Open Heart
Surgery
The story of a broken heart

From day 1 to discharge

THE TERMINOLOGY
LIMA/

RIMA- left or right internal mammary artery
EVH- Endovascular vein harvest
OHS- open heart surgery
POD- Post op day
LAAL- Left atrial appendage
Ligation
PVI- Pulmonary Vein Isolation
CABG- Coronary Artery Bypass
Graft

COMMON
PRE-OP
ORDERS
**SEE BINDER IN UNIT FOR PAPER ORDERS OR
FOLLOW THIS LINK TO VIEW ALL http:// phsintranet.pinnaclehealth.org/collectionCat egorized2.aspx?id=20737418239 PRE-OP
InpatientAka- IN THE HOSPITAL
•

• May be scheduled, urgent, or emergent
• From cath lab
• From ER
• From MD office
• From another facility
• *Waiting in the facility because they are too unstable to go home and wait •
•

Outpatient
Aka- FROM HOME
• After a large MI
• After scheduled cath or other positive diagnostic test • Symptoms are mostly controlled • * Stable enough to go home and wait
• *may need significant time to recover before surgery is safe if post MI

PRE-OP TEACHING
- Give them the pre-op booklet
- May watch “preparing for heart surgery” video
- ISB teaching
- Pain scale and importance of pain medication - Importance and expectation of early & frequent ambulation and use of bipap
- Teach heart pillow for splinting
- Give them “the tentative plan”
- Average post op length of stay is 3-5 days
- Be sure there are no skin conditions or rashes - Must remove all jewelry pre-op

U/A

PRE-OP
TESTING

C&S
MRSA SWAB
CBC, CMP, PT/INR, PTT
**Open heart screen = 2 pink tubes for type and cross, timed for different times. Place 4 units on hold.
Hemoglobin A1C
EKG
CXR
Pulmonary function tests
Carotids
Echo
TEE if severe valve disease
BGM on call to OR

PRE-OP PAPERWORK

***Consent

(PAs fill out, RN can

get signed)
Blood consent
Anesthesia checklist
Online pre-procedure checklist – follow instructions for printed materials MEDS TO GIVE
 Antibiotic

MEDS TO HOLD

sent to OR with

patient
 CABG only- amiodarone 2 days before surgery
 Beta blocker within 24 hours of surgery
 Aspirin 81mg
 Heparin gtt- turn off on call to
OR (when they come to get the patient you turn it off)
 Possible nitro gtt for active chest pain or nitro paste otherwise  Lovenox

24 hrs before

surgery
 ACEs/ ARBs at least
48-72 hours before surgery  Plavix, Effient,
Coumadin, Xarelto,
Eliquis at least 5-7 days preop

MEDICATIONS

This is why we hold ACE inhibitors- they will cause vasodilation that is difficult to combat post-op OTHER IMPORTANT INFO PRE-OP
Hibiclens

bath- night before and morning of surgery
Clipping of excess hair all over before last hibiclens bath
BGM on call to OR
NPO after midnight- morning meds with a sip of water
Endocrine consult pre-op if uncontrolled/ undiagnosed diabetic
PCCMA consult pre-op if COPD/ poor PFT component Hibiclens Bath
Evening

before and morning of surgery
PTs must be assisted with this.
Use new basin for each bath.
Use fresh washcloth and half the bottle
Wash the chest first, scrub in vigorous circular motions Get all folds, crevices, even feet!
Wash groin last
Repeat a second time with the second half of the bottle and a fresh washcloth
Place new disposable leads on the patient after the bath

Surgeries
CABG
https://www.youtube.com/watch? v=bYbNmbR-fCY Valve

https://www.youtube.com/watch? v=AkymZ_eQN5w LAAL

https://www.youtube.com/watch? v=6GQXcnSfu5o PVI
Cox

Maze

https://www.youtube.com/watch? v=q4iCEbww3Bk CABG

VALVES

LAAL / PVI

COX- MAZE –
Afib treatment of choice

The surgical technique “maze” is performed by making cuts and seams in the atria.

ARTERY

 LIMA/

VEIN

RIMA

 RADIAL

 EVH

HARVESTS

BYPASS MECHANICS

BY
PA
SS
EF
FE
C
TS
O
N
B
O
D
Y

LUNGS
DECREASED BLOOD FLOW
POSSIBLE ATELECTASIS
DECREASED GAS
EXCHANGE
INCREASE IN PULMONARY
VASCULAR RESISTANCE

-

-

BRAIN
DECREASED CEREBRAL
PERFUSION
RISK FOR EMBOLI

ENDOCRINE
INCREASED
CATECHOLAMINES
INCREASED STRESS
HORMONES
HYPERGLYCEMIA

-

-

-

-

KIDNEY
DECREASED BLOOD
FLOW