I looked at many on this site and picked things I like from each to come up with the report sheet I use. Mine is front and back and allows me to record up to three patients if I were to ever be tripled. At the top I have space to record name, room #, code status, allergies, covering doctors w/numbers. Below that is space to record the story of the patients admission/hospital stay as I receive the info from the reporting nurse. Under that is space for review of systems: Neuro CV Resp GIGU Skin, then IV access, misc (gtts, family notes, if they need glucose checks, whatever randomness is important to know about the pt), then plan. At the very bottom of the page I allow space to record questions I have. I try to just write a subject word or 2 in that space as the report giving nurse talks if I think of a question during report so I can ask it after the nurse finishes and dont interrupt them. On the back I have time charts from 7:00 - 7:00 and record if I have anything time-sensitive due during that time (labs, meds, glucose checks) and finally on the back under my time chart is my "notes" space - anything that comes up during my day, notes from rounding with docs, new tasks that come up, important notes to remember to pass along to the next nurse...

Always always always ask questions. Never be afraid to ask questions. The saying is there are no stupid questions, and even if you feel they are stupid questions, your orientation time is THE TIME to ask these stupid questions. It's expected anyway.

I like looking at stuff on youtube... ACLS Certification Institute

- YouTube - this guy is pretty good for ACLS, just an example. You can learn a lot about the drips/ therapies / diseases I listed above on Youtube. I find random gems of info everywhere - allnurses, quizlet, slideshare, google images... Hopefully your orientation will give you a resource for learning critical care nursing concepts and sign you up for classes.

Good luck! Reply here if you have any more questions or feel free to send me a PM. Enjoy your new position. ICU nursing is a fun ride.

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Specializes in CTICU.

I work in a CTICU and I would definitely check "Cardiac Surgery Essential" Its a fantastic book.

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Specializes in Thoracic Cardiovasc ICU Med-Surg.

Expect a steep learning curve. Even experienced nurses who transfer into the CTICU have some adjusting to do. It is an intense fast paced environment where any patient at any time could have a sudden event.

Expect to do extra curricular studying. For the first 6 months I practically slept with the 'Manual of peri-op cardiac surgery' by Bojar under my pillow. I also bought the ICU Book.

In my unit we use Epi, Levo, Vaso, Milrinone, Phenylephrine, Heparin and Insulin on the Reg, as well as Amioodarone, esmolol, nicardipine, nitride, cleviprex, bivalrudin etc etc etc.

I really love this patient population, and I hope you will too. :)

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Specializes in Cardiac/Transplant ICU, Critical Care.

Being in The Units, at some point in time, you will experience and be part of a code. I actually just finished a video about nursing roles and positions during a code that might help you prepare. I've got some other videos that might help as well. Good luck and let us know how your first few weeks/months go! :up:

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