What to know before starting CTICU preceptorship?

humanity · Jan 1, 2013

CT-Surgery patients will be post-op CABG, Valve replacements, Heart Transplant if your hospital does it. As a ICU especially CT surgery you have to be familiar with hemodynamic monitoring from front to back need to know the hemodynamic parameters such as CVP,RAP,PA, PAWP, CO, SVR , SVRI, CI, PVR, PVRI and so on need to know what to do if something is abnormal, need to be aware of pressors from head to toe such as dobutamine,levophed,epinephrine, dopamine,amiodorone, esomolol and so on. Also need to know which is compatible with what and which one needs filter, how often you changed tubing. I don't know how your facility works but, if you work in ICU you just not get only CT-Surgery patients but might get SICU or MICU patients. Assessment wise your heart needs two thing to work one is mechanical and other one is electrical. If their is mechanical problem may be due to tamponade then the patient has to go back to OR IMMEDIATELY or they may have to open the chest crack open at bedside familiar yourself your unit Heart Cart. Other thing your heart may need is a jump start from the external pacemakers. Usually a surgeon will connect a pacer wires Right one is Atrial wire with a ground wire and left one is ventricle wire with a ground wire. Make sure it is connected to pacemaker. Take one day at a time. You may have a patient with a balloon pump. Cardiac is my favorite. I hope you'll like CTICU. If in doubt Always ask questions.

Biffbradford · Jan 1, 2013

I just found out that my preceptorship is in the cardiothoracic ICU and I'm excited but extremely nervous. What should I brush up on to not only be at my best but also impress my preceptor and show her that I want to learn. I guess I'm looking for what drips and meds to be aware of and what post op assessments/interventions I should brush up on as well. Also any helpful advise that you can offer would be great!!! Thanks!!

15 years cardiac ICU speaking here:

Don't try to impress, just be a sponge and absorb. Don't pretend to be a know it all, because you don't know squat and we know it!

Be thorough in your work, don't take shortcuts, and if you're not sure ... ask someone.

Cardiac patients, especially surgical, can turn bad in a wink of an eye, so stay on top of things. For example, if the pt is peeing a lot, or very little ... check a K+. Bleeding? Get an HCT. Not breathing right? ABGs. Got a gut feeling that something isn't right, even though they 'appear' okay? Go with your instincts.

Need specifics? Start with the basics: EKG recognition. Review simple pressors like Dopamine, and Vasopressin. Inotropes like Dobutamine. Anti arrhythmics like Amiodarone and Lidocaine. Other common drips: Insulin, Lasix, Fentanyl.

Push drugs: Morphine, Fentanyl, Digoxin, Protonix, Zofran.

The CTICU/CVICU can chew you up and spit you out EASILY so just take it slow and don't get discouraged if you have a bad day. My first few weeks I wanted to quit every day. After a month I only wanted to quit once a week. After 5 years, nothing bothers you anymore and you're on top of the game. After that, it just gets tiring and you begin to want to quit again, but for different reasons.

It's very rewarding however, and such an eye opener ... you have no idea.

GOOD LUCK!

missnurse01, MSN, RN · Jan 2, 2013

you will get tons of stuff to study up on from preceptors, so don't worry!

for fun you can look up some of the hemodynamic websites to start understanding all the numbers we watch and what they mean.

Also you can check out a CCRN review book from the library to look at.

Don't overwhelm yourself! You will always be learning.

good luck

Nyla Maddox · Jan 2, 2013

Wow! I'm looking to get hired in the cardio surgical icu too! Thank you for the great posts!

bug2621, MSN, APRN, NP · Jan 3, 2013

Awesome Suggestions!! Thanks you all so much!!

meandragonbrett · Jan 3, 2013

How about starting with some critical care basis. index is a good website for some basic things that will lay a good foundation for any critical care area.

nihaojailan · Jan 5, 2013

I'm having my preceptorship right now. My preceptor isn't expecting anything from me, and she knows I know nothing special under my sleeves. Lol. She knows I'll be a chicken running with a head cut if something crazy happens, she knows I'll freak the f*ck out the first few weeks (her words). HOWEVER, She's expecting me to know my Anatomy and Physiology, she expects me to ask and not assume I know things, she expects me to calm down so I can comprehend what she's teaching me, she expects me to be open and learn how she teaches me things, she also expects that I don't quit. Lol. Needless to say, she's so awesome that she said these things the 1st day.

Williams75 · Jan 31, 2013

Good Luck!! this is major. Please let us know how are you doing. I would love to here your experience there.

coco317 · Jan 31, 2013

I did my preceptorship in the CVICU and I actually got hired on the unit as a brand new RN after I took my boards. I was in contact via email with the nurse manager before I started my preceptorship. I just asked her what drips were most commonly used at their facility and any other things I could review prior to starting. I was able to brush up on the most commonly used medications and she also gave me an idea of he patients they take care of.

Good luck and just take it all in and ask lots of questions. Ask for honest feedback at the end of the day so you can improve on your weak areas. Any down time (haha like that exists right?? =p) ask for the rationale of why something was ordered-it will help you understand the whole picture better. Be assertive- let your preceptor know your needs and what you expect to gain from your experience.

Jaelle625 · Feb 2, 2013

This was my response from a similar previous post:

I can't speak for experienced CVSICU nurses as I'm new to this specialty myself, but I can give some insight from the "newbie" perspective.

Questions. Ask them. A lot. The amount of knowledge these nurses possess is staggering. Be a sponge! You are in a unique position to learn without all the stress of extreme expectation.

If you don't know the answer, say you don't know. Trust me, your preceptor knows the answer and can smell BS from a mile away.

Study, Study, Study. When you think you're done studying... study some more. i make it a point to make a list throughout the day of things that are mentioned that I want to know more about. Then I look it up as soon as I get home.

If you have down time (which is rare, but may happen from time to time), and your preceptor doesn't mind (which they shouldn't), seek out interesting cases, new admits, transfers... anything that you haven't been exposed to or want to know more about.

You'll know almost right away if this is the specialty for you (or so I've heard; I couldn't imagine not absolutely loving it!). I could go on and on about how amazing this unit is, but in all honesty its not for everyone. Its fast paced, crazy intense, and you're expected to be on top of your game no matter what rolls out of the OR. You MUST have thick skin. You WILL feel dumb at times. You WILL screw up. Learn from it and move on. The gym, my family, and chocolate cake get me past the tough days. ??

All that said, I wouldn't trade it for the world!

Let us know how it's going!

Josscue · Feb 7, 2013

Great advice! I've been in ICU/CCU for 12 yrs.