CVIC Journal

Val Jeffery

3/28/2018

CVIC

The purpose of a coronary artery bypass graft or CABG is to redirect blood flow

from a blockage in a coronary artery. This procedure is done by harvesting a blood vessel

from the leg, arm or chest, and attaching it to another artery in the heart; this will divert

blood flow from the blockage and supply the rest of the heart with adequate oxygenation.

CABG’s are done in patients who have had previous failed coronary stents, one or more

diseased artery in the heart, or in a case where angioplasty is not an option.

Patients returning from the OR are usually placed on multiple monitoring devices

such as a thoracic chest tube, mechanical ventilation or have a Swan Ganz monitor

placed. The purpose of a chest tube is to drain any fluid or air that builds up in the chest

cavity and reduce any cardiac or pulmonary complications. Mechanical ventilation is

necessary post-operatively since patients will most likely be recovering from general

anesthesia, and will not be able to breathe on their own. Putting a patient on a vent will

also significantly decrease the workload of the heart since the machine will carry out the

work of breathing if on an A/C mode. Post-op cardiac patients could potentially have a

Swan Ganz placed for a multitude of reasons, but the main purpose is to monitor blood

flow through the heart and any complications that may arise post-MI. It can also diagnose

a patient with cardiac tamponade, pulmonary hypertension or restrictive cardiomyopathy.

There are many causes to a decrease in cardiac output after surgery, but the main

ones include having a low ejection fraction of the left ventricle because it’s been working
too hard to push blood out, or the patient is in fluid volume excess. Cardiac dysrhythmias

are also a common complication since any trauma, surgical or not, can throw the heart of

track. For example, inserting a Swanz catheter can lead to supraventricular tachycardia if

the catheter is left in the right ventricle, or if a balloon pump that is not calibrated to the

patient’s heart rate inflates on systole, it can cause a back up of blood into the right side

of the heart, causing atrial fibrillation and eventually CHF. Cardiac tamponade is a

medical emergency that must be treated immediately. It is the build up of fluid within the

pericardial space, restricting the ventricles to effectively fill and pump blood to the rest of

the body, eventually leading to pulmonary HTN/edema, shock, then death. A diagnosis of

cardiac tamponade is usually caused by pericardial effusions. A pneumo/hemothorax is

another potential post-op complication resulting from accidental puncture of the lung

during surgery or from mechanical ventilation which can induce barotrauma and oxygen

toxicity if the FiO2 is above 60% for longer than 48 hours.

Overall my experience in the CVIC was very educational. I was with Patricia for

my shift, and she knew a lot regarding balloon pumps and Swanz catheters. Toward the

end of the shift it got a little boring since the patients were all stable and there were no

meds to pass or procedures to do. However, I’d highly recommend going to the CVIC if

you want to brush up on your cardiac education and patient care.