Mia Bruno

Open Heart Journal

On Thursday 9/22, I spent my clinical day in the OR observing an open-heart surgery. I

have observed many other surgeries prior to this day, but this was my first time witnessing an

open-heart surgery. I was very excited for this clinical day because I have loved being in the OR

each time that I have been able to go. I was very interested in seeing a heart as I'm also interested

in the cardiac field. Seeing the surgical team working together like a well-oiled machine always

amazes me. There are circulating and scrub nurses, NPs, Pas, Doctors, residents,

anesthesiologists, and the CRNA all working together. They prep the patient; anesthesiology

gives anesthesia and intubates the patient. After everything is set up, and all equipment is

counted and documented, the circulating nurse calls a time-out. During this time, information

about the patient and the procedure is verified, and everyone in the room must agree. The

procedure is then started.

On this day, I was able to see a CABG, which is a coronary artery bypass graft. The

patient had blockages in multiple arteries, and they were going to graft parts of her great

saphenous vein in her leg to attach to the heart to bypass the blockages in her coronary arteries.

The first thing I was able to observe was the insertion of the ART line prior to the surgery

beginning. This correlates directly to the lecture because we have just learned about ART lines

and have seen some on the floor. The ART line is inserted prior to the procedure as a means of

continuous and accurate blood pressure monitoring. This is needed during the procedure and for

the days following. After the ART line was placed and was reading continuously on the monitor,

the surgery was started!

 First, the Doctor started by opening the chest while the NP and PA worked

together to graft the great saphenous veins in the leg laparoscopically. They had to go in

both legs to get enough viable grafts. They then put the heart on bypass, where the

machine was run by the perfusion team. Once the blood was diverted into the bypass

machine for pumping, the doctor was able to inject a medication into the heart to freeze

it/stop it. While the heart isn’t beating, the doctors work on attaching the grafts to the

heart. Once this is done, the heart is taken off bypass and given blood if needed. Then,

they begin finishing the surgery and closing the patient. The perfusion team explained

each part of the surgery and was very informational and helpful. Overall, I really enjoyed

being able to observe and learn about this open-heart surgery! I enjoy my time in the OR

and would love to go back.