Coronary artery bypass graft (CABG), often known as heart bypass surgery, is a medical procedure used to enhance blood flow to the heart. This procedure is beneficial in managing atherosclerosis, a form of coronary artery disease (CAD).
CAD happens when plaque, a type of blood substance, forms on the artery walls, and less blood flows to the heart muscle. Thus, if the heart does not receive enough blood, it is more likely to become overworked and collapse. Moreover, atherosclerosis can harm any of the body’s arteries.
If the coronary arteries become so constricted or clogged that the patient is at high risk of having a heart attack, or when the blockage is too severe to be treated with medicine or other methods, the doctor may recommend heart bypass surgery.
Types of Coronary Artery Bypass Graft
- Traditional Coronary Artery Bypass Graft. Traditional bypass surgery includes a breastbone or sternum incision and the utilization of a heart-lung bypass machine. There is no need to stop the heart during this treatment. However, the insertion of a heart-lung machine is necessary to pump more blood and execute functions commonly performed by the lungs.
- Off-Pump Coronary Artery Bypass Graft. This procedure can be used to bypass any of the coronary arteries. Since the heart is not stopped and usage of no heart-lung machine is not needed in this procedure, off-pump CABG is also called beating heart bypass grafting. Alternatively, a mechanical device is used to stabilize the area of the heart where the grafting is taking place.
- Minimally invasive CABG. A surgeon conducts coronary bypass surgery through minimal incisions in the chest, frequently using robotics and video imaging to operate in a limited region. Minimally invasive CABG variations may be referred to as port-access or keyhole surgery.
Indications of CABG
Doctors might consider CABG if the patient has the following conditions:
- The patient suffers from significant chest discomfort due to the constriction of multiple arteries that supply the heart muscle, depleting the muscle of blood even during moderate exercise or rest.
- The patient has several damaged coronary arteries, and the heart’s primary pumping chamber, the left ventricle, is not working accurately.
- The left major coronary artery of the patient is substantially constricted or obstructed. This artery delivers the majority of blood to the left ventricle.
- The patient has an arterial obstruction that cannot be addressed by inserting and inflating a tiny balloon to widen the artery (angioplasty) temporarily.
- The patient had a previous angioplasty or insertion of a thin wire mesh tube (stent) to keep the artery open that was unsuccessful, or the artery narrowed again after the stent was placed.
- If the patient is not responding to alternative therapies, coronary bypass surgery may be performed in an emergency, such as a heart attack.
Risks of CABG
Since coronary bypass surgery is an open-heart treatment, problems may occur during or after the procedure. Risks could include:
- Bleeding
- An irregular heartbeat
- Wound infections in the chest
- Memory loss or difficulty thinking usually improves within six to twelve months.
- Kidney problems
- Stroke
- A blood clot forming soon after surgery can cause a heart attack.
Complications of CABG
The following are the significant complications linked with CABG:
- Death
- Ischemic heart disease
- Stroke
- Extended usage of mechanical ventilation
- Acute kidney damage
- Hemorrhage that necessitates a transfusion or reoperation
The risk of complications is usually low, although it depends on the patient’s health before surgery. Complications are more likely if the surgery is performed as an emergency or if the patient has other medical conditions such as emphysema, renal disease, diabetes, or clogged arteries in the legs.
Pre-Procedure Nursing Care: Preparing the Patient for Coronary Artery Bypass Graft Surgery (CABG)
The attending physician or healthcare practitioner should prepare the patient for CABG surgery.
- Obtain informed consent and tell patients about CABG, including its risks, contraindications, and consequences.
- The patient must complete scheduled appointments with the surgeon two or three weeks preceding surgery. Inform the patient that he or she needs to undergo some laboratory tests before the CABG. Most of these tests are necessary so that doctors may assess and compare the patient’s condition before and after CABG surgery. Blood count (hematocrit), prothrombin time, chest x-ray, and cardiac catheterization are some of the tests that must be performed.
- Along with a review of the patient’s medical history, the doctor will perform a complete physical assessment to ensure that the patient is in overall good health before performing the treatment.
- The patient should notify the doctors about all the medications, supplements, vitamins, and herbal medicines that he or she is using. Several medications or supplements can increase the risk of bleeding or interfere with anesthesia.
