jetty

I work in an 8 bed CVICU that has semiprivate rooms with curtains for privacy. The hospital is looking at creating an open visitation for all critical care environments. We currenty have structured visiting but make exceptions when appropriate, I was wondering: 1.what visitations are on other units that care for fresh open heart patients. 2.what is the layout of your unit like (are there private rooms?). 3. Pro's and Con's of the visitation policy.

does ecg HAVE to be with CVp or can CVP be run simultaneously with PAP?

What is standard practice for documenation of strips as far as what needs to be documented together and why. For example a patient has ecg, abg, PAP,CVP, etc. What 2 waveforms gets mounted together in the strips and why?

the unit is only an 8 bed unit and with 2 to 5 cases a day typically we don't have room for a patient that stays long term and still admit a fresh CABG. Its is a bed crunch. It would be a lot easier for the patients as well as staffing if we had a larger unit, but that is not an option currently.

thanks

They may need to stay if they become a long term vent patient, CVVH, etc. Unfortunately our doc's want them to stay in our CVICU ( the only unit to recover fresh cabg pt's) rather than transfer to a true ICU. I was hoping for info on what other facilities do with these patients that have complications

I work in an 8 bed CVICU and we are continually having a bed crunch trying to make room for fresh CABG patients if we have an unstable post-op patient. Sometimes we keep patients for 2-3weeks. What criteria do other places have related to lengh of stay in CVICU before they were to tranfer to a ICU/CCU to make room for fresh CABG type patients?

I have been using Precedex for a little over 3 years in our CVICU. We use it from immediate post-op for all post cabg pt's until the next morning(we keep it on after extubation). This allows the patients to stay calm thru the night, get some rest, cough and deep breathe and we have found our patients use less narcotics with this drug. Dosage for CABG is .2 to .7 mcg/kg/min. We have started using this on Thoracotomy patients that have difficult to control pain (no epidural) and it works great. This is also used at my facility for "De-Tox" patients and we take it up to 1.5 mcg/kg/min as needed. This is a good drug that is not a negative inotrope like diprivan and doesn't drop your B.P. as much. It took me about 1-2 months to get comfortable with it after we switched to it from Diprivan. There has not been an increased # of self extubations either as we thought when first using this.

Ideally the leads being monitered should correspond to what artery was bypassed. Best practice at my facility dictates to know what was bypassed then moniter the appropriate leads. Most the time we moniter in lead 2 to see the inferior, then our 2nd lead is more specific

I have heard of k and Mg routine replacement but not CaCl. The only time I give that is if the patient needs a boost to hr and contractility, I have not heard it associated with AFIB

How soon and how much do your postop CABG pt's receive beta- blockers and how does it relate to a-fib rates?

What type of care do your fresh cabg patient require that is routine. I am interested in seeing how much FLUID other hospitals give their patients related to starting of IV gtts. I think we fluid overload a lot of our patients post-op then have to give lasix/bumex pod #1. Typically Our patients receive 2 to 3 liters( sometimes more) in the first 6-8 hrs postop and I feel this causes an increased # of pulmonary complications. What do your facilities do? :rotfl: