July 2004, Volume 34 Number 7 , p 48 - 49
Outline Common aspects of postoperative care
Complications following on-pump surgery
Two paths to good outcomes
Graphics Find out about the s...
SUPPOSE YOU'RE CARING for two patients who've just had coronary artery bypass graft (CABG) surgery. One underwent surgery while on a cardiopulmonary bypass (CPB) machine; the other had surgery without CPB. In this article, I'll explain how differences in the two techniques affect the postoperative nursing care you provide for each patient.
Operating while the patient is on the CPB machine (also called on-pump surgery ) allows the surgeon to work on a motionless heart. While the heart is still, the CPB machine oxygenates the patient's blood and maintains circulation.
To use the CPB machine, the surgeon performs a median sternotomy, cross-clamps the aorta, and attaches the patient to the pump. He then arrests the heart's action with a cardioplegic solution, usually a potassium-rich solution delivered cold (39.4° F [4° C]) to protect the heart from ischemia.
After bypass grafting, the blood in the CPB machine is gradually warmed and pumped back into the patient's body. Internal paddles are used to shock the heart to restart it. Pacing wires are placed in the epicardium, and chest tubes are inserted.
Performed on a beating heart, off-pump surgery is becoming increasingly popular because it avoids the complications associated with CPB, such as platelet dysfunction, perfusion deficits to major organs, and cognitive complications. Off-pump surgery may be especially appropriate for elderly patients, who are at higher risk for CPB-related complications such as stroke. The procedure isn't recommended for patients with small coronary arteries or diffuse cardiac disease.
The surgeon ...