Heart SurgeryGeorgia Baptist College of Nursing

NUR 351 Critical Care Nursing

Dr. Kathy Plitnick

Coronary Artery Bypass Surgery Definition

Surgical revascularization procedure Restores blood flow to ischemic heart

Goals Relieve symptoms Improve quality of life

Indications for Surgery Intractable Angina Left main stenosis Unsuccessful PTCA, thrombolytics VSD

Risk Factor Modification

CABG Procedure Midline sternotomy Anticoagulation Cardiopulmonary bypass Hypothermia induced Aortic cross-clamping – Cardioplegia Graft retrieval Wean from CPB Internal defibrillation Rewarming – Heparin reversal

Cardiopulmonary Bypass Provides bloodless operative field CPB machine

Venous reservoir, filters, oxygenator, heat exchanger, roller pump, sensors

Physiologic Variables Hemodilution Hypothermia Hemodynamics

Complications of CPB Coagulation altered RBC’s damaged Increased capillary permeability Microembolism Increased SVR Alteration in carbohydrate metabolism

Post-operative Complications Myocardial infarction Low cardiac output state Hemorrhage Cardiac tamponade Dysrhythmias Thrombotic/embolic complications Respiratory complications Coagulation problems

Post-operative Complications Renal dysfunction Fever/infection Altered CNS

Nursing – Preoperative Care Psychological preparation

Reduce anxiety Teaching

ICU environment Incisions & dressings Awakening from anesthesia Expected discomfort Appearance Postop respiratory care Visiting hours

Nursing – Postoperative ICU Care Ventilation and Oxygenation Hemodynamics

Regulate HR, rhythm, BP, CO Chest drainage & Bleeding Urine output Temperature regulation Neurological status Postoperative pain