PROCEDURE 43 • Knowledge of anatomy and physiology of the cardiovascular system is necessary. • Advanced cardiac life support knowledge and skills are needed • Understanding of the 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.6,7 • Knowledge and skills related to aseptic and sterile technique, surgical instrumentation, sternal opening, sternal exploration, sternal closure, and suturing are needed.1,4–6 • Paralytic agents may be a necessary adjunct to sedation to improve oxygenation, diminish muscle activity, and enhance visualization. • 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) and other suture material according to preference • Syringes: 3 ml, 5 ml, 10 ml, and 20 ml • Knife blades: Nos. 10, 11, 15 • Emergency medication and resuscitation equipment, including internal defibrillation paddles and external defibrillation pads or paddles Additional equipment as needed includes the following: • Prescribed analgesia or sedation • Prescribed blood products and intravenous solutions • Defibrillator and compatible internal defibrillation paddles
Emergent Open Sternotomy (Perform)
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 hematoma may be decreased.3
EQUIPMENT
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44: Emergent Open Sternotomy (Assist)
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43: Emergent Open Sternotomy (Perform)
