CABG

CABG

1. Critical Care Nursing - Clinical
Seminar Title :
CABG ( Coronary Artery Bypass Graft )
OR
ACB ( AortoCoronary Bypass )
Served To :
Dr. Lourance Al Hadid
MsN. Hadeel Taleb
Prepared by :
Khaled Mahajna

2. Outlines
•Definition of CABG
•Review of Coronary Arteries
•Purposes
•Indications for CABG
•Contraindications for CABG
•Procedure
•Nursing Management
•Pre operative Phase
•Intra operative Phase
•Post operative phase
•Complications
•References

3. Objectives
At the end of this presentation the students will be able to :
1.Define CABG
2.Describe the review of coronary arteries
3.Describe the process of the procedure
4.Use the nursing management
5.Define the indications , contraindications , complications

4. Definition
•Is a surgical procedure performed to relieve
angina and reduce the risk of death from
coronary artery disease. Arteries or veins from
elsewhere in the patient's body are grafted
(internal thoracic arteries, radial arteries and
saphenous) to the coronary arteries to bypass
atherosclerotic narrowings and improve the
blood supply to the coronary circulation
supplying the myocardium (heart muscle).
This surgery is usually performed with the
heart stopped .

5. Number Of Bypass
•The terms single bypass, double bypass, triple bypass,
quadruple bypass and quintuple bypass refer to the
number of coronary arteries bypassed in the procedure.
In other words :
•double bypass means two coronary arteries are
bypassed (e.g. the left anterior descending (LAD)
coronary artery and right coronary artery (RCA)
• triple bypass means three arteries are bypassed (e.g.
LAD, RCA, left circumflex artery (LCX)
•quadruple bypass means four vessels are bypassed (e.g.
LAD, RCA, LCX, first diagonal artery of the LAD)
• Bypass of more than four coronary arteries is
uncommon.

6. Review Of Coronary Arteries

7. Purposes
•Restore blood flow to the heart
•Relieves chest pain and ischemia
•Improves the patient's quality of life
•Enable the patient to resume a normal lifestyle
•Lower the risk of a heart attack

8. Indications For CABG
•Patients with blockages in coronary arteries
•Patients with angina
•Patients who cannot tolerate PTCA (Percutaneous
transluminal coronary angioplasty ) and do not respond
well to drug therapy

9. Contraindications For CABG
•Aneurysms
•Valvular diseases
•Congenital diseases
•diseases of blood

10. Procedure
•An endotracheal tube is inserted and secured by the anaesthetist and
mechanical ventilation is started. General anaesthesia is maintained
by a continuous very slow injection of Propofol.
•The chest is opened via a median sternotomy and the heart is
examined by the surgeon involves creating a 6 to 8 inch incision in
the chest (a thoractomy) .
•The bypass grafts are harvested – frequent conduits are the
internal thoracic arteries, radial arteries and saphenous veins. When
harvesting is done, the patient is given heparin to prevent the blood
from clotting.
• "on-pump", the surgeon sutures cannulae into the heart and instructs
the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is
established, the surgeon places the aortic cross-clamp across the aorta
and instructs the perfusionist to deliver cardioplegia to stop the heart
and slow its metabolism

11. Procedure
•One end of each graft is sewn on to the coronary arteries beyond the
blockages and the other end is attached to the aorta.
•Chest tubes are placed in the mediastinal and pleural space to drain
blood from around the heart and lungs.
•The sternum is wired together and the incisions are sutured closed.
•The patient is moved to the intensive care unit (ICU) to recover.
•Nurses in the ICU focus on recovering the patient by monitoring
blood pressure, urine output and respiratory status as the patient is
monitored for bleeding through the chest tubes. If there is chest tube
clogging, Thus nurses closely monitor the chest tubes and under take
methods to prevent clogging so bleeding can be monitored and
complications can be prevented.
•After awakening and stabilizing in the ICU (approximately one day),
the person is transferred to the cardiac surgery ward until ready to go
home (approximately four days).

