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Critical Care Nursing - Clinical
Seminar Title :
CABG ( Coronary Artery Bypass Graft )
OR
ACB ( AortoCoronary Bypass )
Served To :Dr. Lourance Al Hadid
MsN. Hadeel Taleb
Prepared by :
Khaled Mahajna
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Outlines
Definition of CABG
Review of Coronary Arteries
Purposes
Indications for CABG
Contraindications for CABG
Procedure
Nursing Management
Pre operative Phase Intra operative Phase
Post operative phase
Complications
References
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Objectives
At the end of this presentation the students will be able to :
1. Define CABG
2. Describe the review of coronary arteries
3. Describe the process of the procedure
4. Use the nursing management
5. Define the indications , contraindications , complications
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Definition
Is a surgical procedureperformed to relieveanginaand reduce the risk of death fromcoronary artery disease. Arteriesor veinsfromelsewhere in the patient's body are grafted(internal thoracic arteries, radial arteries andsaphenous) to the coronary arteriesto bypassatheroscleroticnarrowingsand improve thebloodsupply to the coronary circulationsupplying the myocardium(heart muscle).This surgery is usually performed with theheart stopped .
http://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Coronary_heart_diseasehttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Medical_graftinghttp://en.wikipedia.org/wiki/Coronary_arteryhttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Stenosishttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Coronary_circulationhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Coronary_circulationhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Stenosishttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Coronary_arteryhttp://en.wikipedia.org/wiki/Medical_graftinghttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Coronary_heart_diseasehttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Surgery8/13/2019 cabg-130102113345-phpapp01
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Number Of Bypass
The terms single bypass, double bypass, triple bypass,quadruple bypassand quintuple bypassrefer to thenumber of coronary arteries bypassed in the procedure.In other words :
double bypass means two coronary arteries are
bypassed (e.g. the left anterior descending (LAD)coronary artery and right coronary artery (RCA)
triple bypass means three arteries are bypassed (e.g.LAD, RCA, left circumflex artery (LCX)
quadruple bypass means four vessels are bypassed (e.g.LAD, RCA, LCX, first diagonal artery of the LAD)
Bypass of more than four coronary arteries isuncommon.
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Review Of Coronary Arteries
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Purposes
Restore blood flow to the heart
Relieves chest pain and ischemia
Improves the patient's quality of life
Enable the patient to resume a normal lifestyle
Lower the risk of a heart attack
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Indications For CABG
Patients with blockages in coronary arteries
Patients with angina
Patients who cannot tolerate PTCA (Percutaneous
transluminal coronary angioplasty ) and do not respond
well to drug therapy
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Contraindications For CABG
Aneurysms
Valvular diseases
Congenital diseases
diseases of blood
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Procedure
An endotracheal tubeis inserted and secured by the anaesthetist andmechanical ventilationis started. General anaesthesia is maintained by
a continuous very slow injection of Propofol.
The chest is opened via a median sternotomyand the heart is
examined by the surgeon involves creating a 6 to 8 inch incision in the
chest (a thoractomy) . The bypass grafts are harvestedfrequent conduits are the internal
thoracic arteries, radial arteriesand saphenous veins. When harvesting
is done, the patient is given heparinto prevent the blood from clotting.
"on-pump", the surgeon sutures cannulaeinto the heart and instructs
theperfusionistto start cardiopulmonary bypass(CPB). Once CPB isestablished, the surgeon places the aortic cross-clampacross the aorta
and instructs the perfusionist to deliver cardioplegia to stop the heart
and slow its metabolism
http://en.wikipedia.org/wiki/Endotracheal_tubehttp://en.wikipedia.org/wiki/Mechanical_ventilationhttp://en.wikipedia.org/wiki/Propofolhttp://en.wikipedia.org/wiki/Median_sternotomyhttp://en.wikipedia.org/wiki/Internal_thoracic_arteryhttp://en.wikipedia.org/wiki/Internal_thoracic_arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Saphenous_veinhttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Cardiopulmonary_bypasshttp://en.wikipedia.org/wiki/Perfusionisthttp://en.wikipedia.org/wiki/Cardiopulmonary_bypasshttp://en.wikipedia.org/wiki/Aortic_cross-clamphttp://en.wikipedia.org/wiki/Cardioplegiahttp://en.wikipedia.org/wiki/Cardioplegiahttp://en.wikipedia.org/wiki/Aortic_cross-clamphttp://en.wikipedia.org/wiki/Aortic_cross-clamphttp://en.wikipedia.org/wiki/Aortic_cross-clamphttp://en.wikipedia.org/wiki/Cardiopulmonary_bypasshttp://en.wikipedia.org/wiki/Perfusionisthttp://en.wikipedia.org/wiki/Cardiopulmonary_bypasshttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Saphenous_veinhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Internal_thoracic_arteryhttp://en.wikipedia.org/wiki/Internal_thoracic_arteryhttp://en.wikipedia.org/wiki/Median_sternotomyhttp://en.wikipedia.org/wiki/Propofolhttp://en.wikipedia.org/wiki/Mechanical_ventilationhttp://en.wikipedia.org/wiki/Endotracheal_tube8/13/2019 cabg-130102113345-phpapp01
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Procedure
One end of each graft is sewn on to the coronary arteriesbeyond theblockagesand the other end is attached to the aorta.
Chest tubesare placed in the mediastinal and pleural space to drain
blood from around the heart and lungs.
The sternumis wired together and the incisions are suturedclosed.
The patient is moved to the intensive care unit(ICU) to recover.