- The patient must adhere to the doctor’s instructions regarding when to cease eating and drinking. If the patient fails to comply, the procedure may be canceled.
What Happens During Coronary Artery Bypass Graft (CABG)
A hospital stay is required for coronary artery bypass graft surgery (CABG). The procedure may differ depending on the patient’s health and the doctor’s medical practices. In general, CABG proceeds as follows:
- Removal of any jewelry or other items that may interfere with the procedure is necessary.
- The patient must remove his or her cloth, change to a hospital gown, and empty his or her bladder.
- During the procedure, the anesthesiologist will continuously check the patient’s pulse rate, blood pressure, respiration, and blood oxygen level.
- After the patient has been sedated, a breathing tube attached to a ventilator will be placed in their throat, which will be their source of breath during the surgery.
- A healthcare practitioner will insert an intravenous (IV) line into the patient’s arm or hand. Other catheters will be placed in the neck and wrist to evaluate the heart and blood pressure and to collect blood samples.
- A catheter will be inserted into the patient’s bladder to drain urine.
- An antiseptic solution will be applied to the patient’s skin over the surgical site.
- The doctor will make incisions in one or both legs or one of the wrists to access the blood vessels used for the grafts once all the tubes and monitors are in place. The surgeon will next remove the vessels and close the incisions.
- The incision will be made below Adam’s apple and immediately above the navel by the doctor. The doctor will cut the sternum (breastbone) in half lengthwise, divide the breastbone halves, and stretch them apart to uncover the heart.
- The doctor will use thin wires to stitch the sternum together. The doctor will implant tubes into the patient’s chest to remove the blood and other fluids from the heart.
- The doctor will then apply a sterile bandage or dressing to the wound. Furthermore, patients are assessed and monitored continuously following the CABG operation. The patient will then be transported to the intensive care unit for further evaluation and monitoring.
Post-operative Management of Coronary Artery Bypass Graft Surgery (CABG)
Postoperative care for cardiac surgery patients is complex since changes can occur quickly. The patient’s preoperative status and intraoperative events should be considered in postoperative treatment. In order to obtain a positive outcome for the patient, the nurse must foresee potential difficulties and undertake relevant interventions promptly.
- Postoperative Pulmonary Management. Postoperative pulmonary care involves precise and regular physical assessments, arterial blood gas monitoring, continuous pulse oximetry, pulmonary care, early mobilization, and pain and shivering management. After cardiac surgery, most protocols include a chest x-ray.
- Postoperative Management of Hemodynamics. The nurse should closely monitor the pulmonary artery pressures, cardiac output, and blood pressure when interventions are initiated. According to several studies, hemodynamic indicators should be monitored every 30 to 60 minutes after each intervention throughout the early postoperative phase.
- Postoperative Management of Hemorrhage. The nurse should check for any evidence of hemorrhage from the chest tubes or surgical sites and clinical manifestations of hypovolemia caused by blood loss.
- Postoperative Neurologic Assessment. People who underwent coronary artery bypass surgery are more likely to experience neurologic problems. As a result, the nurse should pay special attention to neurologic examination during the postoperative period. Since the risk of stroke does not end with the operation, neurologic examinations must continue.
- Postoperative Renal Management. Renal impairment is possible in postoperative CABG surgery patients. During the early postoperative period, the nurse must monitor the urinary output at least every hour. The urine should be evaluated for color, features, and quantity.
- Postoperative Pain Management. Since patients respond differently to pain, nurses must individualize pain assessment and management for each patient. Pain management treatments include opioid analgesics, posture, mobilization, distraction, and relaxation.
Home Care after CABG
- Keeping the surgical region clean and dry after the CABG operation and after the patient is discharged from the hospital is critical. The doctor will give the patient special bathing instructions. If the stitches or postoperative staples were not removed before leaving the hospital, they would be removed during a follow-up office appointment.
- The patient should not drive unless instructed to do so by the doctor. Other restrictions on activities may apply.
- Inform the doctor right away if any of the following occur:
- A fever of 100.4°F (38°C) or higher, as well as chills
- Any incision site may have redness, edema, bleeding, or other discharge.
- Pain at any of the incision sites becomes worse
- Breathing difficulties
- A fast or unstable heartbeat
- Leg swollenness
- Numbness in the arms or legs
- Constant nausea or vomiting
Depending on the patient’s specific situation, the physician may provide additional or other instructions following the treatment.
