pre-op
what to do for a first case pre-op before OR?
CHG, mouthwash, change gown, no clothing/jewelry/dentures, gather belongings to bring to CTICU if going there after
What does CABG stand for?
Coronary artery bypass graft
What is a unique education post-op for valve surgery pts?
What kind of tubing for amio gtt?
0.2 micron filter
What does TAVR stand for?
Transcatheter aortic valve replacement
bonus: right surgery, blood consent is checked off
What incisions can be expected for full sternotomy CABG?
MSI, graft sites: radial, SVG, 3 chest tube sites (2 pleural, 1mediastinal), b/l groin sites, radial A line site
what valve surgeries come right to CTSD from PACU?
TAVR, TMVR/mitral clip/TEER, TTVR/evoque, lead extraction, watchman
What lab is to be monitored with pts on dobutamine and milrinone/drawn from where?
mixed venous, only drawn from central line
What are bedrest restrictions post-op?
6 hours total - 2 hrs flat in PACU, 2 hrs flat CTSD then can sit up, 2 hrs after sit up can get OOB
how many nights prior to surgery should CHG wipes start?
3 nights prior
What incisions to be expected for mini/ROBO CABG?
left breast incision, 2 pleural chest tube sites: 1 above/1below breast incision, b/l groin sites
What medication is ordered after mechanical valve placement?
Coumadin -- will trend INR post-op to obtain therapeutic range (typically 2-3)
What is the max rate for precedex on stepdown?
How often to check groin sites/vital signs?
with PACU nurse, Q30 for 2hrs, Q1 or 2 hrs, then Q2
What scans/testing needs to be done pre-op CABG?
Midodrine, metoprolol, diuretic (IV bumex or lasix)
What is the main vital sign to watch for TEVAR patients?
BP - strict parameters, sometimes on IV gtts pre-op
What tubing is used for nitro gtts?
low-sorbing (blue)
What med to give post-op, what med to ask about post-op?
2v, CT TAVR/TMVR, CT chest, CT dental and dental clearance, US carotids, ECHO, EKG
What med is given to maintain RAD graft/reduce spasm?
norvasc 5mg -- given despite BP typically
What is the watchman procedure for?
umbrella-shaped implant placed in LAA to reduce risk of stroke in pts with Afib/prevents clots from forming in LAA; for non-valvular Afib with contraindications to long term AC
When cardene is titrated, how often do HR/BP need to be monitored?
5 minutes after titration, Q15x2, then per unit protocol
How to interrogate TVP
Turn MA down to 0
look at pts intrinsic rate and turn rate of pacer 10-15 above
slowly turn up MA until capture
after capture, turn pacer down to backup rate (usually 40)
double the number that you got capture and set MA to that (if capture at 2, set MA to 4)