What to expect after CABG

SEOBowhntr · Dec 26, 2008

Mom'o'3,

You can expect your Dad to have all of those things you mention, vent, drain tubes, even probably a couple of epicardial pacing wires. But MOST of the time, the ET Tube and Vent will be long gone before MN on the day of surgery. You need to encourage him to use his incentive spirometer regularly and well, use his pillow/bear/whatever they give to splint his chest when coughing or moving around. Encourage him to cough and deep breathe, and when he is ready and able, get up and walk, walk, walk!!!! All that walking is GOOD for him. Encourage him to eat, and if he's not hungry, at least eat the foods with PROTEIN, as his needs are significantly increased due to the healing process his body is going through. Usually, POD 5-7 there is a bad couple days, then things start getting better again. POSITIVE ATTITUDE can do wonders in his recovery. Best of Luck and God Bless!!!

Mommy_of_3_in_AL..RN · Dec 26, 2008

Thanks. That was my next question..how long to expect the vent and all. Like i said, that kind of stuff usually doesnt bother me. I have become accustomed to it, but something about it being my dad has me starting to freak out..i think i am more upset because i know i cant do anything..i cant be in there pushing buttons and titrating drips and things like that. I have to be the family, not the nurse, and i like to have more control than that. I joke with my mom that she would have to tie my my hands up. So, i will maintian my composure, do what i am told, and grin and bear it. I will make sure to do all you said..he can be hard headed, so i may have to push him..hopefully he will listen

TAB_RN · Dec 26, 2008

I worked on a cardiac thoracic surgical floor for a year. Our patients were up and out of bed the evening of surgery (in a chair). Typically, the patient feels better than before the surgery on day 2. They stay one day in ICU, then back to the floor. The chest tubes usually come out by the afternoon of day 2. The wires (pacer) are usually out also on the afternoon of day 2. Day 2 is typically the first day for walking. AMAZING how well these patients do. By day 4 the patient is going home. I LOVE CABG patients. It is one of those surgeries that is like "instant gratification" - the patient looks amazing after regaining their circulatory system!

joeyzstj, LPN · Dec 27, 2008

The national average weaning time is aprox 5 hours from hitting the unit until extubation. Some facilities measure times differently and perform reversals differently. We do a complete wake up in our unit, meaning that we dont reverse and they dont sit in OR post-op for hours like some hospitals. From my experience, without being reversed, anethesia takes about 5-6 hours to "wear off" enough that a person can be extubated. Your dad will most likely have a Swan-Ganz catheter for titrating drips and checking cardiac function. He will have chest tubes.........probably at least two, one being a mediastinal and a pleural possibly. He will have multiple drips, an NG tube, a foley, a central line, an Arterial-line, and within a few hours post-op he is going to look pretty foreign to you due to swelling in the face. His color will most likely look pale, he will be covered in betadine the first time you see him. As he progresses, all of the lines and the vent will come out. We dont get people up into a chair until the next day unfortunately. My faciliy does a lot of typical cases, however we do a lot of cases that were deemed inoperable by other facilites, so the length of stay and severity of the cases can be extreme in some cases. As long as he doesnt smoke and doesnt have a huge history of renal issues he should do fine. Good luck.

Mommy_of_3_in_AL..RN · Dec 28, 2008

Ok. that makes me feel a little better, knowing what to expect. I am familiar with those lines and drains, so i will know what to look for. I am also familiar with most drips and their functions, as well as the sedatives and reversal agents. I was not really aware of the swelling though, so thank you for mentioning that. He is a lifelong smoker..about 2 packs a day for 35 years or so. I know that will make recovery a little more dificult, but i was wondering what differences i can expect to see, and what complications could be made worse by that??

allnurses Guide · Dec 28, 2008

Short term, you can get some increased difficulty getting off the ventilator (although uncommon). More likelihood of respiratory complications.

Longer term, problems with wound healing etc.

RNKPCE · Jan 3, 2009

Once out of ICU and on the floor they will usually have a day where they really feel wiped out. Usually 3rd or 4th day post op. It is veryyyyy common. They don't want to eat and they feel beat up. Just encourage them to take their pain med and still participate in activities such as walking and up in chair for meals and of course their incentive spirometer. Each day the patient will feel better they may not realized til a week or so post op and looking back they will realize it.

Encourage family members to assist the patient in ADL's but not do for the patient. Sometimes I will see a wife spoon feeding her 48 year old husband. I tell them if they were feeding themselves pre-op they need to do it themselves post op. Once out of ICU the post op period is a time of rehabilitation. Getting back to where the patient was or even better.

If the hospital has a cardiac rehab program this a great safe way to start an supervised exercise program on an outpatient basis.

Mommy_of_3_in_AL..RN · Jan 4, 2009

Thanks for everyones input. He had the surgery on Tuesday, and came home today. He did very well with the sugery, but his blood pressure kept running (and staying) low. They started him on a dobutamine drip, and 24 hours later we realized that it had expired SIX MONTHS ago!!! They changed the bag, did all the necessary paperwork, etc..Couple hours later, BP was completely normal, if not a little on the high side. Yesterday morning he went into afib, and they had to bolus amiodarone twice, put him on an amiodarone drip, and by mouth. He converted back to normal after several hours, remained on the drip until last night, and continues to do fine with that. Came home this morniing on amiodarone by mouth, with orders to come back in a week. he will also begin cardiac rehab outpatient.

My problem is that he is rather noncompliant. He doesnt want to eat, because his apetite is bad and nothing tastes good, so he figures he just doesnt have to eat. Also, he will not use the incentive spirometer unless you tell him to..he wont take it upon himself. He is getting up and moving great, but will only do so when told...not as much as he should..so, getting him to comply is going to be the problem!!!

RNKPCE · Jan 4, 2009

I knew one nurse who told her non compliant patient that if he didn't get up walk and use his incentive spirometer he increases his chance of getting pneumonia and he might have to had the tube shoved back down his throat. I know if sounds kind of rough but it is true and some times the thought of being intubated again does the trick.

I always tell pt that in the hospital you have a minimum of three shifts of nurses listening to your lungs, then the doctors and respiratory therapy if ordered, all asking them to take deep breath. At home no one is doing this. At this point getting better is in his court.

Mommy_of_3_in_AL..RN · Jan 5, 2009

LOL i told him that the life insurance was paid up and he would gladly collect if he let himself die cause we werent babying him. I also told him they could put all those tubes back, and may not be so nice as to do it while he was asleep this time.