CVICU/CTICU help!on caring for pt with an open chest!

[sweetart4988]

Hi! I just have some questions about what to do when you have an open chest patient with delayed sternal closure...If the pt should arrest can you perform chest compression on them or is it by internal defib. only? Also for a pt who has an RVAD and an LVAD if they arrest would you do chest compression if you needed to?

[Biffbradford]

READ YOUR ORDERS

Every surgeon will be specific as to what will need to do.

You cannot do chest compressions, the chest is open so it would have to be direct cardiac massage. Only saw that a few times and always by the surgeon.

As far as defib, our surgeons always left a metal retractor in place to hold the sternum open, so there's no way you could use external paddles. We had internal paddles in the bottom drawer of our code carts right along with a chest opening tray that had all kinds of nasty goodness inside.

LVAD/RVAD - READ YOUR ORDERS. In most cases - no compressions. Depending on the type, if the VAD fails, there is usually a hand pump or something as a backup.

Good question!

[PMFB-RN, RN]

Usually internal cardiac message. Have done it a couple times but never with a good outcome. Defib is with the little internal paddles. Our nurses are all trained on how to use them and where to apply them during the open heart orientation.

We do chest compression with LVAD with one surgeons patients and not with another's. Depends on what box they check off on the orders.

[ghillbert, MSN, NP]

As stated - internal massage/defib with open chest.

Re VAD and chest compressions - depends on the device. Generally a bad idea (but may be only idea if other option is being dead.. you can fix surgical bleeds, you can't fix dead). Most definitely not with an open chest.

Hand-pump is not relevant as this is used for failure of a pneumatic device and not to cardiac arrest. Hand pump just provides manual air and suction to the driveline. Most devices used nowadays are continuous flow devices which have electrical and not pneumatic activation, so no hand pump.

You can externally defibrillate any type of VAD patient without disconnecting anything, but you must disconnect the controller of many if you want to internally defibrillate (eg. Heartmate II).

As stated, get orders from your surgeon before you get to this stage!