Comprehens
ive Nursing
Care on
Coronary artery bypass grafting (CABG)
is a surgical procedure in which a blood
vessel from another part of the body is
grafted to the occluded coronary artery so
that blood can flow beyond the occlusion;
it is also called a bypass graft.
The vessel most commonly used
for CABG is the greater
saphenous vein, internal
mammary artery, cephalic and
basillic veins are also used
The purpose of surgical or
myocardial revascularisation is to
improve the blood supply to the
myocardium, relieve symptoms of
angina and to prolong the life
expectancy of the patient
diagnosed with CHD
The Preoperative Phase:-
Review of patients condition to
determine status of vascular,
pulmonary, renal, hepatic,
hematologic and metabolic systems.
Information when conducting
preoperative teaching with a patient
scheduled for CABG surgery may
include sights and sounds that will be
experienced, invasive lines that will be
inserted, anticipated sensations from
preoperative medications, and
anticipated length of the operation.
Preoperative practice with the
equipment (such as an incentive
spirometer) that will be used
postoperatively is helpful.
Type of anaesthesia- general
anaesthesia.
The Intraoperative Phase:-
Prior to initiation of anesthesia, most cardiac
surgery patients undergo the insertion of a large-
bore peripheral intravenous catheter, an arterial
line, and a pulmonary artery catheter. These are
needed so intravenous fluids can be administered
and hemodynamic monitoring during the
operation and in the postoperative period.
• After the patient is anesthetized,
position the patient and there will be a
head-to-toe surgical preparation and
insertion of a urinary catheter.
• Manage the fluid volume status by
increasing the rate of IV fluid as per
the protocol.
The cardiopulmonary bypass (CPB) machine
or heart lung macine can be used during the
operation to maintain cardiopulmonary
function and tissue perfusion.
Perfusionist
Some surgeons elect off-pump coronary artery
bypass (OPCAB). The potential complications
of extracorporeal circulation are minimized
with this surgical option.
Potential benefits of the OPCAB
procedure include a decreased need
for blood transfusions, decreased
time in the intensive care unit, and
reduced hospital time with a
potential decrease in hospital cost.
The Postoperative Phase:-
On-going nursing care during the post-
operative period geared towards:
i. Prevention of complications associated with
cardiac surgery.
[Link] detection of complications.
[Link] of the patient’s self-care
abilities.
Adequate oxygenation is ensured;
respiratory insufficiency is common after
open heart surgery.
If client has muffled heart sounds
post-operatively check the
mediastinal tube for drainage.
Hemodynamic monitoring during the
immediate post-operative period for
cardiovascular and respiratory status and
fluid and electrolyte balance to prevent or
recognize complications.
Drainage of mediastinal and pleural tubes is
monitored.
Fluid and electrolyte balance is monitored
closely with daily weight.
Post-operative Management of Complications:-
Major complications of CABG include:-
*fluid and electrolyte imbalance.
* hypotension
* hypertension
* hypothermia.
* bleeding
* Cardiac tamponade
* decreased level of consciousness.
* Anginal pain.
* infection.
Postoperative Pulmonary Management
Muffled heart sounds and a lack of
drainage from the mediastinal tube
indicate cardiac tamponade or fluid
around the heart. This must be reported
immediately to the physician.
• Pulmonary care (including suctioning while
the patient is intubated and coughing and
incentive spirometry after extubation),
early mobilization, and control of pain and
shivering.
The first meal after coronary artery bypass
graft surgery may be clear liquids, but the
client quickly progresses to low fat and low
salt as soon as it can be tolerated.
• The nurse must assess the patient
for readiness for early extubation.
Extubation should be considered
when the patient is arousable, able
to follow commands,
hemodynamically stable, and
initiating spontaneous ventilations
without excessive respiratory effort.
During the weaning process, the nurse
should assess the patient for an
increase in respiratory and/or heart
rates, use of accessory muscles, fatigue,
and color changes because these
findings may indicate the patient is not
ready for extubation.
Postoperative Management of Hemodynamics
• a) Monitor for hypertension or hypotension
• The Trendelenburg position can offer
symptomatic relief from low BP, especially in the
early postoperative phase, by shifting volume
from the legs to the chest and increasing preload
Postoperative Management of Bleeding:-
• The postoperative period may be complicated by
excessive bleeding.
• Patients who were on anticoagulants and antiplatelet
agents prior to surgery are at an increased risk of
postoperative bleeding.
• When bleeding occurs there is potential for the blood to
accumulate in the pericardium, and therefore, the nurse
must be cognizant of the potential for cardiac
tamponade.
Postoperative Neurologic Management:-
• Patients who require coronary artery
bypass surgery are at an increased risk for
neurologic complications.
Stroke can be caused by an embolic event
during or after surgery.
Postoperative Pain Management:-
• Dependent upon surgical approach, the
patient may have a median sternotomy
incision, leg incision(s), and/or a radial
incision.
• Manipulation of the chest cavity, use of
retractors during surgery, and
electrocautery may all contribute to
postoperative pain.
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