Immediate Care (24- 72 hours)
All monitoring and medications continued. Flushing of arterial lines are done at regular intervals with heparin flush as well as whenever arterial blood is taken for ABG. 12 lead ECG is recorded daily.
As the patient's condition stabilizes, with heart rate, pulse, respiration temperature and arterial BP within normal limit, the patient is weaned off form the pressure lines and vasodilators or vasopressor drugs. LA catheter, arterial pressure line ad CVP to catheter are removed and pressure dressing applied to the arterial puncture site and other dressing applied. Pacing wires kept in place. Hb and hematocrit value monitored daily. Non-invasive pressure monitoring done Q4H along other vital signs.
Fluid and Electorlytes
All fluid drained from the body is measured hourly and recorded. The colour also is noted. Drainage form each chest tube is measured hourly and if there is excess of chest drainage, specially bright red drainage, the patient is closely monitored for haemorrhage. Blood replacement as per hourly status is done. Many surgeon prefer to collect the drainage into an auto-transfusion set(within six hours of operation) and is transferred to the patient in the form of packed cell, platelet or plasma as per need.
IV fluid is infused using a volume flask and microchip set so that hourly needed fluid is infused. Urine output is measured hourly. The colour(any hematuria) specific gravity also in some cases are observed. In the initial hour (first 24 hours),urine output is more than normal due to hemodilution during surgery. Diuretics are administered if urine output is less than 0.5 mllkgfhr (>3ml/hour). See that the urinary catheter is not compressed gas. The colour and mount of gastric drainage (if present) is noted hourly. Serum electrolytes are monitored initially Q2FT and then Q4H for 24 hours and then twice a day. Supplement of electrolytes or correction of hyperkalemia done. Blood urea nitrogen are serum glucose is also done Q4H in the first 24 hours.
The patient is given a test feed after weaning off form ventilator. If tolerates, then start on oral feed of light fluids in small amount and as patient tolerates well, light semi-solid meal is given. Record the intake and output in the flow chart in ICU. Record daily weight. If the patient's condition stabilizes well, urinary catheter and other drainage tubes are removed.
The patient is gradually ambulated.