CVOR vs CVICU

CamillusRN, BSN · Oct 21, 2016

Strictly for open hearts at my H+ the circulator gives no bedside report; it's all from the anesthesia staff. From my experience in a CT/CV ICU, I liked knowing exactly which vessels were bypassed 1) so I could give any consulting docs the info to earn brownie points and 2) pay special attention to the lead affected by the area of the heart supplied by the graft(s) - have based calling the surgeon on this criterion more than once with good outcomes. If I didn't get the bypassed vessels from the bedside report, they were clearly indicated in the post-op record so I'm not sure what the hubbub is about getting them verbally.

CamillusRN, BSN · Oct 21, 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.

None taken. In full agreement here.

DesertSky, BSN · Oct 21, 2016

I'm a new charge nurse in the ICU at our facility and have noticed a lot of friction between the CVOR nurses and the CVICU nurses especially when it comes to the information given in report when the patient is leaving the OR and coming to the ICU.
The OR nurses claim they should not need to tell the ICU nurses which vessels were bypassed or what was done exactly, that its not important and it wont change the way we treat the patient anyways.
On the other hand, the ICU nurses want to know everything down to the smallest minute details.
What is the normal expectation for the report from the CVOR?

Anesthesia and the CVOR RN's bring the patient to our CVICU recovery bay and we do bedside report. The only thing I care about is that the CVOR nurse call me when they are closing so I can call RT and pull my meds.

Sometimes anesthesia doesn't even know the details of the operation regarding grafts, vessels bypassed, etc. And it really does not matter in your post-op care. How would your care differ if a patient had a CABG X2 or a CABG X3?

I usually read the operative report from the CV surgeon once it's up in our EMR. I'm more concerned with hemodynamics, complications during surgery, labs, and things of that nature.

Are these new nurses to the CVICU? Perhaps they are looking for all this information because they want to be prepared and do not realize the expectation during normal post op CVOR report. If that's the case, some education regarding expectations would probably be useful.

Good luck and let us know how it goes!

sjalv · Oct 21, 2016

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

This is exactly what the OR nurses tell us when calling report on a heart and it's all I need to know, for what it's worth. I feel like if the nurses want to know the nitty gritty of the surgery, such as where the bypasses were etc, they can read the operative note which gives a complete start to finish of the surgery.

cticunurse33 · Oct 21, 2016

All I need from the OR is height weight drips, nitric? ecmo? All the rest we get at bedside from anesthesia. I don't see the need for 2 reports.

HouTx, BSN, MSN, EdD · Oct 24, 2016

I agree - many times the ICU nurse's insistence on hearing all the teensy details is simply a form of intimidation, particularly when all those details are readily available from other sources. However, the areas of bypass ARE relevant to immediate post-op ICU care because of the reperfusion effects that can sometimes occur. It really helps to know this up front in order to accurately manage any resulting arrhythmias.

Dang those mean ol' ICU nurses.

Ruby Vee, BSN · Oct 24, 2016

I agree - many times the ICU nurse's insistence on hearing all the teensy details is simply a form of intimidation, particularly when all those details are readily available from other sources. However, the areas of bypass ARE relevant to immediate post-op ICU care because of the reperfusion effects that can sometimes occur. It really helps to know this up front in order to accurately manage any resulting arrhythmias.
Dang those mean ol' ICU nurses.

I suspect that those mean ol' ICU nurses are simply young and/or inexperienced ones who are anxious at the idea of admitting a post op and are trying to control their anxiety by getting every teensy detail. They're not trying to intimidate you because they're already intimidated. But then, I'm a mean OLD ICU nurse who has observed the phenomenon from the ICU side of that phone call.

cticunurse33 · Oct 24, 2016

Sure it's def good to know your grafts but I can get that from anesthesia when they drop the patient off. As far as treating an arrhythmia I don't know how you would treat vtach or anything else regardless of what graft was done. Of course if it's an rca I'm going to expect more ectopy but If you like to know all this before the patient gets there that's ok too.

offlabel · Oct 25, 2016

Sure it's def good to know your grafts but I can get that from anesthesia when they drop the patient off. As far as treating an arrhythmia I don't know how you would treat vtach or anything else regardless of what graft was done. Of course if it's an rca I'm going to expect more ectopy but If you like to know all this before the patient gets there that's ok too.

Just curious...why expect ectopy after grafting part of the RCA?