Emergency Sternotomy take 3
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Transcript of Emergency Sternotomy take 3
Jennifer Kime RN BSN CCRN-CSC-CMC
Michele Dollar RN BSN CCRN-CSC-CMC CNRN
Linay Williams RN
Ed Otton RN BS BSN CCRN
Objectives Review reasons for Emergency Sternotomy/Open
Chest Code
Discuss roles and responsibilities of OHS RN and non-OHS RN during post open heart emergencies
Review skills of aseptic and sterile technique
Emergency Sternotomy specialty supplies
Indications Emergent sternotomy for a patient after cardiac
surgery is performed (usually within the first 2 weeks) to identify and eliminate the following areas of postoperative complications:
Cardiac tamponade with imminent arrest
Exploration due to excessive bleeding
Refractory VF/VT without improvement after standard treatments. (Provides access for open cardiac massage and internal defibrillation)
Open Chest Case Study 6 year prospective study, 79 re-openings
48% survived if patient opened within 10 minutes, survival rate dropped to 12% for more than 10 minute opening.
Concluded favorable determinants:
Arrest within 24 hours of surgery
Reopening within 10 minutes of arrest
Arrest in ICU
In this particular study, all patients reopened outside the ICU died
2002 European Journal of Cardiothoracic Surgery, 22(3), pp. 421-425
Open Chest Code Roles and Responsibilities
Physicians Attending
Fellow
Resident
RTs
Nursing
*Everyone in the room should have a minimum of mask and head cover.
The following people need to be notified (usually charge nurse): SICU team/CT attending and fellow
Blood bank
OR/anesthesia (through operator during off hours)
Family
Chaplin
Nursing Roles and Responsibilities 6 RNs present
Bedside RN (may be only “Heart” RN in the room) Designated Nursing Team leader during Code. Maintains and
monitors sterile field.
Assigns roles of nursing staff
Medication Administration RN
Code Cart/Defibrillator RN
Recorder
Runner
Sterile RN (maybe deferred to resident or OR staff)
Non-sterile RN to manage white drawers, and instrument trays
Open Chest Procedure 1) Continue CPR until open chest supplies are ready, sterile
field is prepared, and surgeon is ready to perform procedure.
2) Assist surgeon with sterile gown and gloves. Mask, head cover, eye protection.
3) Remove Silverlon dressing, duraprep chest wall 4) Setup sterile field –large drape 5) Empty contents onto sterile field *#10 scalpel blade and
wire cutters. Suction tubing and yankauer x2. Lap sponges and saline bowl. Sternotomy instrument tray on end table.
Maintain Sterile Field
Emergent Sternotomy Specialty Tools Two items will be taped to top of the
sternotomy tray: #10 Blade and
Wire cutters AKA Side cutters
Emergent Sternotomy Specialty Tools
Internal paddles
2 sizes, adult and pediatric
Hooks to defib, 5-20 joules