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Flashcards in Cardiac Surgery Deck (43)
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What is the most common incision used for cardiac surgery?

Median sternotomy: Sternal saw cuts through sternum then a rib spreader is used, sternum closed with wires


What are chest drains used for post surgery?

To drain fluid and air from the mediastinum


When are chest drains removed?

Generally after 24 hours (better outcomes if removed in first 24 hours)


What can result if chest drains are left in for too long?

- Mechanical irritation of pericardium
- Infection
- Pain/discomfort
- Less able to mobilise due to pain - muscle wasting


What are the key safety points for handling chest drains?

- Take care when handling patient - keep tube visible
- Ensure unit is visible to avoid damage
- Avoid application of positive airway pressure unless indicated
- Check before disconnecting suction prior to intervention
- Maintain drain below level of the chest
- Ensure clamps are available for emergencies
- Monitor pain associated with drains


What are some of the common cardiac procedures?

- Coronary artery bypass graft (CAG, CABG)
- Valve repair/replacement (AVR, MVR)
- Repair of congenital defect
- Heart transplantation


What is an alternative to CABG surgery that is becoming more common?

Percutaneous coronary intervention (PCI)
- Patient is awake
- Wires inserted into arteries to clear blockages


How does surgical management compare to conservative in cardiac illnesses?

Surgical results generally better than conservative for some conditions


What are the functions of a heart-lung machine (cardiopulmonary bypass machine)?

- Receives blood
- Adds O2
- Eliminates CO2
- Controls body temperature
- Returns blood under pressure & flow


What are the consequences of a heart lung machine?

- Lungs aren't fully expanded (risk of PPCs)
- Non-pulsatile perfusion (abnormal organ blood flow)
- Activation of inflammatory cascades (hypotension)
- Blood component factors (bleeding, coagulopathy)


What is one of the risks of cannulation?

- Clamps arteries shut, causing a blood clot
- When released, can release the blood clot


What is the risk of a LIMA (left internal mammary artery) harvest?

- Proximity of phrenic nerve
- 2-10% diaphragmatic paralysis


What are the CABG graft sites?

- Aorta
- Right coronary artery
- Left anterior descending coronary artery
- Circumflex coronary artery
- Left main coronary artery


What are the two most common CABG graft harvest sites?

- Saphenous vein graft (SVG) - 25-50% functional 10 years post
- Left internal mammary artery (LIMA) - 90% functional 10 years post


What occurs at the conclusion of open heart surgery?

- Sternal closure
- Routine ventilation 4-8 hours
- Multiple drain tubes
- Temporary pacing wires


What are the possible complications of cardiac surgery?

- Infections (wound, UTI)
- Haemorrhage
- Renal failure
- Ventricular dysfunction
- Cardiac tamponade
- Abnormal BP
- Cardiac arrhythmias
- Cerebral complications
- Musculoskeletal problems


What are the operative risk factors?

- Obesity
- Diabetes
- Smoking
- Pre-existing lung disease (restrictive/obstructive)
- Osteoporosis
- Increased age
- Co-morbidities (renal failure, malnourished, unwell)


How can cardiac surgery affect the pulmonary system?

Lower lobe atelectasis (mainly left, 30-88% patients)
- Compression of LLL
- Cold injury to phrenic nerve

Pulmonary oedema
- Agressive fluid replacement
- Consequences of heart lung machine

Pleural effusion (30%, mainly left side)
- Heart failure
- Trauma
- Unknown origin

Pulmonary embolism


What has physio management of cardiac surgery patients traditionally focused on?

Prevention of PPCs


What are the musculoskeletal complications of cardiac surgery?

- Brachial plexus injuries
- Sternal instability
- Drain site adhesions
- C/S & T/S dysfunction
- SC & MS subluxaion
- Rib fractures
- Phrenic nerve palsy
- Scar thickening
- Chest wall hypersensitivity
- Deep chest wall pain
- Paraesthesia


What are the possible reasons for MS complications?

- Sternal retraction
- Dissection of IMA
- IJV cannulisation
- Patient position
- Devascularisation of sternum


What are some of the questions that should be asked in the pre-op subjective Ax?

- Mobility/gait aids
- Home situation
- MS deformity/dysfunction
- Type/date of procedure
- Reason for procedure
- Previous experience of post op physio
- Risk factors for PPCs
- Usual sputum load
- Language/communication barriers


What does post-op respiratory care involve?

- Positioning (high sit is best)
- Mobilisation
- TE techniques
- FET/coughing with wound support
- PEP devices
- Humidification if indicated


What does post-op MS care involve?

- Reinforce sternal precautions
- Assessment, monitoring, management of sternum
- Thoracic/shoulder ROM


What generally happens day 0 post op?

- Extubated within 10-12 hours (breathing tube removed)
- No physio


What generally happens day 1 post op?

- Physio chest Rx if indicated
- Transfer to ward
- Mobilise with physios
- Remind patient of sternal precautions


What generally happens day 2 post op?

- Removal of pacing wires
- Mobilise
- Further chest Rx
- Encourage SOOB all day
- Independent mobilisation if possible
- Introduce UL/thoracic ROM exercises


What generally happens day 3-4 post op?

- Increase independent mobilisation
- May not require physio if managing chest & mobilisation


What generally happens day 5 post op (discharge)?

- Stair check with physio
- Sternal check
- Group education session (sternal precautions, exercise guidelines, ADLs, exercises)


How long does the sternum take to heal post sternotomy?

8-12 weeks