Claro B.

Ebora

52
Male

Coronary Artery Bypass Grafting

Major

Dr. James Esquivel

February 18, 2010

564697
GETA
Dr. Rafael Poblete
 It is also known as Bypass surgery, Coronary artery
bypass surgery or Heart bypass surgery
Coronary artery bypass grafting (CABG) is a type of
surgery that improves blood flow to the heart. It's used for
people who have severe coronary heart disease (CHD), also
called coronary artery disease.
It is surgery that involves the bypass of the blockage in
one or more of the coronary arteries using saphenous veins,
mammary artery, or radical artery as conduits or replacement
vessels.
It is the surgical restoration of blood flow to the vessels
serving the heart. It is a commonly used approach for those
with obstructions of the heart vessels.
Anatomy involve
The chest is opened by median
sternotomy for the access and
pericardium is incised. Saphenous
veins are being harvested.

The great saphenous vein is the

conduit of choice for vascular
surgeons when available, for doing
peripheral arterial bypass
operations because it has superior
long-term patency compared to
synthetic grafts or biosynthetic
grafts
  Coronary Artery

The aorta (the main blood supplier to the body) branches off into two
main coronary blood vessels (also called arteries). These coronary arteries
branch off into smaller arteries, which supply oxygen-rich blood to the entire
heart muscle.
The right coronary artery supplies blood mainly to the right side of
the heart. The right side of the heart is smaller because it pumps blood only
to the lungs.
The left coronary artery, which branches into the left anterior
descending artery and the circumflex artery, supplies blood to the left side of
the heart. The left side of the heart is larger and more muscular because it
pumps blood to the rest of the body.
Functions of organs or body involve
Saphenous vein was used as a conduit it is performed by two
teams: one harvest the greater saphenous vein and the other
opens the chest and prepares for CPB. An adequate vein is
removed to obtain sufficient graft material.
Etiology of disease
Accumulation of lipids, complex carbohydrates, blood products,
fibrous tissue, and calcium deposits that results in the
narrowing of coronary artery.
Signs& symptoms
It is performed with arteriosclerotic coronary artery disease.
Usually clients with continues angina and abnormal ECG or
stress test are candidates for CABG.
Symptoms of coronary artery disease may include, but are
not limited to, the following:
 chest pain

 fatigue

 palpitations

 shortness of breath
Intra Operative Complications

Cardiovascular complications
include dysrhythmias,
decreased cardiac output, and
persistent hypotension. When
heart’s metabolic demands are
reduced during surgery, heart
needs nutrient blood and
oxygen supply.
 Post Operative
Complications

 The heart can be

ischemic, and not
fully contracting.
Dysrhytmias may
develop from
electrolyte
imbalance, surgery
near the conducting
system, and ischemia.
Skin preparation
The skin preparation usually involves iodophor scrub and
solution. The chest to groin to and including ankles should be
free from hair.
Draping
The cardiovascular drape is used exposing the entire body
except feet, genitalia and pubic areas.

Position
Supine Position place patients legs on a rounded pillow or
cushion and in frog leg position.
Anesthesia
General Endotracheal anesthesia is used and
premedicated with morphine and scopolamine. Inhalation with an
airway tube placed in the windpipe.
Endotracheal anesthesia is a form of anesthesia in which
inhaled gases are delivered directly into the trachea with the use
of an endotracheal tube. As long as gases are supplied through
the tube, the patient will remain deeply unconscious and
insensate to pain. This technique is widely used for the purpose
of keeping patients unconscious in surgery in a technique known
as general anesthesia. It can be practiced by an anesthesiologist
or nurse anesthetist.
Incision site
The skin incision should continue proximally wothout
creating flaps. The desired legth of vein is freed, it should
be ligated at distal end after being clamped.
The dissection of the chest may be done with forceps,
cautery and metzenbaum scissors. It is grafted in the usual
distal having been pass over or through pericardium.
In coronary artery disease, the blood vessels that nourish the heart
muscle become narrowed or completely blocked, causing the amount of
blood flow through them to decrease. The purpose of coronary artery
bypass graft surgery is to improve the blood supply to an area of the
heart that has been deprived of adequate circulation. Veins from other
parts of the body are grafted onto the diseased coronary artery above
and below the blockage. This graft restores blood circulation to the
damaged area. Coronary artery bypass surgery is actually two surgeries
performed at the same time. One incision is made in the leg to remove
a vein. This vein is used as a graft, or conduit, to create a new coronary
artery. Another incision is made in the chest to allow the surgeon to
reach the heart. The length and number of incisions depend on how
many bypasses are needed. One end of the vein graft is sewn in the side
of the aorta, the large artery of the heart. The other end of the graft is
sewn below the area of the blocked coronary artery. This vein actually
detours, or “bypasses,” the blood around the obstruction to restore
good blood flow to the area. The graft is usually taken from the
saphenous vein in the leg, an internal mammary vein or a radial artery.
 Nursing Diagnosis Scientific Analysis Goals and Nursing Intervention Rationale
Objectives
Acute pain related to Unpleasant sensory and Goal: after 1 hour of
postoperative emotional experience nursing intervention, the
nerve trauma arising from actual or client will exhibit
potential tissue damage comfort as evidenced by
or described in terms of verbalization of
such damage; sudden or decreased pain
slow onset of any
intensity from mild to Objectives:
severe with an The client will have Monitor vital signs. Heart rate usually increases with pain,
anticipated or normal vital signs. although a bradycardiac response can
predictable end. occur in a severely diseased heart. BP may
( NANDA page 492) be elevated slightly with incisional
discomfort but may be decreased or
unstable if chest pain is severe and/or
myocardial damage is occurring.

Pain is perceived, manifested, and

The client will report Encourage patient to report tolerated individually. Many CABG patients
type, location, and type, location, and do not experience severe discomfort in
intensity of pain, rating intensity of pain, rating on chest incision and may complain more
on a scale of 0–10. a scale of 0–10. Note often of donor site incision discomfort.
associated symptoms. Ask Severe pain in either area should be
the patient how this investigated further for possible
compares with preoperativecomplications.
chest pain.  
  

The client will identify a Identify/promote position These nonverbal cues may indicate the
position of comfort using of comfort, using adjuncts presence/degree of pain being
adjuncts as necessary. as necessary. experienced.
 Nursing Diagnosis Scientific Analysis Goals and Nursing Rationale
Objectives Intervention
Acute pain related to The client will verbalize Provide comfort May promote relaxation/redirect attention
postoperative comfort through the measures (e.g., back and reduce analgesic dosage needs/frequency.
nerve trauma nonpharmacologic rubs, position changes),
measures. assist with self-care
activities
The client will verbalize    Relaxation techniques aid in management of
comfort through the use Identify/encourage use stress, promote sense of well-being, may
of diversional activities. of behaviors such as reduce analgesic needs, and promote healing.
guided imagery,
distractions,
visualizations, deep
breathing.