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Help with post CABG pts

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Cheers_G is a BSN, RN and specializes in ICU.

1,436 Profile Views; 66 Posts

Hi everyone!

So I'll be training on how to take care of post CABG patients soon and it's pretty exciting and stressful at the same time. What other resources besides your hospital training have you used to prep you for that? Any books or online courses?

Thank you!!

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

165 Articles; 21,045 Posts; 192,828 Profile Views

Are you an APRN or RN? Am unsure if you will be doing bedside care versus overseeing care? I want to point you in the right direction.

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Cheers_G is a BSN, RN and specializes in ICU.

66 Posts; 1,436 Profile Views

Thanks for your reply! I'm an RN.

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Mr. Southern NP has 11 years experience as a MSN, RN, NP and specializes in Nephrology/Hemodialysis.

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It depends on your facility. I went straight into CVICU after graduating from nursing school and had a pretty intensive 6-month orientation process. Taking your first post-CABG patient on your own is pretty exciting. Most likely you will have several co-workers to help support you.

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Cheers_G is a BSN, RN and specializes in ICU.

66 Posts; 1,436 Profile Views

12 minutes ago, Mr. Southern RN said:

It depends on your facility. I went straight into CVICU after graduating from nursing school and had a pretty intensive 6-month orientation process. Taking your first post-CABG patient on your own is pretty exciting. Most likely you will have several co-workers to help support you.

In our facility, we are required to have at least 1 full year ICU experience including preceptorship before we are trained on open hearts. But the training itself doesn't seem extensive to me - we take a class, watch an open heart surgery in OR and then have 1 or 2 shadowing shifts with a nurse. I feel like I need to get better at hemodynamics, numbers and needed interventions since our ICU gives a lot of freedom to nurses in terms of choosing the following steps. So just wanted to get a bit ahead in understanding how everything works. So far, saw a "monitoring hemodynamics" book on Amazon but need actual nursing reviews before I buy

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Mr. Southern NP has 11 years experience as a MSN, RN, NP and specializes in Nephrology/Hemodialysis.

27 Posts; 533 Profile Views

Having the year of ICU experience beforehand will be helpful, but open heart patients are a completely different ball game. Hemodynamics is a critical component. Being able to read a cardiac profile from a Swann-Ganz catheter and knowing your ABGs thoroughly are two things you will definitely want to spend time learning. I would expect there would be reasonable amount of ventilator management from previous ICU experience. CRRT will likely come into play eventually, along with LVADS and biVADS, impellers, ECMO, etc. Not saying all of this to overwhelm. Just take everything in stride and apply yourself. It’s really hard work, but can be very rewarding once you’re able to start seeing the results of your intervention and skill. 

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Cheers_G is a BSN, RN and specializes in ICU.

66 Posts; 1,436 Profile Views

5 minutes ago, Mr. Southern RN said:

Having the year of ICU experience beforehand will be helpful, but open heart patients are a completely different ball game. Hemodynamics is a critical component. Being able to read a cardiac profile from a Swann-Ganz catheter and knowing your ABGs thoroughly are two things you will definitely want to spend time learning. I would expect there would be reasonable amount of ventilator management from previous ICU experience. CRRT will likely come into play eventually, along with LVADS and biVADS, impellers, ECMO, etc. Not saying all of this to overwhelm. Just take everything in stride and apply yourself. It’s really hard work, but can be very rewarding once you’re able to start seeing the results of your intervention and skill. 

Yeah exciting. I already do CRRT and we don't do ECMO. So mostly CABG, biVADS, LVADS. I'm ok with ABGs but for open hearts will prob try to get more details. Thank yoU!

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Mr. Southern NP has 11 years experience as a MSN, RN, NP and specializes in Nephrology/Hemodialysis.

27 Posts; 533 Profile Views

You're welcome. It sounds like you're off to a good start. Congratulations and good luck! On ABGs, it becomes very helpful to be able to determine whether it is respiratory vs. metabolic acidosis or alkalosis, and whether or not it is being compensated in one way or another. I can't think of the resource that I had for that, but I was eventually able to look at a few components of an ABG and know that it was a compensated respiratory acidosis, etc.

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16 Posts; 1,187 Profile Views

I'm currently on orientation in a high acuity CVICU (ECMO, LVADs, RVADs, BiVADs, heart/lung transplants, etc).  Three books that I find the most helpful are:

1) Fast Facts for the Cardiac Surgery Nurse-very quick and basic read, good for the basics

2) Cardiac Surgery Essentials for Critical Care Nursing-excellent book from the nursing perspective covering everything you really need to get started and get into details as well.  This is the book my unit recommends to all new hires, and I strongly recommend it.

3) Manual of Perioperative Care in Adult Cardiac Surgery-another great, detailed book.  It's not specific to nursing, however it contains very detailed information that fleshes out what you read in the prior two books.

These three books are all you really need to have a didactic background to your orientation recovering fresh hearts.  Hope that helps!

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Cheers_G is a BSN, RN and specializes in ICU.

66 Posts; 1,436 Profile Views

1 hour ago, CVVH said:

I'm currently on orientation in a high acuity CVICU (ECMO, LVADs, RVADs, BiVADs, heart/lung transplants, etc).  Three books that I find the most helpful are:

1) Fast Facts for the Cardiac Surgery Nurse-very quick and basic read, good for the basics

2) Cardiac Surgery Essentials for Critical Care Nursing-excellent book from the nursing perspective covering everything you really need to get started and get into details as well.  This is the book my unit recommends to all new hires, and I strongly recommend it.

3) Manual of Perioperative Care in Adult Cardiac Surgery-another great, detailed book.  It's not specific to nursing, however it contains very detailed information that fleshes out what you read in the prior two books.

These three books are all you really need to have a didactic background to your orientation recovering fresh hearts.  Hope that helps!

Thank you!!! These look amazing, can't wait to be competent enough to take care of open hearts 😄

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

165 Articles; 21,045 Posts; 192,828 Profile Views

Moved to critical care forum.

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AspiringCRNA22 has 3 years experience as a BSN and specializes in SICU.

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We care for post op CABG patients in our large SICU. 

Alot of understanding how to take care of post of CABG, MVR/AVR, sternotomy patients is understanding proper hemodynamics and gtts that effect these hemodynamics. All of our patients come out with a swan ganz or on a vigeleo, so you must give volume ( LR, albumin, bolus), titrate gtts ect based upon these numbers you are receiving through their hemodynamic catheter. Also, very important to understand ABG's and how to wean to extubate on your post op heart patients. 

Something that really helped me connect the dos was taking and studying for my CCRN. The Barrons CCRN book has a great hemodynamic section that tells you what gtts effect what. I still look at it every now again again for a refresher. 

Good luck, taking care of CABG patients is a fun journey. 

Edited by AspiringCRNA22

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