Top 10: Cardiac Surgery
I worked in the Operating Room for almost 9 years before I ever did cardiac surgery. I knew nothing about it, except that it was the most intimidating service at the hospital. Anyone else feel that way about cardiac surgery? I wasn't able to go through the cardiac service during orientation, but it intrigued me enough that I would wander back when they were working late in the evening to see what was going on. When I was on general call, I would get called in occasionally to help with a cardiac emergency and it really took me back to my trauma days.
I realized one night that cardiac surgery was the only surgical service I hadn’t tackled. So in September of 2020, I left the general OR and transferred to the Cardiovascular OR. While I still learn things daily, there are 10 things that stand out that every OR nurse and scrub should know about cardiac surgery. Here's my Top 10:
1. Always have blood in the room.
Significant blood loss is likely to occur during cardiac surgery. Blood is a key treatment to treat anemia that can occur during cardiac surgery and also help oxygen delivery.
2. When things go bad, they go bad fast.
Let’s be honest, you’re dealing with a major organ and the plumbing that keeps the body alive. One wrong move and your patient can go from stable to critical in mere seconds. Being able to stay calm and clear concise communication with the field can help reign in a situation spiraling out of control.
3. Have ice ready.
Yes, you read that right. Ice. Perfusion will need ice to use in their heart/lung machine to keep the patient cold during bypass. Sometimes circulatory arrest is done to cool the body and to help stop the heart. Bags of ice are needed to quickly cool the patient. So easy access to ice is essential for cardiac surgery.
4. You will never be alone in a case.
Cardiac surgery can have multiple teams doing different aspects of surgery at the same time. It’s just not feasible for one person to do it all. There will always been extra hands to help ensure surgery goes smoothly. Whether it's another circulator, scrub, or assistant, it truly is a team effort.
5. Know the status of blood products in your hospital.
This includes packed red cells, platelets, plasma and cryoprecipitate. The last thing you need is a doctor urgently calling for something and having the blood bank tell you only have one unit in house or even worse none.
6. Know your hemostatic agents.
In addition to blood products, a variety of agents can be used to help with blood loss. The surgical team could be trying to contemplate what else they could use that they haven’t tried, and knowing what else is available could be the key to a successful surgical outcome.
7. Know that there are multiple surgical fields.
It is very common to use radial arteries and saphenous veins for conduits to be used for bypasses. This means that in addition to a chest incision it’s not uncommon to have incisions on the arms and legs. Be prepared for extra counts and areas to assess post-surgery.
8. Get to know your perfusionist.
Perfusionists are key members of the surgical team. They operate the heart/lung machine during cardiac bypass, and artificially keep the heart and lungs working while they cannot work on their own. They give products and medications to keep the patient stable. They sometimes need an extra hand, so always check on them and be aware of their role in cardiac surgery.
9. Know your labs!
It’s helpful to look at labs pre-operatively to help you prepare for any intra-op complications. If you see that the platelet count is low, you can go head and have some platelets ready to go. Other labs to know include white blood cell count, red blood cell count, fibrinogen, PT, PTT and INR.
10. You will not master it overnight.
Whether it’s circulating or scrubbing, it will be a minimum of at least a year before you feel proficient in this service. I have been in cardiac for two years and I still learn something new every day. Even our chief will tell me time and time again that it takes years to master the cardiac scrub role.
If you're an experienced cardiac circulator or scub, what else would you add to this list? We're all learning, every single day, and we can benefit from the wisdom that others have to share. Feel free to include your advice in the comments! And stay tuned, because next month we'll be bringing you another Top 10!