Mediastinal chest sump tubes following cardiac surgery: an unconventional method.

The practice of using conventional mediastinal chest tubes (MCTs) connected to a closed collection device is commonplace in cardiovascular surgery care settings. The MCT collection device requires a closed system to maintain a negative intrathoracic pressure with the goal of preventing inadvertent trapping of air and blood within the mediastinal space. Despite the proposed integrity of the closed system, there is no guarantee that the suction's negative pressure will prevent cardiac tamponade. In addition, it has been postulated that the required negative intrathoracic suction may potentiate mediastinal tissue damage. This clinical paper will describe the use of multi-lumen MCTs open to atmosphere following surgical repair for congenital heart defects. It is postulated that open MCTs may potentially reduce the risks of cardiac tamponade and mediastinal tissue damage. Through case presentation, the mechanics of open MCTs, nursing care, and possible complications will be delineated.

Continuous venous hemodiafiltration with trisodium citrate anticoagulation in cardiac surgery patients.

Despite advances in perioperative organ protection during cardiovascular surgery, acute renal failure remains a serious complication. The purpose of this clinical article is to describe the role of continuous renal replacement therapy (CRRT) in proactive maintenance of fluid and electrolyte balance and treatment of acute renal failure in patients following cardiovascular surgery. Implications for nursing practice, education, and future research will be delineated using a case study of a patient who required mechanical circulatory support and CRRT. The complexity of the patient's care was compounded by the need to alter conventional anticoagulation therapy to trisodium citrate.

Discharge information needs and symptom distress after abdominal aortic surgery.

The purpose of this study was to describe the discharge information needs and symptom distress of people after abdominal aortic reconstructive surgery. Interviews (N = 51) were conducted prior to, and 4 weeks after, hospital discharge. People indicated that the most important information to help them manage their care after discharge related to the recognition, prevention and management of complications. Broken sleep and incisional pain were the most distressful of symptoms prior to hospital discharge, whereas fatigue and broken sleep were most distressful once home. These results may assist nurses to understand the discharge information needs and symptom distress of people recovering from aortic reconstructive surgery and the importance of discharge education to help people to manage their care once home.

Symptom distress, anxiety, depression, and discharge information needs after peripheral arterial bypass.

The purpose of this study was to describe the symptom distress, anxiety, depression, and discharge information needs of patients after peripheral arterial bypass surgery. Patients (n = 38) were interviewed before and after hospital discharge. The symptoms of incisional pain and broken sleep, as measured by Visual Analogue Scales, were the most distressing symptoms experienced before and after discharge. Patients reported low levels of anxiety and depression as measured by the Profile of Mood States. A moderate amount of information, assessed by the Patient Learning Need Scale, was perceived by patients to be important to help manage their care after discharge. The most important information related to the recognition, prevention, and management of complications. The findings contribute to an understanding of discharge information needs after peripheral arterial bypass and emphasizes the importance of patient education to facilitate transition to the home.

Caring for a Marfan patient with cardiovascular complications.

The Marfan syndrome is a heritable disorder of connective tissue associated with characteristic abnormalities of the skeletal, ocular and cardiovascular systems. Common cardiovascular manifestations of this syndrome are mitral valve prolapse with mitral regurgitation and dilatation of the ascending aorta resulting in aortic insufficiency, dissection, aneurysm and/or rupture. Although the prognosis for a patient with the Marfan syndrome is significantly more favorable than it was ten years ago, the cardiovascular complications continue to greatly reduce life expectancy. This article presents an overview of the Marfan syndrome including: history and epidemiology, clinical manifestations, diagnostic criteria, surgical intervention and follow-up. A case study is outlined which focuses on priority nursing diagnoses and a plan of care.

Postoperative autotransfusion: an overview of techniques and clinical efficacy.

In summary, the purpose of this discussion has been to provide an overview of the theoretical, technical and clinical nursing considerations in the use of postoperative autotransfusion. The relative safety and efficacy of utilizing autotransfusion techniques following cardiac surgery has been reported by many researchers. However, there remains other aspects and considerations in the use of autotransfusion that require further clarification. The limited documentation on the reported number of positive bacteriological cultures with open system and the associated risks of systemic sepsis warrants additional investigation. The comparative risk of sepsis between the open and closed systems requires more extensive evaluation. Another aspect of the technique that remains unestablished is the period of time that an autotransfusion system remains effective in replenishing red cell mass. This is apparent in the reported variations in time frames that have been described with the use of this technique. Protocol comparisons among various institutions that employ this technique might yield significant information about this variation. Concerns associated with the risks and cost of homologous blood products have been firmly established. The hazard of AIDS contamination secondary to blood transfusion, although remote, is often foremost in the patient's perception of risks associated with expectant surgery. Nurses have a vital role to play in providing patients with information on current medical treatment modalities, and can thereby potentially reduce preoperative anxiety. Furthermore, the education of nurses on the technique of postoperative autotransfusion provides them with the capability to safely utilize this valuable technology in patient care.