Switching from Neuro ICU to Cardiac ICU

[AreEn123]

Hello everyone. Just as the title says I am switching from one ICU to another. I have 3 years of neuro ICU experience and I've recently made the choice to try something completely different. I wonder if anyone else here has done the same thing? Specifically I'm looking for advice on what to study up on. I'm going thru a mini residency/preceptorship. Since I'm an experienced ICU nurse it won't be as long as something a new grad gets. Any tips will be greatly appreciated :)

[RNperdiem, RN]

A couple of random things come to mind. I have floated a lot to both types of units.

In neuro ICU, you watch blood pressure carefully to make sure your patient has enough perfusion pressure, but in cardiac, the cardiologists seem to tolerate lower heart rates and blood pressures than I am used to. As long as the patient feels fine and is making urine, all is well.

Cardiac patients often look so normal, yet are so sick. A lot of these patients are awake, talking and ordering meal trays, but in a moment they can turn gray and your whole shift takes a turn.

[trep]

Hey there. I'm a new grad who started in a CVICU about 8 moths ago. While I don't have neuro ICU experience, I did do my senior preceptorship in a Neuro ICU during school. These units are very different, but it will definitely help having ICU experience.

As for some things to look at, I would suggest anything to do with hemodynamics and CV physiology. Start with things like PA/Swan catheters - learn your hemodynamic values for things like PA pressures, wedge pressure, etc if you don't know these already. Secondly, if you don't know your rhythms, brush up on these (although if you have ACLS you likely already know these). Other suggestions would be to research some common CVICU devices to at least familiarize yourself with them - IABP counterpulsation, LVADs (my institution uses HeartMate II, Heartware, and impella). Refreshing your mind on vasopressors and ionotropes would be beneficial too (dopamine, dobutamine, milrinone, levophed, etc) as these are very commonly used. This should provide you with a good start and you can adjust what you look at once you start.

Also, coming from a Neuro background you are probably used to having the majority of your patients intubated and sedate. In CVICU you will be surprised at how normal and healthy some of the patients may seem at first (don't get me wrong, there are a lot of sickies, but you will have a lot of walkie-talkie type patients too). These patients may seem extremely stable, but at any time they are susceptible to coding. You will see a lot of codes in CVICU compared to Neuro ICU, where you mostly see withdrawal of care.

Hope this helps and best of luck

[AliNajaCat]

In CVICU you will be surprised at how normal and healthy some of the patients may seem at first (don't get me wrong, there are a lot of sickies, but you will have a lot of walkie-talkie type patients too). These patients may seem extremely stable, but at any time they are susceptible to coding.

Oh yeah. My favorite cardiac surgeon used to say, "Never trust a mitral valve with a good tan." That was because it usually meant they were too sick to do anything much more than lie around in the sun. Damned if he wasn't right, too.

[AreEn123]

Thanks for all of your replies. And you're absolutely correct... A lot of the patients in my ICU are intubated and sedated... But for the ones that are not, they are consistently trying to crawl out of bed, they cant speak, they have some or both forms of aphasia and it can get pretty hectic in that sense. Whenever I walk thru the cardiac ICU I see patients just like you spoke of... Walking & talking... Seemingly very normal looking. Im looking forward to the change and to the challenge... We definitely don't watch pressures or rhythms as much as cardiac does so I have a lot to brush up on. Im excited :) Thank you again.

[TheCommuter, BSN, RN]

Moved to the Cardiac forum for more replies and feedback.

[cdibley]

Look up chest tubes, epicardial pacing wires/boxes, definitely rhythms especially afib and on your first day find out what your units preferred treatment is for afib rvr, have to act fast so it's helpful to anticipate what the MD will order (my facility is amiodarone), cardiac tamponade, sternal precautions, ask someone to print you the standard post-op orders because that's what is nice about CVICU that many of the patients have the same PRN orders. You will need to be on top of electrolyte replacement as it prevents arrhythmias. I cam to CVICU from SICU and it was an awesome change. Drips to know: Cardene, Nitro, Dopamine (rare now), Dobutamine, Milrinone, Levophed, Epinehrine, Precedex. Many of our hearts come out on precedes as their only sedation because we want to extubate them quickly. Also know the proper extubation criteria, you'll do a lot of that.

[LoveAnRN123]

Hi!

I know my post doesn't provide any helpful advice but I'm hoping that I can get some advice from all of you wonderful nurses.

I'm debating between Neuro and cardiac icu. I wondered if anyone can provide some insight for both units. I see both to be fascinating units to work on but I'm hoping to go with a unit that can be helpful if I was to continue onto something else. my other dilemma is that I really like the manager on the Neurosurgical icu floor and it seems that I would have more of a chance going on days then cardiac. But I also really enjoy learning more about the heart and it seems that there would be more opportunities in the future if I was to work on the cardiac icu floor.

I would appreciate any advice/support!

AreEn123, if you can please email me at [email protected], I would really appreciate it! :) I have a few questions I'm hoping to ask you privately. Thanks!

[Kimmy_RN]

I strongly encourage you to be a tracer on a patient who is undergoing complex heart surgery from preop through the postop or PACU phase. That way you see everything a patient goes through and what the staff are mindful of when they're caring for and stabilizing this patient. If your facility allows this.. do it. At the very least.. shadow a CVICU Nurse for a couple of shifts.. to see what really goes on with the patient's when the docs aren't around.

Familiarize yourself with postop heart hemodynamics, Swans, heart rhythms, CRRT, epicardial pacing, chest tubes, and the unit's protocols for emergency management of open hearts. For a dessert.. maybe brush up on ECMO!

I Love CVICU.

[MYSTICOOKIEBEAR]

Cardiac/Transplant ICU RN checking in! Become familiar with your Adrenergic Agonists, vasopressors, and vasopressor like meds. You already have ICU experience so you know how to walk the walk, now it's just fine tuning your skills to a different specialty. I made a video to help as a refresher to this realm!

[video=youtube;hiI-8GV-kBk]

Good luck and let us know how it goes!