to all seasoned CICU RNs, please help!

Specialties CCU


Hi, I'm a new grad who will be starting a Fall residency at a cardiac ICU unit soon. Before I start in Fall I just wanted to find out how "high" acuity are these patients are. During the interview, they told me that cardiac ICU that I will be working for are usually long-term patients who are waiting for a heart transplant. 

Cardiac ICU = waiting for heart, long-term heart failure patients

CVICU = they got the heart, post-op heart-transplant patients

what kind of machines and skills should I be familiarize before I start in the unit?

impella? art line? CRRT? what type of vent? and any tips along the way will be very much appreciated! I am super nervous and I don't want to make a mistake! Please help this new grad ! ?

Specializes in Critical Care.

Location & size of facility are all factors so it is difficult for me to give you a good answer. I've worked inpatient, outpatient, in small hospitals and large ones, in ICUs and procedural areas. The heart - and how we are able to fix it when it's broken - fascinates me. CICU is where I got my start. 

My two cents: 

Know that if you state you are a new grad, the nurses training you are going to know that it will take time for you to become a competent ICU nurse. Be humble, listen to your preceptors, stay curious, and take lots of notes. It is a bit of a learning curve to jump right into ICU but you can do it as long as you're honest with yourself and to others about what you know and what you do not know. 

IDK if others have different thoughts but I would not worry too much about "what type of vent" as there are many "brands" of vents (same with other machines). Also, you're not going to be expected to understand how Vents / Impellas / IABPs / CRRTs / TTM machines / LVADs / Art Lines / ECMO / Central Lines /Swan catheters etc work on day one. In my experience, most preceptors want to first know that a new grad will listen, be receptive to feedback, is able to follow instructions, carry out basic nursing tasks, see growth in new nurse over time, and trust you, before they will be comfortable enough to allow you to touch anything super invasive.

You'll get a better idea of what to focus on once you start working with your preceptor. My personal suggestions: Brush up on your basics. You know that this is a cardiac ICU environment. You will be constantly monitoring these patients for a reason and changes can happen in an instant. Familiarize yourself with lab values, cardiac medications / continuous drips including sedation  & paralytics (phenylephrine, epinephrine, norepinephrine, vasopressin, ketamine, propofol, fentanyl, nimbex, etc..). Pay attention to how you set up your pumps for any continuous drip. Never let your drips run "dry" (as in, they run out all of a sudden - which can leave your patient crashing all of a sudden). Learn from others about how to handle emergencies, EKG interpretation, & cardiac procedures (ask all the why and how questions). As you go through training, make notes, or a "journal" about what you saw / learned / what feedback you received / questions you have / reminders of what you should focus on. I made myself a binder and collected all notes and references that I could get my hands on so that I could look at it later as I was learning in CICU. First things I added to my binder were resources (as in the numbers of people to call when in a bind or needed help) + BLS/ACLS references + a map of the facility. 

Misc random thoughts: If the facility is holding pre heart transplant patients I would imagine they would use Swan Catheters on these people. don't know since I don't know where you're working and stuff? but if you do get people with Swan Caths please treat catheters with caution. They can be tricky little buggers. Respect them. 

Thank you for your honest advice! I recently got to talk with the manager and she told me they do Swan Caths! I am excited to start at this unit and I am planning to study beforehand what you have recommended! Thank you so much! ?

Specializes in Critical Care.

When do you start? I'd love to hear about your first impressions. 

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