Working on specialized stepdown unit

Editorial Team / Admin · Nov 18, 2015

Well, this is my experience as an OR nurse at my facility (yours may vary).

In this unit they do patients with lumbar drains. How do these relate to cardiac surgery? What are the nursing considerations?

The only procedure I've seen lumbar drains placed on cardiac patients is for thoracic endoscopic aneurysm repair (TEVAR). Issues with paralysis can be a risk for these patients, and

One approach with support in the literature is the preprocedural placement of an intrathecal drainage catheter via a lumbar approach to drain cerebrospinal fluid and thereby keep the intrathecal pressure low. This approach, when combined with permissive postoperative hypertension, allows for an elevated relative spinal perfusion pressure. An alternative approach is placement of a lumbar drain with the plan to lower the spinal perfusion pressure in the event that the patient develops signs of SCI or placement of a drain only in the event of symptoms. A large meta-analysis found in support of placement of lumbar drains in patients at risk for paraplegia based on aneurysm length, but advised of significant risk of subdural hematoma and meningitis.

(from Thoracic Interventions: Endovascular Repair of Thoracic Aortic Aneurysms) I can't really tell you about the nursing considerations for these as we always have a neuro ICU nurse present to set up the monitoring devices.

Also, they have post CABG and MVR and AVR. Are the chest tubes mostly going to be mediastinal? Will they be to gravity or suction? I haven't done chest tubes in a while and when I did manage them, they generally were pleural.
Thank you so much all!
Z

My valve patients typically leave the OR with two mediastinal chest tubes that are to suction. CABG patients will have the mediastinal chest tubes as well as a pleural chest tube if an internal mammary artery (IMA) was used for a graft. Typically, we will use the LIMA to graft the LAD. In some younger, non-diabetic patients, we may also use the RIMA. In addition, we may place pleural chest tubes if the patient is found to have a pleural effusion. We actually connect all of our chest tubes (pleural and mediastinal) from cardiac surgery to a single collection device at -20 for suction.

Definitely ask about this during your orientation, and never be afraid to ask a colleague about things you have questions about.