Bundles

After coronary artery surgery there are some pharmacological “bundles” that are used at UHS. In stable IHD if DAPT has been used preoperatively the clopidogrel is usually stopped 5-7 days before surgery. Aspirin is omitted on the day of surgery, if the patient is on it, and there may well be residual platelet dysfunction.

Post-operatively on CICU these patients receive no s.c. heparin, nor aspirin on the day of surgery. On day 1 aspirin is started on all patients having CABG surgery unless contraindicated. If the patient isn’t bleeding and is otherwise routine, s.c. heparin is prescribed the evening of postoperative day 1. Again if no contraindication a statin is also presribed for post op day 1.

A series of chest drains are often used for cardiac surgery. Patients have both pleural and mediastinal ‘Portex’ drains. These are used to identify post operative bleeding. If there is no bleeding they are removed on day 1 after discussion with the surgeons.

There is a smaller mediastinal drain called the ‘Redivac’. This is left in whilst the patient has epicardial pacing wires in situ. The EPWs are normally removed around day 4 – the redivac detects bleeding then. If there has been none it can then be safely removed.

We do not routinely X-ray our patients on admission from the OR as all patients will have a post drain removal CXR to check for pneumothorax on day 1.