Page 63 - Critical Care Notes

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Management
Routine postoperative care with special attention to the following:
■ Assess lung sounds, respirations and O 2 saturation and ABGs. Pulse oxime-
try unreliable.
■ Keep intubated until anesthesia cleared from system.
■ Assess cardiac sounds, rate, rhythm. Continuous ECG monitoring. Pacing
with epicardial wires may be warranted.
■ A VAD-generated pulse and patient’s intrinsic or native electrical activity
will both appear on the monitoring system. The VAD-generated pulse is
ordered in a fixed-rate mode or volume or automatic mode.
■ If VF or asystole occurs, patient will still have a palpable pulse resulting
from ongoing pump ejection of the VAD.
■ Assess neurological status to ensure cerebral perfusion.
■ Monitor VS. Administer vasodilators as needed for MAP 65–80/90 mm Hg.
Automated BP cuffs unreliable. Use arterial line. BP measurement via
Doppler recommended if no A-line.
■ Monitor hemodynamics: cardiac index, cardiac output, CVP, PAP, PCWP.
■ Monitor fluid and electrolyte balance including urine output. Note signs of
fluid overload and decreased urinary output.
■ Administer anticoagulants (unfractionated heparin, warfarin, aspirin).
■ Assess incisions and dressings for drainage, bleeding, erythema.
■ Obtain and monitor labs: CMP, CBC, PT/PTT, with close attention to K +
and Mg.
■ Medicate for pain as needed.
■ Antibiotics may be ordered prophylactically.
■ The patient is also monitored via chest x-rays and echocardiograms.
■ Address psychosocial issues and refer as needed.
Complications
■ Device malfunction resulting from mechanical problems or thrombosis
■ Infection
■ Low flow or output of the VAD
■ Pulmonary embolism or stroke
■ Cardiac arrhythmias
■ RV dysfunction in left VAD implantation
■ Hemorrhage, cardiac tamponade
■ Secondary organ dysfunction including kidneys, liver, lungs, and brain

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