Notes
Definition
- Coronary artery bypass grafting (CABG) circumvents an occluded coronary artery with an autogenous graft, thereby restoring blood flow to the myocardium.
- Intracardiac procedures will necessitate the use of cardiopulmonary bypass. To fully comprehend cardiac abnormalities and the function of extracorporeal perfusion, knowledge of the anatomy of the heart and the circulatory system is mandatory.
Position
- Supine with arms extended on armboards.
Packs/ Drapes
- Cardiovascular pack
- Adhesive incise drape sheet
- Extra drape sheet
Instrumentation
- Cardiac procedure tray
- Sternal saw/ cord
- Specialty tray
- Vein harvesting tray
- Hemoclips
Supplies/ Equipment
- Thermal blanket with control unit
- Cardioverter with internal paddles
- Cell-saver unit
- Heart-lung machine
- Mayfield overhead table
- Hemodynamic monitoring lines
- Basin set
- Large graduated pitcher
- Blades
- Beaver blade
- Assorted syringes and needles
- Asepto syringes
- Foley catheter
- Medications
- Solutions
- Heparinized saline
- Pacemaker wire with external pacemaker
- Chest tube with Y-connector
- Sealed chest drainage unit
Procedure
- The patient is properly positioned, and a median sternotomy incision is performed.
- The internal mammary artery or segment of the greater saphenous vein is harvested and properly prepared for reimplantation.
- Cannulation for cardiopulmonary bypass is achieved.
- The aorta is occluded and the cardioplegia solution is infused.
- The occluded coronary artery is isolated and dilators may be inserted.
- The graft is anastomosed to the coronary artery and tested for leaks.
- Multiple grafts may be necessary, and are placed sequentially.
- The aortic cross-lamp is gradually released, and a portion of the aorta is then occluded.
- The grafts are measured, cut, and anastomosed to the aorta.
- The clamp on the aorta is removed.
- The grafts are again inspected for leaks. All sources of air bubble accumulation are vented.
- Cardiopulmonary bypass is discontinued.
- The wound is irrigated with warm normal saline, with or without antibiotics.
- Temporary pace maker electrodes are sewn to the heart.
- Chest tube are inserted and the wound is closed in a routine manner.
- The chest tubes are connected to a sealed drainage unit and suction is applied.
Perioperative Nursing Considerations
- Circulating nurses and scrub personnel must be thoroughly familiar with the sequence of events and the routine of the surgeon since time is crucial.
- All instruments must be kept clean and free of tissue debris.
- Sterile iced saline slush should be available and transferred to the field in an aseptic manner before and during cardiopulmonary bypass.
- Once the patient is on the pump, urinary output is measured every 15 minutes, with amount and color noted.
- Warm saline solution is used during the closing sequence once the patient is off the pump.
- A separate tray of instruments for the vein harvesting may be requested.
- Communication with the family and significant others should be continual throughout the procedure.
- The circulating nurse should accompany the team to the postoperative unit.
image courtesy of : http://www.nhlbi.nih.gov/
