PROCEDURE 44 • 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 • Knowledge and skills related to aseptic and sterile technique are needed. • Internal defibrillation may be necessary if life-threatening dysrhythmias occur (see Procedure 42). • 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 • 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 • Syringes: 3 ml, 5 ml, 10 ml, and 20 ml • Knife blades: Nos. 10, 11, 15 Additional equipment as needed includes the following: • Prescribed analgesia and sedation • Blood products and intravenous solutions as prescribed • Defibrillator and compatible internal defibrillation paddles
Emergent Open Sternotomy (Assist)
PREREQUISITE NURSING KNOWLEDGE
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 hematoma3 may be decreased.
EQUIPMENT
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44: Emergent Open Sternotomy (Assist)
