June Education Newsletter | Cardiovascular Intensive Care Unit

JoAnna Bentsen

August 6, 2024

1. PD Documentation is charted in real-time. Do not back chart.
2. A few post-op cardiac surgery reminders are listed below.
3. EKOS Catheters: Keep Normal Saline infusions running until the EKOS catheter comes out.
4. Procedure Course July 23rd
5. Bedside Open Chest Sim September 25th. Let Jo/CSL know if you would like to be enrolled!
6. Interested in helping with targeted teaching? Next Date is August 1st!
7. Care partner Career pathway work groups are over the next 6 weeks if you are interested in attending one
8. Medication Updates: Changes and additions to the IV Push Med List. Key drugs that you use regularly!

PD Documentation: NO Backcharting!!

When starting PD, it is important to remember to document in REAL TIME.
PD Consists of 3 Cycles that run in this order:
1. DRAIN- what is currently in their abdomen
2. FILL- the abdomen with the prescribed volume and concentration of dialysate
3. DWELL- For the ordered number of hours/minutes.
These three numbers will calculate a net filtration in 24-hour periods that start at 7 AM.

Because our patients cannot always verbalize what their standard fill volume is, here are two examples below of what this initial documentation looks like.

** EACH cycle, you will document in real time what you drained/filled/and the fill time to come for the fluid you just instilled in the patient's abdomen**

Post-Op Surgical Reminders:
1. ACE Wrap Dressings come off on Post-Op-Day (POD) 1
- Compression helps prevent edema related to the graft sites of CABG Patients
2. Defibrillator Pads need to be changed every 24 hours
- Not only does this ensure that adhesive on pads remains intact for use, but keeping these pads in place longer than 24 hours makes patients susceptible to skin tears at these sites.
3. Be mindful of lines/drains that need to be completed with the patient in bed.
- PA Catheters, Central Lines, Arterial Lines, Chest Tubes, Sheaths
** Can these lines be removed before the patient gets up in the morning?**

EKOS Catheters:
Used to treat Submassive/Massive Pulmonary Embolisms. EKOS Catheters are placed in the Cath Lab and then maintained in the unit.

Patients Come out of the Cath lab with a DUAL lumen catheter, controller and two to three Alaris Infusion pumps per EKOS catheter.

The two lumens to the catheter allow for the EKOS catheter to send ultrasonic waves into the pulmonary embolism, while the infusion catheter delivers either Anticoagulant (Heparin) /Thrombolytic (TPA, -plase drug) AND a coolant to the patient.

Coolant = Normal Saline infusion running from the Alaris pump to the coolant port as pictured below.

What is the coolant?!
Ultrasonic waves of the core generate energy which translates as heat inside the catheter, which is sitting within the patient's body.
To keep this heat from damaging the patient, a COOLANT runs through the catheter, decreasing heat generation.

The medication orders for these infusions only run as long as the timer for the ultrasound is set. If the team is not readily available to remove these catheters, the bedside RN must maintain the coolant line as long as the catheter is in
You must have a coolant running while the EKOS catheter is on!

What is the role of the Bedside nurse for EKOS catheters? Maintenance and Monitoring
**All non-listed assessment standards default to orders/CVICU Standards**

Procedure & Emergency Management Course: July 23rd!

Bedside Open Chest Sim: September 25th

We are excited about the opportunity to host Focus Groups for Unlicensed Assistive Personnel (Medical Assistants, Care Partners, Behavioral Health Specialist, Patient Care Techs, etc.) in the coming weeks to discuss Career Pathways at VUMC!

The attached flyer shares details on the virtual opportunities for staff to join the focus group conversations.

Let me know if you would like the flier to join these virtual sessions!!

Medication Updates: New IVP Doses

Multiple Medications will now be given in IV Push Formulation as opposed to IV Piggy Back

Thiamine (up to 500mg)
Furosemide (changing from up to 80mg to up to 120mg)
Ceftriaxone 1g, 2g,
Cefazolin 500mg (1g and 2g already IV push)
Cefoxitin 1g, 2g
Ceftazidime 1g, 2g
Acetazolamide (up to 500mg)
Folic acid (up to 5mg)

Process for administration of IV push medications: Look at “Admin Instructions:” within nursing MAR for specific medication preparation and administration instructions (see example below).

A screenshot of a computer

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CVICU INQUIRER | June 2024
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