CABG Flashcards
What is the goal of CABG
Goal: Improve quality of life and reduce
cardiac-related mortality
What are the indications of CABG
Critical LCA or three‐vessel disease
- Failure of medical management
- Not candidate for/failure of Percutaneous
Coronary Intervention (PCI)
What factors increase the benefit of PCI over CABG
-Elevated mortality risk with CABG • Elevated stroke risk • Extreme frailty • Prior CABG • Acute STEMI at presentation
Factors for which CABG increases the survival benefit:
- Left ventricular ejection fraction of 45% or less
- Diabetes mellitus
- Ischemic mitral regurgitation
- PCI failure, with or without acute MI (AMI)
What does a CABG do for the patient
Surgery that creates new conduits around the narrowed/blocked coronary arteries ►Increases blood flow to deliver oxygen to the myocardial tissues ►Relieves chest pain ►Does not alter atherosclerosis, but improves quality of life
PreOP nursing care for CABG Pts Forms? Meds? Testing? Assessments?
►Informed consent ►Lab work, CXR, ECG ►Baseline cognitive status ►Comorbidities ►Administer medications • Anxiolytics • Prophylactic antibiotics • Anticholinergics ►Safe transport to OR with monitoring vital indicators
reason for use in CABG pts Chest tubes
2-4 CTs may be used to
prevent clotting and
accumulation of blood in the
chest after surgery
Monitor drainage
Ensure patency
No “stripping”
Report excessive drainage
POST OP Cabg management
Hint: BP
Maintain *tight control of BP with vasoactive medications
to preserve graft function
• Hypotension may result in graft collapse (Use fluids and
vasopressors/vasoconstrictors)
HTN may result in bleeding (use vasodilators)
what should happen with CABG drainage post op
• Mediastinal drainage should gradually decrease. Drains
are removed on POD 1 or 2
Post CABG diet
Advance diet after extubation
Medications post opp
- insulin for tight glucose control
• Low-molecular-weight heparin and antiembolism stockings/foot
pumps/SCDs for DVT prophylaxis
• PCA for pain relief first several days postoperatively, then oral analgesia
- Prophylactic antibiotics for 24 to 48 hours post-op
- Stool softeners and laxatives can be used from POD 1
- Prophylactic baby aspirin daily within the first 6 hours postop
- Clopidogrel (Plavix) – antiplatelet
• Statins should be started on postoperative POD 1
Is ECG needed after CABG Post opp? Why
ECG monitoring for decreased myocardial function R/T to myocardial edema
and ischemia-reperfusion injury – May need inotropic support and/or pacing
Nursing assessment post op CABG
Maintain perfusion - Assess LOC, pulses, color, UOP, chest tube drainage,
fluid and electrolyte status
Monitor incisions and report manifestations of infection
Can post op cabg pts ambulate?
• OOB chair on postoperative day 1 with early ambulation as soon as possible.
Complications of CABG surgery
-Vasoplegic syndrome (low SVR)
►Cardiogenic shock, Heart failure
►Post perfusion syndrome - Systemic inflammatory response
►MI due to pulmonary embolism, hypotension, or graft
failure
►Dysrhythmias/A fib
►Coagulopathies/bleeding
►Pericardial tamponade
►Perfusion insult/clots to brain, kidneys, liver, lungs -
cognitive changes, embolic stroke, renal issues
Pneumothorax, hemothorax, atelectasis, pleural effusions,
pneumonia
Heparin-induced thrombocytopenia
Electrolyte imbalances
Non union of the sternum and sternal infection