CABG Nursing Diagnosis
CABG Nursing Care Plan 1
Nursing Diagnosis: Risk for Injury related to anesthesia-induced confusion, sensory or perceptual abnormalities, immobility, and musculoskeletal impairments secondary to postoperative CABG surgery. Signs and symptoms do not support a risk diagnosis since the problem has not yet happened, and nursing interventions are aimed at preventative measures.
Desired Outcomes:
- The patient will not sustain any injuries as a result of postoperative confusion.
- The patient will be free of any unfavorable skin or tissue injuries or changes that remain longer than 24-48 hours after the surgery.
- The patient will report improvement of localized numbness, tingling, or alterations in sensation caused by positioning within 24-48 hours.
| CABG Nursing Interventions | Rationale |
| Keep the extremity safe and secured where IV fluids are inserted. | This intervention eliminates excessive tension and dislocation of IV lines. |
| Keep the patient’s body away from any metal elements of the operating table. | The goal of this intervention is to lower the risk of electrical injury. |
| Ensure that the patient’s bed wheels are securely locked. | This strategy seeks to offer a sense of comfort and security. This intervention also lowers the possibility of patients slipping out of bed, especially after being sedated with general anesthesia. |
| Secure the patient on the OR table with a safety belt, explaining the need for restraint. | Since OR tables and arm boards are narrow, patients are at risk of harm, especially during fasciculation. When sedated or recovering from anesthesia, the patient may become resistive or aggressive, increasing the risk of injury. |
| Raise the patient’s bed’s side rails. | This simple intervention attempts to lessen the danger of a patient falling out of bed, assist the patient in repositioning, or support the patient transitioning into or out of bed. |
CABG Nursing Care Plan 2
Nursing Diagnosis: Fear or Anxiety related to lack of familiarity with the environment, changes in medical status, and detachment from regular support networks secondary to postoperative CABG surgery as evidenced by heightened tension, nervousness, lower self-assurance, stated concern about changes, fear of repercussions, and restlessness.
Desired Outcomes:
- The patient will be able to recognize emotions and find healthy strategies to deal with them.
- The patient will appear relaxed and capable of resting or sleeping adequately.
- The patient’s fear and anxiety will be reduced to a reasonable level.
| CABG Nursing Interventions | Rationale |
| Provide postoperative instruction to the patient, including the visit of OR personnel or surgeon after surgery if possible. Discuss any issues that may concern the patient. | This intervention can provide reassurance and relieve patient anxiety while providing information for postoperative care planning. This approach recognizes that a new environment might be unsettling and helps to ease the patient’s worries. |
| Provide the patient with clear, straightforward instructions and explanations for postoperative CABG management. | Because of cognitive impairment, it is difficult for the patient to comprehend long instructions and explanations concerning postoperative CABG management. |
| Determine the source of the patient’s anxiety. Give the patient a piece of accurate and factual information. | The identification of a specific fear assists the patient in dealing with it realistically. The patient may have misconstrued postoperative instructions or received erroneous information about CABG surgery. |
| Inform the patient or significant other of the nurse’s duty in postoperative CABG surgery management. | This technique fosters trust and rapport, reducing the patient’s worry and anxiety following CABG surgery. |
| Control the external stimuli of the patient. | Unnecessary noises and commotion may heighten the patient’s fear or anxiety about the potential outcomes or complications of CABG operation. |
CABG Nursing Care Plan 3
Nursing Diagnosis: Deficient Knowledge related to lack of exposure or recall, misunderstanding of knowledge, lack of familiarity with information resources, and cognitive restriction secondary to postoperative CABG surgery as evidenced by queries or requests for information, statements of misconception, incorrect execution of orders, or the emergence of avoidable complications.
Desired Outcomes:
- The patient will be able to explain the condition, the implications of the procedure, and any potential complications.
- The patient will be able to explain his or her understanding of therapeutic needs.
- The patient will understand postoperative care for CABG surgery.
