Page 70 - Critical Care Notes

4223_Tab02_045-106 29/08/14 10:00 AM Page 64

CV
■ Monitor glucose levels and administer insulin as needed.
■ Provide DVT and stress ulcer prophylaxis.
■ Watch for signs of bleeding, and monitor hemoglobin and hematocrit
every 4 hr.
■ Monitor patient’s pain, and medicate as needed.
Complications
■ Complications are associated with anesthesia, cardiopulmonary bypass,
sternotomy, and the operation itself. These complications may include the
following:
■ Myocardial dysfunction including hemodynamic instability
■ Aortic dissection
■ Cardiac tamponade
■ Cerebrovascular complications
■ Acute renal failure
■ Respiratory tract infections
Variations of On-Pump CABG
■ Off-pump CABG
■ Totally endoscopic coronary artery bypass graft
■ Minimally invasive direct coronary artery bypass (MIDCAB): small incision
made in left chest; internal mammary gland artery sewn to left anterior
descending artery
Coronary Stenting/Percutaneous Coronary
Intervention (PCI)
PCI is a common intervention for angina, obstructive CAD, myocardial ischemia,
prevention of myocardial necrosis, and a nonsurgical alternative to CABG. In a
catheterization lab, a catheter equipped with an inflatable balloon tip is inserted
into the appropriate coronary artery. When the lesion is located, the catheter
is passed through the lesion, the balloon is inflated, and the atherosclerotic
plaque is compressed, resulting in vessel dilatation. Intracoronary stents are
usually inserted during PCI. Stents are used to treat abrupt or threatened abrupt
closure or restenosis following PCI.
Procedure
Stents are expandable meshlike structures designed to maintain vessel paten-
cy by compressing the arterial walls and resisting vasoconstriction. Stents are
carefully placed over the angioplasty site to hold the vessel open.
Clinical Presentation Prior to PCI
■ Atypical or typical chest pain
■ SOB
■ Dyspnea
■ Symptoms of angina or CAD
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