CVOR vs CVICU

Ruby Vee, BSN · Oct 19, 2016

Is anesthesia not giving a report on which vessels were bypassed, what drugs were given (and when) and patient history?

bauern5513 · Oct 19, 2016

Yes they do at bedside when the patient comes out.

The ICU nurses are demanding the circulating OR nurses tell them everything over the phone before.

It seems a bit ridiculous to me.

Editorial Team / Admin · Oct 19, 2016

Heck, when I'm calling report to the ICU, I don't know what vessels were bypassed. I know what vessels were blocked, but that doesn't necessarily mean they were bypassed- some are too small, some are buried too deep in the muscle to safely dig out, some are bypassed so far distally that it's actually another vessel (like bypassing the PDA when the RCA is blocked on the distal end). And honestly, does knowing that the PDA was grafted proximally instead of the distal RCA truly make a difference? I really can't imagine that it does.

Here's what we include in our report when the patient is being closed:

-patient name (the nurse already has the background and additional information because the beds are assigned first thing in the morning and they have time to look the patient up)

-surgeon and procedure (such as Dr. A did a CABG x3 and an AVR)

-current hemodynamics (HR and rhythm plus if we're pacing, art line reading, PA pressure, CVP pressure)

-locations of lines/drains (art line, CVC, swan, chest tubes)

-any blood products given

-current IV drips that are running

offlabel · Oct 19, 2016

Yes they do at bedside when the patient comes out.
The ICU nurses are demanding the circulating OR nurses tell them everything over the phone before.
It seems a bit ridiculous to me.

I can understand the ICU wanting height and weight, drips and non routine devices so that they can be fully prepared. But giving the full history and report risks the very real probability of contradicting the anesthetist and causing confusion and error. It's not a good practice at all and if your anesthesia department is aware of it and doesn't care, that surprises me.

If you start asking anesthesia for all of the stuff you don't know because the ICU wants it, they'll probably get sick of it and tell the ICU to stuff it.

Ruby Vee, BSN · Oct 20, 2016

Yes they do at bedside when the patient comes out.
The ICU nurses are demanding the circulating OR nurses tell them everything over the phone before.
It seems a bit ridiculous to me.

It seems a bit ridiculous to me, too. The circulating OR nurses don't KNOW everything. Height/weight (so we can set up for cardiac output and index) drips, pacing/not pacing, surgeon and procedure seems adequate. Also an ETA. One major irritant for me as the ICU nurse was when you'd get a call from the circulator saying "we'll be out in 20 minutes", and then 20 minutes go by and you look at the OR monitor (we can do that from the bedside) and the patient is back on bypass and you haven't been called. If it's 20 minutes, I won't bathe or ambulated my other patient, start on that 30 minute decub dressing change or go to lunch. But if the patient is back on bypass, I have time for any or all of those things!

Kuriin, BSN, RN · Oct 20, 2016

Giving report to an ICU nurse still remains the most daunting things I have to do. Haha.

bellini · Oct 20, 2016

I don't expect the CVOR nurse to know let alone report "everything". I get that from the EPR before the patient arrives, and in the report from the anesthesiologist and the surgeon when the patient arrives. Sounds like a bit of "I'm better than you" chest thumping to me.

MunoRN, RN · Oct 20, 2016

I've only ever gotten report from the anesthesiologist, I'm not sure the OR nurses' report would be all that useful (no offense to OR nurses). What I need are general idea of what drips they've been requiring, any significant issues, etc. The doc shows up around the same time as the patient and that's where I get the details of what was done, getting that sort of information through what's more comparable to hearsay is just prone to errors.

Editorial Team / Admin · Oct 20, 2016

It seems a bit ridiculous to me, too. The circulating OR nurses don't KNOW everything. Height/weight (so we can set up for cardiac output and index) drips, pacing/not pacing, surgeon and procedure seems adequate. Also an ETA. One major irritant for me as the ICU nurse was when you'd get a call from the circulator saying "we'll be out in 20 minutes", and then 20 minutes go by and you look at the OR monitor (we can do that from the bedside) and the patient is back on bypass and you haven't been called. If it's 20 minutes, I won't bathe or ambulated my other patient, start on that 30 minute decub dressing change or go to lunch. But if the patient is back on bypass, I have time for any or all of those things!

Just the OR point of view on not getting a call:

When we go back on bypass, it's usually emergent. So, you may see it in the OR record, but I'm still scrambling to open the extra supplies we need for whatever reason we went back on bypass. I do try to call, but it's not my priority when a patient is crumping.

BSN16 · Oct 20, 2016

Usually when i get patients back from OR, the PACU/OR nurses tell me a bunch of info that i don't actually care about. Like i don't care that they got one dose of ancef before the surgery, seriously i don't. I do care about who did the surgery, who's on their case, have they given any PRNs, what are their activity orders....etc. But every floor is different and want to know different things

adventure_rn, MSN, NP · Oct 21, 2016

Usually when i get patients back from OR, the PACU/OR nurses tell me a bunch of info that i don't actually care about. Like i don't care that they got one dose of ancef before the surgery, seriously i don't. I do care about who did the surgery, who's on their case, have they given any PRNs, what are their activity orders....etc. But every floor is different and want to know different things

Non-CVOR/CVICU-nurse here, but I wonder if it would be helpful for the units to collaborate on making a standard report sheet. That way you both know what information is necessary to report, you both know what information is superfluous and can be left out, and you don't have to go digging around mid-report to find minute details. In my own ICU experience, standarized report sheets seem to make report go much more quickly, with fewer miscommunications, and fewer important details left out.

If you want to go wild and crazy, you could even include anesthesia in this collaborative report sheet effort (so you know what is anesthesia's responsibility to report and what is the CVOR nurse's).. :woot: