Mary Duda

Critical Care

10/02/20

Mrs. Shugart

On Friday October 2, 2020, I had the opportunity to observe open heart surgery. I saw a

Coronary Artery Bypass Graft Surgery with a Mitral Valve repair with Dr. Henn. The Mitral

Valve repair was done with half of a ring, or a band. The OR team harvested part of the greater

saphenous vein for the graft. The OR team was a lot bigger than I expected. It consisted of one

surgeon, the surgeon’s assist, 2 anesthesia nurses, two scrub nurses, two people worked on

harvesting the graft, there was a perfusionist who controlled the bypass machine, and lastly, the

circulating nurse. The staff was rotating in and out of the room to give breaks, and to complete

their portion of the surgery.

The purpose of the cardiopulmonary bypass machine is to direct the blood flow away

from the vascular system and the non-beating heart and is circulated through a system of

reservoirs and pumps to maintain circulation of blood and oxygenation to the body. After the

heart is stopped, extracorporeal circulation replaces the normal circulatory system. The

extracorporeal circulation method filters the blood, it undergoes oxygenation, filtration and

cooling after this takes place, the blood is returned back into systemic circulation. The

cardiopulmonary bypass machine uses moderate levels of hypothermia to reduce the oxygen

demand of the myocardium which in turn protects organs from potential damage. There are quite

a few nursing priorities post-CABG. The first priority upon arrival to the ICU is maintaining a

patent airway, this includes assessing proper placement of the ET tube, listening to breath
sounds, and ventilation management (pulmonary hygiene, Q2 hour turns, and suctioning.) The

next priority is maximizing cardiac output and tissue perfusion and preventing/treating

complications, this includes physical assessments, vitals, the presence of any arrythmias, I/O,

and LOC. Open heart surgery increases the risk of post-op infection, so it is important to monitor

any signs and symptoms of infection. Pain management is another nursing priority because open

heart surgery is painful with a saw being used to open the sternum for access to the chest cavity.

Chest tube management is a priority to restore negative pressure to the pleural space, the chest

tube system is connected to suction and an occlusive dressing is necessary for the chest drainage

system to work. Care of arterial lines for continuous monitoring of blood pressure, NG tubes and

urinary catheters are important for monitoring intake and output. The nurse will need to obtain

report from the OR team, and will need to draw some post-op labs, a chest x-ray and a 12 lead

EKG to monitor for post-op complications. All these nursing priorities try to monitor and

prevent any post-op complications from occurring like bleeding, arrythmias, pain, anxiety,

infection, hypovolemia, cardiac tamponade, and vasodilation. Lastly, patient and family

education are major nursing priorities to ensure effective self-care for patients when they return

home, including detailed discharge instructions.

Overall this experience was amazing, I truly enjoyed this experience. I am very interested

in surgical nursing, and I hope to get a job in surgery after graduation. I would 100% recommend

this experience for future students. I observed really good communication and effective

treatment for the patient by the surgical team. OR teams are a good example of intradisciplinary

management to provide the best care possible for the patient. This experience solidified my

feelings about what kind of unit I want to work on after graduation.

Sources:

“Chapter 15/ Alterations in Myocardial Tissue Perfusion.” High-Acuity Nursing, by Kathleen

Dorman Wagner et al., 7th ed., Pearson, 2018, pp. 418–442.