CABG

Nursing Management of Patient
Undergoing
Coronary Artery Bypass Graft (CABG)
Patients will be cared for in the ICU during

the immediate Post-operative period.
After extubation and when hemodynami-
cally stable, they will be transferred to Cardiac

Unit.
DESIRED PATIENT OUTCOMES:

1.
Patient will experience minimal/no

complications related to CABG surgery.
2. Patient will achieve maximal level of comfort

during the post-operative period.
A. PATIENT ARRIVAL
a. Connect patient to the monitoring system.
b. Connect chest tubes to wall suction.
c. Note type and rate of intravenous infusions,
d. Validate respiratory settings on ventilator with
respiratory therapy.
e. Attach warming apparatus.
B. INITIAL POST-OP ASSESSMENT

To be completed within 15 minutes of arrival to ICU:
a. Cardiovascular Status:
1) Obtain full set of vital signs.
2) Obtain a cardiac profile and verify waveforms.
3) Verify ECG rhythm,
4) SVO (superior vena cava oxygen saturation )

through a Swan-Ganz catheter
5) Note amount/quality of chest tube drainage.
6) Note quality of peripheral pulses, temperature and
color of extremities.
7) Demand pacemaker settings
Swan Ganz Catheter
b. Respiratory Status:
1)
Auscultate bilaterally for breath sounds,.
2) Obtain O2 saturations via probe.

3) Obtain ABG,
4) Note peak pressures, expiratory volumes
and minute ventilation on current vent

settings.
c. Neuromuscular Status:
1) Validate LOC.
2) Check for pupil reactivity.

3) Check for quality and quantity of motor response.
4) Identify type and time of last dose of anesthesia,
narcotic or paralyzing agent used.
d. Genitourinary Status:
1) Measure urine output.
To be completed within 60 minutes of arrival:

1.
Perform a brief physical assessment and validate

the status of the following with the physician.
a. Integumentary Status:
1) Note presence and characteristics of wound(s):
a) chest
b) legs/arms - check bandages
2) Note presence and characteristics of exit site(s):
a) catheters
b) drains
c) pacer wires
3) Assess pressure points for erythema/potential
points of break down.
b. Gastrointestinal Status:
1) Check bowel sounds.
2) Verify placement of N/G tube, if applicable.

Attach to wall suction per MD order
C. INITIAL POST-OP CARE:

1. To be done within 30 minutes of arrival.
2. Review Post-operative orders, clarify as needed.
3. Obtain 12-lead ECG and chest x-ray as per MD

order.
4. Draw blood , per MD order.
D. ONGOING ASSESSMENT
1.
Obtain vital signs every 15 minutes for 4 hours

or prn, every 30 minutes for 4 hours, then every
1 hour until stable. Obtain temperature every
4.
2. Obtain Cardiac profiles . Evaluate need for
volume, medica-tions
medications.
or
withdrawal
of
3. Monitor respiratory status as per Ventilator

protocol. Initiate Weaning Protocol when
appropriate.
4. Monitor temperature of extremities, color,
capillary refill, presence of edema, quality of
pulses, and motor, function and sensation every
4.
5. Monitor I+O every 1. Assess need for diuretic

therapy.
6. Monitor chest tube drainage every 15 minutes
for initial 1-2 hours, then q1-2 hour for 24 then
every 2-4 until discontinued.
- From post-op hour 2-24 hrs, drainage
should decrease to less than 30cc/hour.
CT may be discontinued on post-op day
1 when CT output less than 80cc for 812.
7. Monitor neuro status every 1hr till stable, then
every 2hrs. Reorient patient to time, surroundings

and person as appropriate.
8. Check wounds, pacer wires and dressings every
2.
9. Assess bowel sounds every 4 while intubated,
monitor for flatus.
10. Assess heart sounds every 1-2, x6-8 hours, note

any additional sounds or new murmurs. Then
assess heart sounds q2-4 after this.
11. Report the following symptoms immediately to
the MD:
a. CT drainage > 100cc/hr

b. Sudden onset or change in:
1) ECG rhythm
2) Systolic blood pressure < 90 or > 140mm Hg
c. Decreased urine output < 30cc/hr

d. hypothermia
e. HCT < 27
g. Extreme shivering
h. Loss of swan or arterial line
i. Extreme agitation despite medication
j. Any sudden or dramatic change in neuro status
k. Poor ABG's or drop in O2 sat from baseline
l. Wound bleeding
E. ONGOING PATIENT CARE

