oakmax

We use elastoplast tape and prep the skin with no-sting skin barrier. Change the tube nightly side to side. Not too many complications cw

Hang in there/ I found with experience/sicker patients I find myself managing my time better. So look for the sickest patients, that being said I find myself more "frazzled" with 2 post op extubated cabg pts, they are almost always more needy and are more work than the sedated intubated patient. Also try other shifts, may be slower at nite. If it doesen't work out I'd stay in critcal care, I find stepdown busy but non stimulating if that makes sense.

Yep, same docs, we've only needed a couple of pts transfered. As the volume of more compromised patients rises I see the need for cvvhd rising. Cw

Our hospital has a new (2 yrs old) CT surgery program, our sister hospital appx 15 miles away has a more tenured program using the same Surgons and perfusionists. On occasion we need to send our sick patients for cvvhd. This happens about 2 times per year. Is it worth it to provide the service in our faciliy. I bring this up today because of a recent case. 55yo F, 3v cabg 2 mos ago, Presenting w/ flu like symptoms/cp/triponin up. Stat cath revealed 100% rca occlusion, patent 2 mos ago, vsd. IABP inserted, stat vsd repair with 1 om redo. Pt was on pump 4.5 hrs, index 1.2, on various gtts, 3 days postop renal failure, fluid overload required dialyses, Before transfer. Paced 110, 90/50, vented ac18, lungs ok, gasses ok, epi .3 mcg/kg /min, dobutrex 10mcg/kg/min. index 2.0 Upon transfer, epi was suspended for short time, pacer was pacing on qrs, p 60-70 systolic. This was in my opinion due to the difference of equipment the mobile unit has. Upon admission to the recieving hospital, index was 1.2 with various gtts. Based on this single event I feel we should provide cvvhd to our patients, I would hate to see this or any other patient die because of the transfer. Please give any advice of which device is best Thanks, Chris

Young mom post emergent c section, must have nicked a uterine artery, kept bleeding had 20 units of blood total in 12 hours, plasma, plt, prbc, cryo. Had a hgb of 1 at one point in time. Was transfered to cleveland clinic with a hgb 5-6. Stable, found to have a large clot in the uterine area caused DIC. This was an amazing, and ultimately great outcome, everyone was healthy, mom home within 2 wks.

2:1, rare open chest cart at bedside. :uhoh21: 1:1 post op/ unstable 1:2 stable/extubated 1:3 stable/stable/stable stepdown unit full

I was a new grad, straight to ccu, 1 year later cticu, this is common where I'm at. Figo, It apears you kept your cool, I probably wouldn't have, pleae write a letter. This person evidently has a control issue.

We're 1:1until extubated or unstable. Usually 4-8 hrs

All of our medistinal/pleural chest tubes are pulled the day after surgery, pending complications of course. Personally I feel the surgeons are the ones who know hands on where everything is in the chest If they want you to pull it I would. The big concern with chest tubes is the chance of pulling a graft out with the tube, this seems moot with instance of the blake in the pleural space. Take into consideration the experience you have, your fellow staffs experience, surgeon, and the nursing policy. I feel I would pull the tube. I only have 2 years experience with CABG patients, but feel confident co workers and facility, should SHTF. No I have never pulled p pleural tube.