- The patient will make the essential lifestyle modifications and follow the treatment plan.
| CABG Nursing Interventions | Rationale |
| Examine the patient’s knowledge about CABG surgery, future expectations, and possible complications. | This intervention provides patients with a piece of knowledge about the procedure that they underwent. This approach will also prevent complications from arising. |
| Educate the patient on the importance of eating a good diet and staying hydrated after undergoing CABG surgery. | This intervention aims to educate the patient about the factors that must be considered for tissue regeneration or healing and how to maintain tissue perfusion and organ function. |
| When needed, review and have the patient or significant other demonstrate dressing or wound care. | This method encourages competent self-care and increases independence. This intervention will also teach the patient how to prevent infection from surgical wounds. |
| Educate the patients about the signs and symptoms that require medical attention, such as nausea and vomiting, trouble urinating, fever, persistent or odoriferous wound drainage, incisional swelling, erythema or edge separation, and unresolved or changing pain characteristics. | Early detection and treatment of emerging problems may prevent a more complicated or life-threatening situation. |
| Include the significant other in the teaching program or discharge preparation, and give written instructions or educational resources. Instruct the patient or significant other regarding the usage of specialized equipment as necessary. | This intervention provides additional resources for after-discharge reference. This approach will help the patient and significant other to be knowledgeable about postoperative care for CABG surgery. |
| If the patient enjoys smoking prior to surgery, encourage and educate him on the significance of quitting. | Tobacco smoking raises the incidence of lung infections, promotes vasoconstriction, and decreases blood oxygen-binding capacity, reducing cellular perfusion and perhaps delaying healing. |
CABG Nursing Care Plan 4
Nursing Diagnosis: Acute Pain related to disruption of skin, tissue, and muscle stability secondary to postoperative CABG surgery as evidenced by complaints of discomfort, pain masking on the face, distraction, and restlessness.
Desired Outcomes:
- The patient will report pain relief or pain control.
- The patient will appear relaxed and capable of resting, sleeping, and participating in activities as needed.
| CABG Nursing Interventions | Rationale |
| Provide the patient extra comfort measures like backrubs and heat or cold applications. | This method increases circulation and lowers pain-related muscular tension and anxiety. |
| Even if the patient denies pain, check his or her vital signs for tachycardia, hypertension, and rapid breathing. | Changes in these vital signs are frequently associated with severe pain and discomfort. |
| Encourage relaxation exercises such as breathing techniques, mental imagery, meditation, and music. | This method relieves muscle and psychological stress, improves control, and may improve coping abilities with pain. |
| Evaluate the patient’s pain regularly, such as every 2 hours, noting characteristics, location, and intensity on a 0-10 scale. | This approach will provide information on whether the interventions for acute pain are effective or not. |
| Administer analgesics if acute pain occurs after the CABG surgery. | This intervention aims to relieve the patient’s pain and discomfort brought about by the CABG surgery. |
CABG Nursing Care Plan 5
Nursing Diagnosis: Impaired Skin Integrity related to disrupted blood circulation and the consequences of specific procedures related to postoperative CABG surgery as evidenced by disturbance of the skin’s surface or layers and tissues.
Desired Outcomes:
- The patient will obtain fast wound healing.
- The patient will exhibit behaviors or techniques that encourage recovery and help to avoid problems.
| CABG Nursing Interventions | Rationale |
| Reinforce the first dressing and change it as directed. Use rigorous aseptic procedures. | This intervention aims to protect the wound from physical irritation and infection. |
| Inspect the patient’s wound regularly, taking note of its characteristics and integrity. Patients at risk of delayed healing should be noted. | Early detection of delayed healing or growing problems may prevent severe complications. Wounds may heal more slowly in people with comorbidities or in the elderly, where decreased cardiac output reduces capillary blood flow. |
| Irrigate the wound and, if necessary, aid the patient with debridement. | This method eliminates infectious exudate or necrotic tissue and encourages healing. |
| Instruct the patient not to touch the wound. | This technique seeks to keep the wound from becoming contaminated or infected. |
| When changing the wound dressing, gently remove the tape. | This method tries to limit the risk of skin damage and wound disruption. |
| Maintain or monitor the patient’s dressings. Make use of hydrogel or vacuum dressing. | Hydrogel or vacuum dressings can accelerate healing in large, draining wounds or fistulas, promote patient comfort, and reduce the frequency of dressing changes. This intervention allows drainage to be measured more precisely and analyzed for pH and electrolyte contents. |
| If necessary, apply ice to the incised area. | This method decreases edema formation, putting unnecessary pressure on the incision during the initial postoperative phase. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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