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Nursing Care: Robotic-Assisted Cardiac Surgery

Nursing Care: Robotic-Assisted Cardiac Surgery. Jane C Whalen RN, MSN, CCRN, CCNS. October 22, 2011. Objective. Adapt nursing care and patient education for patients undergoing minimally-invasive / robotic – assisted cardiac surgery. Are They Different?. What have you heard?

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Nursing Care: Robotic-Assisted Cardiac Surgery

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  1. Nursing Care: Robotic-Assisted Cardiac Surgery Jane C Whalen RN, MSN, CCRN, CCNS October 22, 2011

  2. Objective • Adapt nursing care and patient education for patients undergoing minimally-invasive / robotic – assisted cardiac surgery

  3. Are They Different? • What have you heard? • What would you expect? • What do you think patients want to know?

  4. Pre-Operative Patient Education Incisions • Yes, you will have them! • They’re just different Pain • Yes, you will have pain • It can be more painful than a sternotomy

  5. Sternotomy

  6. Robotic / Minimally-Invasive Incisions

  7. Femoral Cannulation • Unilateral incision • Bilateral incisions Radial Arterial Lines

  8. Pre/Post-Operative Care: Prevent Infection Same as with sternotomy • Intranasal mupirocin (Bactroban®) • Pre-op skin prep • Wound care post-op • Insulin infusion / glucose management

  9. Post-Operative Care: Activity • Same progression as with sternotomy • No “sternal precautions”, but… • Limit lifting, affected side, for pain control • Return to work in 2-4 weeks

  10. Post-Operative Care: Pain • Pain more severe in 1st 48 hours • Ketorolac (Toradol® ) IV • 15-30 mg q6h x 24 hours • If renal function OK • Not with CABG ( risk of thrombosis) • IV Acetaminophen (Ofirmev®) • 15 mg/Kg q6h x 24 hours • D/C all other forms of acetaminophen

  11. Post-Operative Care: Pulmonary • Unilateral pulmonary edema common • Crackles, diminished breath sounds • Pulmonary toilet is critical

  12. Case Study #1 Mr. S • 68 yo male • Elective robotic mitral valve repair • Crossclamp time 80 minutes • Extubated: 3 hours, 50 minutes post-op

  13. Case Study: Mr. S POD #1 • Hemodynamically stable • SpO2 96-98% on 2L nasal O2 • CT 310 ml/8 hrs • To telemetry

  14. Case Study: Mr. S POD #2 • Small PTX • SpO2 93% 5L O2

  15. Case Study: Mr. S POD #3 • Desaturated during night (POD #2 – POD #3) • 0930 ABGs on 12L O2 pH 7.53 PCO2 35.8 PO2 60 HCO3 30 Sat 94%

  16. Case Study: Mr. S POD #3 • Pulmonology consult • Furosemide (Lasix®) infusion • Sputum culture • Antibiotics • 100% Non-rebreather

  17. Case Study: Mr. S POD #4 • Transfer to ICU • ABGs on 100% non-rebreather mask pH 7.49 PCO2 41 PO2 58 HCO3 30.5 Sat 92% • Bi-PAP • Steroids

  18. Case Study: Mr. S POD #5 • CXR improving POD #6 • Weaned to 4L O2 • Up to chair • PT/OT for deconditioning POD #8 • Transfer to telemetry

  19. Case Study: Mr. S POD #9-14 • Weaning O2 • Continued needing increased O2 with activity • Changed furosemide to po dosing • CXR improved POD #15-18 • Improving • Home day 18

  20. Case Study #2: Ms. K • 30 yo female, non-smoker • Dyspnea, chest pain • Work-up revealed left atrial myxoma

  21. Case Study: Ms. K • Robotic-assisted resection of LA myxoma • Crossclamp time 15 minutes; CPB 1 hour • Extubated 3 hrs, 5 minutes

  22. Case Study: Ms. K POD #1 • Chest tube D/C’d • To telemetry POD #2 • Home

  23. Minimally-Invasive vs Sternotomy • No difference in average extubation time • Pain less after first 48 hours • Less infection risk • Length of stay 1-2 days shorter • Full recovery in half the time (4-6 weeks)

  24. Questions ?

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