Post-Open Heart Surgery Job

TopherSRN · Apr 13, 2006

Most open heart patients are recovered in the CICU. I can't think of any reason why they would send fresh cases to PACU due to their complexitiy. While I can understand your feelings on chronics, they come with the territory. Unfortunately not everyone is extubated and on the floor 12 hours later, but the chronics/re-entries are sometimes very interesting in their care. CICU probably has the fewest chronics of any unit. If you think your unit is bad try NSICU or MICU where they have chronics there for months.

In my limited experience, I doubt a setup like you describe exists. i do hope for your happiness I am wrong. I just can't imagine how a CVOR PACU would make more sense than taking cases straight to the unit. Less staff, Less moving, and case gets to unit (which is safest place other than OR with CV team) asap.

suzanne4, RN · Apr 13, 2006

I know of a few hospitals that take fresh open hearts in their PACU, but that is only until a CVICU bed opens. And because of a bed crunch. They do not have specific set-up for that, same as with getting a patient into the PACU.

The majority of patients with open heart surgery are out of the CVICU the next day. Not sure why you feel that you are taking care of a long-term patient. Standard PACU Recovery time is one hour after general anesthesia. Most CABG patients are extubated well within a six hour window, provided that they are stable, and do not have any type of respiratory history.

Sure, there are going to be patients that cannot get off of the vent, or that develop a sternal infection, and need their chest left open. They need to be treated somewhere. And they are not ready to be sent out of the unit. There are always going to be a patient with a complication, no matter how good that the surgeon is. Remember also where you are working; they take patients that other surgeons would not touch. So yes, you are going to see maybe even a higher number that are not out the door in the next 12 hours or so, but they also need the care.

And as stated above, those are some of the most fascinating patients to care for, much more so than the assembly line routine CABG. I love getting a patient like that and seeing them get better, and knowing that I made a difference. And I have experience on both sides; the OR side, and the CVICU side.

heartICU · Apr 14, 2006

Remember also where you are working; they take patients that other surgeons would not touch.

Very true! As a former CTICU nurse at CCF....it is unbelievable the patients that they will operate on, and many of them do remarkable well!

Cleveland-RN I sent you a PM.

Cleveland-RN · Apr 14, 2006

We do get very difficult cases that other facilities wouldn't dream of touching so I know that complexity is there. I have been here for over 2.5 years and I get the most complex cases available during the shifts that I work. However, after the initial 24-48 hours things can change quite alot. Even with that being said, I don't mind caring for this type of patient for a week or so but after that it is totally not my idea of a fun time. We have several patients that have been in our unit for 1-2 months and this is the pt that I'm referring to. It just seems like it's all we have had for the last few months and it feels like being in an LTAC.

The job that I described to you is one that was described to me by a fellow CCF nurse that left for this very reason and she took a position in NY state that was described to me as being the open-heart pacu. She said after the initial 24-48 hours, if they weren't ready to go the floor then they were sent to the ICU while her unit kept accepting the fresh cases.

I'll have to keep researching. Thanks for all your input.

my2sons · Apr 17, 2006

What you are looking for is usually termed a "CV Recovery" Unit, and they are out there. St. Luke's in Houston has one. From what I understand, they do "pure" recovery (rewarming, VS stabilization, extubation) then they are shipped to CVICU.

Cleveland-RN · Apr 17, 2006

This is exactly what I'm looking for. Thank you for replying to my post.

zipporah · Apr 21, 2006

Naples Florida also has a CVRU. In fact they getting close to moving into their new unit. They send pts out quickly if they are doing well or to the icu if they are not for the most part. Maybe balloon pts stay, but the balloon doesn't stay in that long and when it comes out? Voila, an ICU pt.

Cleveland-RN · Apr 21, 2006

Now that I know it's called CV Recovery, I've been able to locate a couple of programs. What's the name of the facility in Naples?

zipporah · Apr 23, 2006

Naples Community Hospital, there are 3 surgeons, it is a seedy little unit right now but they are getting thier new 11 bed unit soon, not sure when.

Cleveland-RN · Apr 23, 2006

Thank You. I'll check into it!

my2sons · Apr 29, 2006

My sister took a travel assignment in Naples. Absolutely gorgeous beaches. And lots of rich old people.