12. Explanation

13. Heart Lung Machine

14. Nursing Management
•Pre operative Phase
•Intra operative Phase
•Post operative Phase

15. Pre operative Phase
Assessment
• Patient history
• Physical Examination (head to toe )
• Diagnostic procedure

16. Patient History
•Patient history of major illness, previous surgery,
medications, and usage of drugs and smoking and
drug history
•A systematic assessment of all systems performed
,with emphasis on cardiovascular functioning

17. Physical Examination
•Functional status of the cardiovascular system
determined by reviewing the patient symptoms ,
including past and present experience with chest
pain ,hypertension, palpation ,cyanosis, breathing
difficulty ,leg pain that occur with walking
,Orthopnea, peripheral edema.because alteration
in cardiac function (cardiac out put can affect
renal, respiratory, gastrointestinal ,
integumentary, hematological, and neurological
functioning )

18. Physical Examination
•General appearance and behavior.
•Vital signs
•Nutritional and fluid status ,weight, height
•Inspection and palpation of the heart ,noting the point of
maximal impulses ,abnormal pulsation ,and thrills
•Auscultation of the heart ,noting pulse rate ,rhythm, and
quality; S4 and S3 , murmur, and friction rib
•Jugular venous pressure
•Peripheral pulses
•Peripheral edema

19. Psychosocial Assessment
•Meaning of the surgery to the patient and family
•Coping mechanisms that are being used
•Measures used in the past to deal with stress
•Anticipated changes in life style
•Support system in effect
•Fears regarding the present and future
•Knowledge and understanding of the surgical procedure,
postoperative course and long term rehabilitation

20. Nursing Intervention
•Explain all treatment and procedure done for the patient
answering any question patient may have .present
information at patient understanding level to reduce
patient anxiety
•Orient patient to surrounding
•Assign the same nurse to care for patient when ever
possible to provide consistency of care, enhance trust and
reduce threat often associated with multiple care givers.
•Spend time with patient each shift to allow time for
expression of feelings, provide emotional outlet and
promote feeling of acceptance.

21. Intra operative Phase
•Patient will receive general anesthesia ,be intubated , and placed on
mechanical ventilator, the preoperative nurse are responsible for the
patient safety and comfort. Some of the areas of intervention
include positioning, the skin preparation wound care, and
emotional support to the patient and family.
•Before chest incision is closed, chest tubes are positioned to evacuate
air and drainage from the media sternum and the thoracic cavity .

22. Intra operative complication
•Possible Intraoperative complication
includes Dysrthmyais,Hemorrhage ,
Emobilization , Organ failure from shock ,
or adverse drug reaction.

23. Post Operative
•GOAL: achieving or maintaining homodynamic
stability and recovery form general anesthesia
•Assessment
•Neurological system
•Cardiac status
•Respiratory status
•Peripheral vascular status
•Monitor complication
•Renal function
•Pain
•Fluid and electrolyte

24. Complications
• Decrease C/O • Fluid overload
• Hypothermia • HTN
• Tachydysrythmias • Bradycardia
• Cardiac failure • Acute renal failure
• Electrolyte imbalance • Hepatic failure
• Infection

25. Nursing Diagnosis Related To CABG
•Decrease cardiac output
•Impaired gas exchange
•Risk for imbalance fluid volume
•Acute pain
•Deficient knowledge

26. ANY QUESIONS

27. References
• Medscape  http://emedicine.medscape.com/article/1893992-overview
•AHA  http://my.americanheart.org/professional/General/2011-ACCFAHA-
Guideline-for-Coronary-Artery-Bypass-Graft-Surgery
•Textbook  Brunner and Siddhartha's Textbook of Medical-Surgical Nursing
, 12th edition, Brunner and Siddhartha's Textbook of Medical-Surgical
Nursing 2012

28. THANK YOU
FOR
GOOD LISTENING

29. KHALED MAHAJNA .RN
FACULTY OF NURSING
AL ISRA UNIVERSITY
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Khaled Mahajna