FATIMA AZZAHRA RAJU KAPADIA Coronary Artery Bypass Graft Polytechnic Ministry Of Health Pontianak Department of Nursing 2023 FATIMA AZZAHRA NS, RAJU KAPADIA, S. K EP, M.MED (ED)

Polytechnic of Health Ministry of Health Pontianak Department of Nursing 2023 Polytechnic of Health Ministry of Health Pontianak Singkawang Nursing Department Campus , located at Jalan Dr. Soetomo No. 46, Ex. Pasiran, Kec. West Singkawang , Singkawang City Author : Fatima Azzahra, Ns. Raju Kapadia, S.Kep, M.Med (Ed)

CABG 2 Period & Goals 4 Home Care 12 Reference 13 CVD 1 Follow-up 8 Contents Indication & Complication 3 Nursing Management 9

550 Million living with heart & circulatory disease 54% 19 Million Deaths 34% of total 0 100 200 300 400 North America Europe Asia & Australasia Africa South America North America Europe Asia & Australasia Africa South America 15 10 5 0 Cambodia Indonesia Laos Malaysia Myanmar Philippines Singapore Thailand Vietnam 20 15 10 5 0 Heart & Circulatory Disease (Cardiovascular Disease; CVD) Worldwide Global Heart & Circulatory Disease Prevalence 2022 (Health Intelligence Team, 2022) Estimated Deaths from Heart & Circulatory Diseases (2019) (Health Intelligence Team, 2022) Global 290 milion There are around 550 million people living with heart and circulatory diseases across the world – this number has been rising due to changing lifestyles, an ageing and growing population, and improved survival rates from heart attacks and strokes – and will continue to rise if these trends continue. Today it’s estimated that globally there are more women than men living with heart and circulatory diseases (Health Intelligence Team, 2022) Cardiovascular diseases are the most common cause of death in the world. Coronary artery bypass (CABG) is one of the most common treatments for patients with coronary artery disease. Heart & circulatory Desease (Cardiovascular Disease; CVD) is an umbrella term for all diseases of the heart and circulation. It includes everyhing from condition that are inherited or that a person is born with, to those that develop leter, such as coronary heart desease, artial fibrillation, heart failure, stroke and vasculas dementia. (Sarkar & Prabhu, 2017). 260 milion 46 M 99 M 310 M 58 M 32 M 1.1 M 11 M 4.1 M 1.7 M 1 M 15.4% 11.1% 9.1% 11.6% 5.6% 8.9% 10.1% 18.8% 9.3% Late adults in Indonsia has cardiovascular disease (CVD). (Wahyuni et al., 2022) 1

Its inlcudes a breastbone or sternum incision and the utilization of heartlung bypass machine. There is no need to stip the heart during this treatment. However, the insertion of a heat-lung machine is necessary to pump more blood and execute funtions commonly performe by the lungs. CABG Coronary artery bypass surgery provides a bloodless field for cardiac surgery. It incorporates an extracorporeal circuit to provide physiological support in which venous blood is drained to a reservoir, oxygenated and sent a back to the body using a pump. Team effort between surgeon, perfusionist and anaesthesiologist is paramount for the successful use of CABG. Cardiopulmonary bypass (CPB) may contribute to the complications and cost of coronary artery bypass grafting (CABG) Coronary Artery Bypass Graft Traditional coronary artery bypass graft. Type Off-pump coronary artery bypass graft. This procedure can be use 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, frequenly using robotics and vidio imaging to operate in a limited region, minimally invasive CABG variations may be reffered to as portaccess or keyhole surgery. Sumber : The Society of Thoracic Surgeons, 2019 2

COMPLICATIONS MAY ARIES INDICATION Complications associated with the surgical site Kidney Injury Challenges in control of diabetes mellitus Gastrointestinal bleeding Stroke Extended usege of mechanical ventilation Hemorrage that necessitates a transfusion or reoperation Ischemic heart disease Death According to (de Waard et al., 2021) there are some complications that may be arise by CABG wich are: Patient Suffers from significant chest discomfort due to the constriction of mutiple arteries that supply the heart muscle, depleting the muscle of blood even during moderate exercise or rest. The patient has several demage coronary arteries, and the heart’s primary pumping chamber, the left ventricel, 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 ventricel. The patient has an arterial obstruction that cannot be addressef by inserting and inflating a tiny balloon to widen the artery (angioplasty) temporarily Patient had a previous angioplasty or insertion of a thin wire mesh tube (stent) to keep the artery open that wa unsuccessfuk, or the artery narrowed again afater the stent was place. If the patient is not responding to alternative therapies, coronary bypass surgery may be performed in an emergency, such as a heat attack. (Abdelhadi, 2022). INDICATION AND COMPLICATION MAY ARISE Coronary Artery Bypass Graft 3 Chest Pain (Pericarditis, Myocardial infarction after CABG) Shortness of breating (Pleural Effusion, atelectasis, CHF, Pneumonia, Pulmonary embolism) Cognitive or neurologic problems may patients experience According to (Abdelhadi, 2022) there are several complications that may be arise by CABG wich are:

PREBYPASS PERIOD AND GOALS INDUCTION AND MAINTENANCE OF ANESTHESIA Maintain optimal myocardial O2 supply and minimize demand to prevent or treat ischemia ANTIBIOTIC PROPHYLAXIS Timely administration of selected antibiotics POSITIONING Careful arm, hand, and head positioning to avoid injuries FLUID MANAGEMENT Maintain optimal myocardial O2 supply and minimize demand to prevent or treat ischemia PREBYPASS TEE EXAMINATION Assess regional LV wall motion abnormalities Assess global LV function Assess global RV function Assess structure and function of cardiac valves Evaluate thoracic aorta, interatrial septum, and left atrium with left atrial appendage Detect development of ischemia, hypovolemia, hypervolemia, or low SVR 1. 2. 3. 4. 5. 6. INCISION AND STERNOTOMY Treat hypertension and tachycardia due to painful stimuli Briefly interrupt ventilation during sternotomy to avoid lung injury 1. 2. HARVESTING OF THE INTERNAL MAMMARY ARTERY Reduce tidal volume ANTICOAGULATION FOR CPB Administer heparin and ensure adequate anticoagulation (confirm with ACT) ANTIFIBRINOLYTIC ADMINISTRATION Administer antifibrinolytic agent to minimize microvascular bleeding PERFUSIONIST COMPLETES CPB CIRCUIT SETUP, PRIMING, TESTING OF ALARMS AND CIRCUIT, ADHERENCE TO CHECKLIST Confer with perfusionist if indicated AORTIC CANNULATION Reduce systolic BP to