44: Emergent Open Sternotomy (Assist)

Published on 07/03/2015 by admin

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Last modified 07/03/2015

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Emergent Open Sternotomy (Assist)

Linda Schakenbach

Emergent open sternotomy for a patient after cardiac surgery is performed to identify and eliminate areas of persistent hemorrhage, relieve pericardial tamponade, and provide access for open cardiac massage and internal defibrillation.

PREREQUISITE NURSING KNOWLEDGE

• Knowledge of the anatomy and physiology of the cardiovascular system is necessary.

• Advanced cardiac life support knowledge and skills are needed.

• Understanding of signs and symptoms of cardiac tamponade is necessary.

• Emergency open sternotomy is performed for patients who have undergone a median sternotomy, usually within the first 2 weeks of cardiac surgery.

• Emergent open sternotomy is indicated for exsanguinating hemorrhage or cardiac tamponade with imminent cardiac arrest.5,6

The goal of mediastinal exploration for persistent hemorrhage is to stop the bleeding and retain circulating blood volume. The requirement for homologous blood transfusion and incidence of wound infection associated with an undrained mediastinal hematoma ³ may be decreased.

The goal of mediastinal exploration for cardiac tamponade is to relieve the pressure on the ventricles during diastole. The decreased pressure allows the ventricles to fill during diastole, which should increase contractility, stroke volume, and cardiac output to improve systemic perfusion.

• Knowledge and skills related to aseptic and sterile technique are needed.

• Internal defibrillation may be necessary if life-threatening dysrhythmias occur (see Procedure 42).

EQUIPMENT

• Antiseptic solution (e.g., 2% chlorhexidine-based preparation)

• Head cover, masks, eye protection, sterile gown, sterile gloves, sterile drapes

• Sterile open-chest set and sternotomy tray

Kelly clamps and skin snaps

• Electrocautery equipment: Generator, cautery, electrical dispersing pad (e.g., grounding pad)

• Large sterile suction catheter (e.g., Yankauer)

• Suction containers, tubing, regulator, and suction source

• Radiopaque gauze or other surgical sponge materials

• Polypropylene (Prolene) suture (cutting needle), other suture material according to preference

• Clip applicator and clips

• Syringes: 3 ml, 5 ml, 10 ml, and 20 ml

• Knife blades: Nos. 10, 11, 15

• Sternal wires or bands

• Sterile stapler or sutures

• Sterile dressing supplies

• Emergency medication and resuscitation equipment

Additional equipment as needed includes the following:

• Prescribed analgesia and sedation

• Blood products and intravenous solutions as prescribed

• Sterile staple remover

• Defibrillator and compatible internal defibrillation paddles

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