What Other Terms are used to Describe Coronary After Bypass Graft Surgery?

• CABG
• Bypass Surgery
  

What is a CABG?

• CABG is a surgical procedure to treat severe coronary artery disease (heart disease).
• Part of a vein or artery (called a graft) from another part of the body is used to bypass a blockage in one or more of the coronary arteries.
• The type of graft used, a vein from the leg, or an artery from the chest, depends on the number and location of the blockage.
• The graft is attached above & below the blocked area so that blood actually flows around it and to the area of the heart below the blockage.
• Improves blood flow and thereby oxygen and nutrients to the heart muscle itself. Improved blood flow relieves symptoms of angina (chest pain), improves heart function and may prevent a heart attack.

What Pre-surgery Events will Occur?

• The surgeon or one of his assistants will explain the surgery and have the patient sign a consent.
• The anesthesiologist will talk to the patient the day before surgery.
• The patient will receive a copy of the booklet Coronary Bypass Graft.
• Blood tests, chest x-rays, EKGs, will be done.
• A normal dinner will be given, but nothing to eat or drink after midnight will be allowed.
• Surgical preparation will include being shaved (neck and chest) and taking a shower with Phisohex soap.
• Medications, such as antibiotics, may be given.
• Medications to decrease anxiety and help the patient relax will be given just before the patient is taken to surgery.
• Transportation to surgery will be provided by stretcher.
• Anesthesia will be administered by the anesthesiologist.
• After surgery, care will be given in the Intensive Care Unit (ICCU) so the patient can be closely monitored.
• The family will receive a copy of ICCU Visiting Guidelines.

What Can be Expected Post-operative while in the Intensive Care Unit (ICCU)?

• Equipment
  • Breathing Tube
    • A tube is put through the mouth into the windpipe and is attached to a machine called a "ventilator" that breathes for the patient during and after surgery.
    • Talking will not be possible until the tube is removed usually 8-24 hours after surgery. However, by nodding "yes" or "no" to questions, communication with the nurse or family is possible.
    • The nurse will suction mucous from the lungs through this tube. It will cause a coughing feeling that quickly subsides. This is necessary to keep the tube and lungs clear.
  • Vascular Catheters
    These catheters are inserted during surgery, while the patient is asleep, to assess and treat his condition. They are attached to the bedside monitor, give a continuous display of events and are usually removed in one or two days. They include:
    • Pulmonary artery pressure monitor
    • Arterial catheter for blood pressure monitoring
    • IV tubes to administer fluids, medications and blood if necessary
  • Heart Monitor
    The monitor is connected by wires to patches on the chest and gives a continuous display of heart activity. All of the above equipment have alarms that sound frequently when the patient moves and do not necessarily indicate a problem.
  • Chest Drainage Tubes
    These tubes are placed in the chest near the bottom of the incision and drains the small amount of blood that collects around the heart temporarily after surgery. They are removed after one or two days.
  • Bladder Catheter
    A small tube is inserted into the bladder that drains urine. It may cause a feeling of the need to urinate. It is removed after one or two days.
  • Dressings
    A bandage will be maintained on the mid-chest incision for three to four days.
  • Nasogastric Tube
    This tube is placed through the nose into the stomach to relieve any nausea or gas. If this tube is necessary, it is usually removed when the breathing tube is removed.
• Treatment and Care
  • Post-operative care will include:
    • blood tests, chest x-rays and EKGs
    • administration of several IV medications
    • frequent monitoring of blood pressure, respiratory status, heart pressures, heart rate and rhythm, incisional drainage, and urine drainage
    • administration of blood transfusions may be necessary in some cases
  • Respiratory treatments will be administered to keep the lungs clear:
    • coughing and deep breathing will be encouraged frequently to help loosen secretions and expand the lungs.
    • frequent turning from side to side in bed and getting out of bed with assistance soon after surgery will also help.
    • a small pillow will be provided to hold over the chest incision to help "splint" or support the chest and lessen discomfort when moving or coughing.
  • Pain at the incision site:
    • the nurse will frequently ask the patient about his level of pain and medication will be offered to help the patient keep his pain under control.
    • pain medication will be given through the IV while in the ICCU to control pain in the immediate post-op period. Soon thereafter, pain is well controlled with oral pain medications.
    • if needed, pain medications will be prescribed for use at home.

What Happens When Intensive Care is No Longer Needed?

• After one day in the ICCU and depending on individual recovery rate, the patient will be transferred to the Progressive Care Unit (PCU). By this time, the following will have been removed:
  • Breathing tube and ventilator
  • Vascular catheters, except one in the arm
  • Chest tubes
  • Bladder catheter
  • Nasogastric tube (if used)
• Following removal of the bladder catheter, there may be some burning. If this continues after the first urination, the nurse must be notified.
• The diet will gradually return to normal.
• Post operative tests will continue such as blood tests, chest x-rays and EKGs.
• Oxygen will be continued if needed.
• IV Medications will be continued or resumed orally as ordered by the doctor.
• Pain medication may be requested to ease discomfort especially when getting out of bed.
• Activity will gradually increase from sitting on the side of the bed in the ICCU to showering and walking in the hallways in PCU.

Telemetry (monitoring of the heart rate and rhythm) will continue via chest patches, attached to a small telemetry box. This box is secured to the patient's gown and allows unrestricted activity. This telemetry box is worn at all times (removed only when in the shower) and the patient must remain on the PCU unit floor so the signal will be picked up by the monitoring equipment.