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

Internal Defibrillator & Open Chest Box

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 Duraprep

Emergent Sternotomy Specialty Tools Two items will be taped to top of the

sternotomy tray: #10 Blade and

Wire cutters AKA Side cutters

Inside the Sternotomy Tray

Loose Instruments Stringer Instruments

Emergent Sternotomy Specialty Tools

Internal paddles

2 sizes, adult and pediatric

Hooks to defib, 5-20 joules

Emergency Sternotomy Video https://www.youtube.com/watch?feature=player_deta

ilpage&v=B5sStG4RadY