Nurses in the ICUfocus on recovering the patient by monitoring
blood pressure, urine output and respiratory status as the patient is
monitored for bleeding through the chest tubes. If there is chest tube
clogging, Thus nurses closely monitor the chest tubes and under take
methods to prevent clogging so bleeding can be monitored and
complications can be prevented.
After awakening and stabilizing in the ICU (approximately one day),
the person is transferred to the cardiac surgery warduntil ready to go
home (approximately four days).
http://en.wikipedia.org/wiki/Coronary_arteryhttp://en.wikipedia.org/wiki/Coronary_artery_diseasehttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Chest_tubehttp://en.wikipedia.org/wiki/Human_sternumhttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/Intensive_care_unithttp://en.wikipedia.org/wiki/ICUhttp://en.wikipedia.org/wiki/Chest_tubehttp://en.wiktionary.org/wiki/wardhttp://en.wiktionary.org/wiki/wardhttp://en.wikipedia.org/wiki/Chest_tubehttp://en.wikipedia.org/wiki/ICUhttp://en.wikipedia.org/wiki/Intensive_care_unithttp://en.wikipedia.org/wiki/Surgical_suturehttp://en.wikipedia.org/wiki/Human_sternumhttp://en.wikipedia.org/wiki/Chest_tubehttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Coronary_artery_diseasehttp://en.wikipedia.org/wiki/Coronary_artery8/13/2019 cabg-130102113345-phpapp01
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Explanation
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Heart Lung Machine
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Nursing Management
Pre operative Phase
Intra operative Phase
Post operative Phase
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Pre operative Phase
Assessment
Patient history
Physical Examination (head to toe ) Diagnostic procedure
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Patient History
Patient history of major illness, previous surgery,medications, and usage of drugs and smoking and
drug history
A systematic assessment of all systems performed
,with emphasis on cardiovascular functioning
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Physical Examination
Functional status of the cardiovascular systemdetermined by reviewing the patient symptoms ,
including past and present experience with chest
pain ,hypertension, palpation ,cyanosis, breathing
difficulty ,leg pain that occur with walking
,Orthopnea, peripheral edema.because alteration
in cardiac function (cardiac out put can affect
renal, respiratory, gastrointestinal ,integumentary, hematological, and neurological
functioning )
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Physical Examination
General appearance and behavior.
Vital signs
Nutritional and fluid status ,weight, height
Inspection and palpation of the heart ,noting the point of
maximal impulses ,abnormal pulsation ,and thrills
Auscultation of the heart ,noting pulse rate ,rhythm, and
quality; S4 and S3 , murmur, and friction rib
Jugular venous pressure
Peripheral pulses
Peripheral edema
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Psychosocial Assessment
Meaning of the surgery to the patient and family
Coping mechanisms that are being used
Measures used in the past to deal with stress
Anticipated changes in life style
Support system in effect
Fears regarding the present and future
Knowledge and understanding of the surgical procedure,
postoperative course and long term rehabilitation
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Nursing Intervention
Explain all treatment and procedure done for the patientanswering any question patient may have .present
information at patient understanding level to reduce
patient anxiety
Orient patient to surrounding Assign the same nurse to care for patient when ever
possible to provide consistency of care, enhance trust and
reduce threat often associated with multiple care givers.
Spend time with patient each shift to allow time forexpression of feelings, provide emotional outlet and
promote feeling of acceptance.
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Intra operative Phase
Patient will receive general anesthesia ,be intubated , and placed on
mechanical ventilator, the preoperative nurse are responsible for the
patient safety and comfort. Someof the areas of intervention
include positioning, the skin preparation wound care, and
emotional support to the patient and family. Before chest incision is closed, chest tubes are positioned to evacuate
air and drainage from the media sternum and the thoracic cavity .
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Intra operative complication
Possible Intraoperative complication
includes Dysrthmyais,Hemorrhage ,
Emobilization , Organ failure from shock ,or adverse drug reaction.
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Post Operative
GOAL: achieving or maintaining homodynamicstability and recovery form general anesthesia
Assessment
Neurological system Cardiac status
Respiratory status
Peripheral vascular status
Monitor complication
Renal function
Pain
Fluid and electrolyte
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Complications
Decrease C/O Fluid overload
Hypothermia HTN
Tachydysrythmias Bradycardia
Cardiac failure Acute renal failure
Electrolyte imbalance Hepatic failure
Infection
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Nursing Diagnosis Related To CABG
Decrease cardiac output
Impaired gas exchange
Risk for imbalance fluid volume
Acute pain
Deficient knowledge
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ANY QUESIONS
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References Medscape http://emedicine.medscape.com/article/1893992-overview
AHA http://my.americanheart.org/professional/General/2011-ACCFAHA-
Guideline-for-Coronary-Artery-Bypass-Graft-Surgery
TextbookBrunner and Siddhartha's Textbook of Medical-Surgical Nursing, 12th edition,Brunner and Siddhartha's Textbook of Medical-Surgical
Nursing 2012
http://emedicine.medscape.com/article/1893992-overviewhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://my.americanheart.org/professional/General/2011-ACCFAHA-Guideline-for-Coronary-Artery-Bypass-Graft-Surgeryhttp://emedicine.medscape.com/article/1893992-overviewhttp://emedicine.medscape.com/article/1893992-overviewhttp://emedicine.medscape.com/article/1893992-overviewhttp://emedicine.medscape.com/article/1893992-overviewhttp://emedicine.medscape.com/article/1893992-overview8/13/2019 cabg-130102113345-phpapp01
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THANK YOUFOR
GOOD LISTENING
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KHALED MAHAJNA .RN
FACULTY OF NURSING
AL ISRA UNIVERSITY
Mobile(+962)-78-6627008
Khaled Mahajna