Page 163 - Critical Care Nursing Demystified

148 CRITICAL CARE NURSING DeMYSTIFIED

Interventions

See interventions for HF and CABG.
Teach the patient wound care to monitor for early signs of mediastinal
infection.
Teach the patient that he or she will need systemic anticoagulation with
coumadin if the patient has a mechanical heart valve as these valves are
prone to developing blood clots.

Reinforce antibiotic prophylaxis to prevent endocarditis.

Coronary Artery Bypass Grafting (CABG)
What Went Wrong?
CABG involves taking veins (saphenous) from the legs or arteries (radial, inter-
nal mammary) to bypass an obstructed coronary artery. CABG is performed
when coronary angioplasty and stents do not keep an artery open or the block-
age cannot be reached during angioplasty. This type of open-heart surgery may
require that the heart be stopped to work on the arteries that are on the epi-
cardial surface of the heart. To maintain adequate tissue perfusion, the patient Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
needs to be on a heart-lung machine (cardiopulmonary [CP] bypass) when the
heart is stopped.
Veins chosen are sewn from the aorta to the areas where the blockages are
revascularizing areas that are ischemic or injured. CABG cannot revascularize
dead or infarcted tissue. A minimally invasive technique can be used where the
surgery is done without CP bypass. This is limited to patients with proximal
disease of the left anterior descending or right coronary artery disease.
Some patients have inoperable disease and will need to be treated medically.
These patients include those with very small coronaries distal to the blockage,
severe aortic stenosis, and severe left ventricular dysfunction with other organ
system disease.
After the patient is prepared, a midline incision is done (sternotomy) and the
heart is stopped usually by an iced saline and potassium solution. The veins/
arteries are procured and reimplanted. Then the heart is restarted by defibril-
lation.

Prognosis
CABG is done to increase the quality of life by decreasing anginal attacks and
improve patient survival.