Want to Discuss Hearts?

Editorial Team / Admin · Jul 15, 2006

hello, nedanurse

i moved your post to its own thread from a thread that was over a year old.

have you checked out the sticky in this forum:

TennRN2004 · Jul 21, 2006

Anyone still ou ther and wanna talk hearts??? I yr nurse at a CS ISU lot to learn and hope someone wants to talk???????

Hi nedanurse!

I work in a SICU that has hearts on one side with general surgeries on the other. I love the hearts! They are my favorite type of patient. I would definitely like to see more threads about open heart patients.

hrtprncss · Jul 21, 2006

Yes, more threads about Open Hearts...

TennRN2004 · Jul 21, 2006

Yes, more threads about Open Hearts...

So, where do you guys want to start? I'll give you a run down of how it is where I work. Six surgeon cardiac thoracic team, do an average of 3-4 CABs daily, lots of thoracic cases also, a few AAAs, usually 1 0r 2 IABPs weekly, only gets VADS about every other year. Our goal is to have our hearts extubated, off all gtts, pull the Swan, and have them sitting up in a chair first day post op, hopefully transfer to the floor in 24 hours. Here lately though, they seem to be sicker and sicker, lots of redos, chronic renal issues, CHFers with crappy pumps (EFs in the 20-30 % range), so we're keeping a lot of them in the unit longer. How is it where you guys work?

Toby's mum · Jul 22, 2006

Nedanurse, I join a CSICU team in about a week.

Given you have had a year+ on your unit, what suggestions do you have to succeed on this high acuity unit?

In hindsight, is there anything you would do differently? I really appreciate your thoughts on this as I'm pretty nervous (and excited) about what I'm about to get into. Thanks. Steph

chaosRN, ASN, RN · Jul 22, 2006

I love love love the heart!!! :redbeathe

I just can't seem to learn enough. I'm constantly learning & looking things up outside of work & school.

In our CVICU - we have 2 surgeons. We don't do CABG's every day, but we have some type of vascular surgery every day (CEA, fem-pop, AAA repair). We get spurts of IABP. Currently we have 3 pts on IABP's (we haven't had any in about 3 weeks). Like TennRN2004, we try to have the pts up in the chair 1st POD being off all gtts & lines. We keep the chest tubes til the output is slowed. Also like TennRN2004, hopefully transfer to step-down 24 hours. Here lately it's been 48-72 hours due to the sicker pts. My favorite, VADS we too only get maybe 1 or 2 a year.

Toby's mum, good luck with the new job!!

hrtprncss · Jul 22, 2006

Same here we get them up the morning of POD#1, most of the time that's when we take the lines out. So basically we have overnight to get patients off the drips...Usually though, by the time nightshift comes along DOS, we try as much as we can to have the patient already extubated and weaned off gtt's. At my other hospital before, we would get 2 or 3 hearts per day, but they had about 3 groups of CV surgeons, and we were expected to take out all the lines like ct's, swans, jp, and pacer wires. At this institution, we're not allowed to take out pacer wires, only CT. I love hearts because you're busy for the first hour, and then usually smooth sailing most of the time until you get them extubated about 4 to 6 hours later. Except those not so rare times where a patient goes unstable, otherwise I like the "monotony" of it, meaning you pretty much know what's going to happen next. Come to work, pick up a patient, set up the room, give up your patient, admit the open heart, stabilize and wean off, extubate, and finish charting. When you guys admit an open heart, how long do you wait before you try and send the family members home?

SorenDrake · Jul 23, 2006

My unit has also seen a lot of sick hearts lately; especially MVRs. TOby's mum, I've found it's very important to stay organized! We use computer charting, but it can be difficult to actually sit and chart in those first hours. I have a spreadsheet for each pt, with slots for everything I need to keep track of. The doc's really like it too, since most of them don't favor the computer charting and find it easier to look at my notes.

Toby's mum · Jul 23, 2006

SorenDrake, for the spreadsheet you created to help stay organized and document as you go until you have time to chart in the computer, did you write or print a hard copy of the computerized flow sheet and then supplement with your comments? If not, how do you decide what spreadsheet entries to include? I'm very interested in this approach not only because it sounds like a good idea, but the unit I'll be on has computer charting so I may be facing a similar situation. Thank you for your comments and suggestions.

SorenDrake · Jul 23, 2006

Toby's Mum:

I print off copies and keep on a clipboard I carry with me everywhere! I'll email you a copy.

TennRN2004 · Jul 23, 2006

Same here we get them up the morning of POD#1, most of the time that's when we take the lines out. So basically we have overnight to get patients off the drips...Usually though, by the time nightshift comes along DOS, we try as much as we can to have the patient already extubated and weaned off gtt's. At my other hospital before, we would get 2 or 3 hearts per day, but they had about 3 groups of CV surgeons, and we were expected to take out all the lines like ct's, swans, jp, and pacer wires. At this institution, we're not allowed to take out pacer wires, only CT. I love hearts because you're busy for the first hour, and then usually smooth sailing most of the time until you get them extubated about 4 to 6 hours later. Except those not so rare times where a patient goes unstable, otherwise I like the "monotony" of it, meaning you pretty much know what's going to happen next. Come to work, pick up a patient, set up the room, give up your patient, admit the open heart, stabilize and wean off, extubate, and finish charting. When you guys admit an open heart, how long do you wait before you try and send the family members home?

It's neat to hear how other facilities work. At my hospital, we don't pull anything-CTs or pacing wires, the surgeons or their nurses only do it. We have a few of the ICU nurses who are certified to pull CTs, but they almost always let CV RNs do it.

Usually we pull most of our CTs POD 1 after patient has been up and made sure they're not going have big dumps of fluid out of the CTs. Lately, we've left the Mediastinals in another day or so and put them to bulb suction, then they get pulled POD 2.

I work nights, so as far as families go, I typically ask at the visiting hour if they are going to stay overnight or go home and get some rest. The majority of our families want to stay in the waiting rooms, and when we extubate the patient, even if it's midnight, the families usually come back to see them when they are awake and able to talk. It gives the families and patients peace of mind when they're finally alert enough to know the surgery is all over and they are doing well.

What typical gtts do you guys use? We use Dobutrex, few of the surgeons really like dopamine, nitroglycerine/cardene, and neosynephrine are our routine gtts. Most of ours come out AV paced too for the first few hours.

How much volume do you give post op? From what I've heard with nurses who've worked other hospitals with hearts, we give a lot of volume. We use hespan/albumisol on almost all the hearts for cvp/bp/uop reasons. One of the surgeons hates volume, so we try not to in his unless we absolutely have to. I find in my practice though that they usually need the volume the first 12 hours out, then we usually diurese pretty heavily the am of POD 1.