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Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011 October 22, 2011

Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

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Page 1: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Nursing Care: Robotic-Assisted Cardiac Surgery

Jane C Whalen RN, MSN, CCRN, CCNS

October 22, 2011October 22, 2011

Page 2: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Objective

Adapt nursing care and patient Adapt nursing care and patient education for patients undergoing education for patients undergoing minimally-invasive / robotic – assisted minimally-invasive / robotic – assisted cardiac surgerycardiac surgery

Page 3: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Are They Different?

What have you heard?What have you heard?What would you expect?What would you expect?What do you think patients want to know?What do you think patients want to know?

Page 4: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Pre-Operative Patient Education

IncisionsIncisionsYes, you will have them!Yes, you will have them!They’re just differentThey’re just different

PainPainYes, you will have painYes, you will have painIt can be more painful than a sternotomyIt can be more painful than a sternotomy

Page 5: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Sternotomy

Page 6: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Robotic / Minimally-Invasive Incisions

Page 7: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Femoral Cannulation

Unilateral Unilateral incisionincisionBilateral incisionsBilateral incisions

Radial Arterial Lines

Page 8: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Pre/Post-Operative Care: Prevent Infection

Same as with sternotomySame as with sternotomy

Intranasal mupirocin (Bactroban®)Intranasal mupirocin (Bactroban®)

Pre-op skin prepPre-op skin prep

Wound care post-opWound care post-op

Insulin infusion / glucose managementInsulin infusion / glucose management

Page 9: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Post-Operative Care: Activity

Same progression as with sternotomySame progression as with sternotomy

No “sternal precautions”, but…No “sternal precautions”, but…

Limit lifting, affected side, for pain controlLimit lifting, affected side, for pain control

Return to work in 2-4 weeksReturn to work in 2-4 weeks

Page 10: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Post-Operative Care: Pain

Pain more severe in 1Pain more severe in 1stst 48 hours 48 hours

Ketorolac (Toradol® ) IVKetorolac (Toradol® ) IV• 15-30 mg q6h x 24 hours15-30 mg q6h x 24 hours• If renal function OKIf renal function OK• Not with CABG Not with CABG (( risk of thrombosis) risk of thrombosis)

IV Acetaminophen (Ofirmev®)IV Acetaminophen (Ofirmev®)• 15 mg/Kg q6h x 24 hours15 mg/Kg q6h x 24 hours• D/C all other forms of acetaminophenD/C all other forms of acetaminophen

Page 11: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Post-Operative Care: Pulmonary

Unilateral pulmonary edema commonUnilateral pulmonary edema common

Crackles, diminished breath soundsCrackles, diminished breath sounds

Pulmonary toilet is criticalPulmonary toilet is critical

Page 12: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study #1 Mr. S68 yo male68 yo maleElective robotic mitral valve repairElective robotic mitral valve repairCrossclamp time 80 minutesCrossclamp time 80 minutesExtubated: 3 hours, 50 minutes post-opExtubated: 3 hours, 50 minutes post-op

Page 13: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Mr. S

POD #1POD #1Hemodynamically stableHemodynamically stableSpOSpO2 2 96-98% on 2L nasal O 96-98% on 2L nasal O22

CT 310 CT 310 mlml/8 hrs/8 hrsTo telemetryTo telemetry

Page 14: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Mr. S

POD #2POD #2Small PTXSmall PTXSpOSpO22 93% 5L O 93% 5L O22

Page 15: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Mr. S

POD #3POD #3Desaturated during night Desaturated during night (POD #2 – POD #3)(POD #2 – POD #3)

0930 ABGs on 12L O0930 ABGs on 12L O22

pHpH 7.537.53PCOPCO22 35.835.8

POPO22 6060

HCOHCO33 3030

SatSat 94%94%

Page 16: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Mr. S

POD #3POD #3Pulmonology consultPulmonology consultFurosemide (Lasix®) infusionFurosemide (Lasix®) infusionSputum cultureSputum cultureAntibioticsAntibiotics100% Non-rebreather100% Non-rebreather

Page 17: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Mr. S

POD #4POD #4Transfer to ICUTransfer to ICU ABGs on 100% non-rebreather maskABGs on 100% non-rebreather maskpHpH 7.497.49PCOPCO22 4141

POPO22 5858

HCOHCO33 30.530.5

SatSat 92%92%

Bi-PAPBi-PAPSteroidsSteroids

Page 18: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Mr. S

POD #5POD #5CXR improvingCXR improving

POD #6POD #6Weaned to 4L OWeaned to 4L O22

Up to chairUp to chairPT/OT for deconditioningPT/OT for deconditioning

POD #8POD #8Transfer to telemetryTransfer to telemetry

Page 19: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Mr. S

POD #9-14POD #9-14Weaning OWeaning O22

Continued needing increased OContinued needing increased O22 with activity with activity

Changed furosemide to po dosingChanged furosemide to po dosingCXR improvedCXR improved

POD #15-18POD #15-18ImprovingImprovingHome day 18Home day 18

Page 20: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study #2: Ms. K

30 yo female, non-smoker30 yo female, non-smokerDyspnea, chest painDyspnea, chest painWork-up revealed left Work-up revealed left atrial myxomaatrial myxoma

Page 21: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Ms. K

Robotic-assisted resection of LA myxomaRobotic-assisted resection of LA myxoma

Crossclamp time 15 minutes; CPB 1 hourCrossclamp time 15 minutes; CPB 1 hour

Extubated 3 hrs, 5 minutesExtubated 3 hrs, 5 minutes

Page 22: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Case Study: Ms. K

POD #1POD #1Chest tube D/C’dChest tube D/C’dTo telemetryTo telemetry

POD #2POD #2HomeHome

Page 23: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Minimally-Invasive vs Sternotomy

No difference in average extubation timeNo difference in average extubation time

Pain less after first 48 hoursPain less after first 48 hours

Less infection riskLess infection risk

Length of stay 1-2 days shorterLength of stay 1-2 days shorter

Full recovery in half the time Full recovery in half the time (4-6 weeks)(4-6 weeks)

Page 24: Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

Questions