How long before turning?

No turn order for 4 hours post op.

We turn OHS patients typically within the first hour to move leads around to front, get the OR draw sheet out from underneath them (and invariably some caps and other odds and ends), and a quick wipe-down. We don't typically delay this if they are hemodynamically unstable, since it's position changes that help to alleviate the vasoplegia that often contributes to BP instability post-OHS.

Usually within the first 15 minutes of admission from the CVOR. Get them on the CVICU monitor, CXR, draw ABG, initial labs and then roll them aggressively. Check for chest tube output, get the dirty CVOR sheet out and see what their vital signs do.

As soon as I have CXR and ABG drawn, I get my patient turned to finish assessment and change sheets. So... 30 mins-ish after landing in CVICU?

Within the first 30 minutes

Why are you having to change the sheets in the first 30min? We bring out all fresh hearts on a new clean bed so not sure why the sheets would need to be changed so quickly.

On 3/18/2018 at 5:13 PM, MunoRN said:

We turn OHS patients typically within the first hour to move leads around to front, get the OR draw sheet out from underneath them (and invariably some caps and other odds and ends), and a quick wipe-down. We don't typically delay this if they are hemodynamically unstable, since it's position changes that help to alleviate the vasoplegia that often contributes to BP instability post-OHS.

I can't understand the urgency some places have to do all that stuff. We (anesthesia and surgery) had to put a stop to the short sighted insistance on turning, changing, wiping down etc. without regard to specific patient issues. No differentiation between a circ arrest ascending aorta replacement and a routine healthy "boutique" CABG. Patients would dump because someone wanted to change their sheets on admission to the unit...Ughhhhh!

I usually turn 'em within an hour. I basically admit, get report from anesthesia, send labs/ABG, check CT outputs and titrate drips for 20-30 minutes to get a handle on their vitals/how labile they're going to be, then turn. If they've been bleeding and my CTs seem to be patent and are all draining...I'm less likely to turn them right away, mostly because I'm busy with other interventions

If their CTs dump when they turn...better out than in. I'd rather quantify their blood loss and be able to give cryo/products if necessary than have the patient tamponade and be doing an emergent resternotomy in their room. I know that's an extreme example, but still...

As to the post-op CHG bath and removing OR linen...All the patients are on clean beds/sheets when they come from the OR (except the pools of blood in their neck/hair/OR sheet from line placement), but when moving from the OR table to the bed, they are slid over on the OR sheet, onto the ICU bed with clean linen. You just tip them side to side to remove the sheet from the OR, then things look neat and pretty again, and you know any pool of blood you find from then out is from your own time. CHG bath is our protocol within 6h postop, and I'd rather do it while they're intubated on a fent gtt because I get a lot more pushback once we've extubated and are nonstop c/o pain, dry mouth, and the like.

On 1/20/2019 at 4:49 PM, PaSSiNGaS said:

Why are you having to change the sheets in the first 30min? We bring out all fresh hearts on a new clean bed so not sure why the sheets would need to be changed so quickly.

No you don’t. Lol.