1. Respiratory:
a. Continually monitor Sa O sat via probe.
b. Obtain ABG's per MD order.
c. Wean from ventilator as per protocol.
d. Turn, cough and deep breathe every 2.
e. Post extubation, initiate Respiratory Care

Protocol.
f. Incentive spirometer every 1-2 while awake, and
PRN post-extubation, per MD order.
g. Assist patient in use of pillows to splint incision
while coughing.
h. O2 per MD order after extubation
2. Cardiovascular:
a.
Maintain pacer wires.
b.
12-lead ECG and chest x-ray as per MD order.
3. Nutrition:
a. Remove NG tube post-extubation
b. Maintain NPO until extubated.
c. When extubated, progress diet as per MD order.
5. Fluid/Electrolytes:
a. Replace electrolytes as per MD orders.
b. Obtain lab tests as per MD orders.
c. Weigh patient daily, if ordered

6. Mobility:
a. Turn side-to-side q 2 hours.
b. Dangle bedside when stable, then out of

bed with assist BID when extubated and SwanGanz catheter removed.
7-PAIN MANAGEMENT:
1. Assess patient every 1-2 hours concerning
presence of discomfort and characteristics:
a. Duration of pain
b. Quality (0-10 scale if applicable)
c. Location
d. Radiation
e. Aggravating/alleviating factors
8- WOUND CARE:
1. Keep dressing clean and dry, and aseptically

redress wound.
After 24 hours, open to air if there is no drainage.
9. Assess for S/S of wound infection:

a. Spreading erythema
b. Superficial drainage
c. Sternal instability
d. Excessive incisional pain
e. Fresh dehiscence (the separation of a surgical incision
or rupture of a wound closure).
Assess for S/S of wound infection:

f. fever
g. Purulent drainage
h. Positive blood cultures
i. Marked leukocytosis
j. Signs of systemic sepsis

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Nursing Management of Patient

Patients will be cared for in the ICU during

After extubation and when hemodynami-

cally stable, they will be transferred to Cardiac

DESIRED PATIENT OUTCOMES:

Patient will experience minimal/no

2. Patient will achieve maximal level of comfort

B. INITIAL POST-OP ASSESSMENT

4) SVO (superior vena cava oxygen saturation )

7) Demand pacemaker settings

Swan Ganz Catheter

Auscultate bilaterally for breath sounds,.

2) Obtain O2 saturations via probe.

and minute ventilation on current vent

2) Check for pupil reactivity.

To be completed within 60 minutes of arrival:

Perform a brief physical assessment and validate

b) legs/arms - check bandages

2) Note presence and characteristics of exit site(s):

2) Verify placement of N/G tube, if applicable.

C. INITIAL POST-OP CARE:

3. Obtain 12-lead ECG and chest x-ray as per MD

4. Draw blood , per MD order.

Obtain vital signs every 15 minutes for 4 hours

2. Obtain Cardiac profiles . Evaluate need for

3. Monitor respiratory status as per Ventilator

5. Monitor I+O every 1. Assess need for diuretic

7. Monitor neuro status every 1hr till stable, then

every 2hrs. Reorient patient to time, surroundings

8. Check wounds, pacer wires and dressings every

9. Assess bowel sounds every 4 while intubated,

monitor for flatus.

10. Assess heart sounds every 1-2, x6-8 hours, note

11. Report the following symptoms immediately to

a. CT drainage > 100cc/hr

c. Decreased urine output < 30cc/hr

E. ONGOING PATIENT CARE

e. Post extubation, initiate Respiratory Care

h. O2 per MD order after extubation

Maintain pacer wires.

12-lead ECG and chest x-ray as per MD order.

c. Weigh patient daily, if ordered

b. Dangle bedside when stable, then out of

1. Keep dressing clean and dry, and aseptically

After 24 hours, open to air if there is no drainage.

9. Assess for S/S of wound infection:

Assess for S/S of wound infection:

j. Signs of systemic sepsis

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