Published
In our SICU, our fresh CABGs and valves are 1:1 for at least the first 12 hours. Doesn't matter if they are on pressors or not. Usually, we also get a few hours to set up the room too. Sometimes we will have a floor patient awaiting a bed, or a low acuity patient while we set up, but when the CABG arrives, he/she is always a 1:1, no exceptions. Our policy states that cardiac surgery patients can be 1:1 for up to 24 hours, or longer if hemodynamically unstable. Balloon pump patients are always 1:1 per our policy.
If stable and uncomplicated, they are extubated within 6 hours. A couple of times recently, we have had CABGs come out of the OR already extubated. We have our CABGs delined (swan-ganz out, a-line out) and up in a recliner chair early morning of post op day 1, and walking in the hallway by the afternoon.
It's all about bed space. Early morning conference calls between all surgeons and charge nurse to move patients OUT if they want to get their new cases IN that day. It's a factory, it's all about $$$. Gotta crank 'em out. On some days you're lucky if your surgery wasn't canceled for lack of ICU space. Seriously.Are these surgeons aware? I think they would even have a fit about their patients having this load. It's 1:1 the first 8 hours the two hospitals I worked at
bhrusa09
3 Posts
I have a quick question. I recently started working in a busy 25 bed SICU that recovers aprox 1000 CABG's a year. I have previously worked in a CCU where a CABG was 1:1 for the first 6 hours, however at my new job a fresh CABG is frequently my second,and in yesterdays case, my third.... Is this ridiculous to anyone else? These aren't "easy" hearts, pts all come out on epi, neo, nitro, dobutrex, require lyte and blood replacement frequently. I'm supposed to manage this pt, two others (one on vent with drips) and extubate my heart in 6 hours? Some input would be appreciated here guys, tell me if I just need to suck it up and become super nurse. Thanks