{"id":3073,"date":"2025-12-10T00:00:00","date_gmt":"2025-12-10T08:00:00","guid":{"rendered":"https:\/\/www.nicolekupchikconsulting.com\/news\/?p=3073"},"modified":"2025-12-15T07:53:27","modified_gmt":"2025-12-15T15:53:27","slug":"caring-for-the-post-op-cardiac-surgery-patient-with-an-open-chest-what-you-need-to-know","status":"publish","type":"post","link":"https:\/\/www.nicolekupchikconsulting.com\/news\/caring-for-the-post-op-cardiac-surgery-patient-with-an-open-chest-what-you-need-to-know\/","title":{"rendered":"Caring for the Post-Op Cardiac Surgery Patient with an Open Chest: What you Need to Know!"},"content":{"rendered":"\n<p>As a Cardiac Surgery nurse, every now and again your patient comes back with an open chest! It can seem daunting, so let\u2019s talk about it!&nbsp; Less than 5% of cardiac surgery patients come back with an open sternum.&nbsp; Also, in cardiac surgical post-operative patients, most patients will exhibit hemodynamic instability within the first 6 &#8211; 12 hours in the ICU so, it is imperative that you are paying close attention to these patients.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What is an open chest?<\/h2>\n\n\n\n<p>An open refers to a delay in sternal closure after cardiac surgery to avoid myocardial compression.&nbsp;This avoids decreased cardiac output from impairment of venous return.<\/p>\n\n\n\n<p>A sterile, occlusive dressing, such as Ioban packed with Esmark is usually left over the chest.&nbsp; As a safety reminder: DO NOT put defib pads on the Ioban as the energy can ARC! This creates both a fire risk because of proximity to oxygen, as well as puts your patient at risk of being burned.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Why would your patient\u2019s chest be left open?<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Low cardiac output<\/li>\n\n\n\n<li>Intractable bleeding<\/li>\n\n\n\n<li>Myocardial edema<\/li>\n\n\n\n<li>Arrhythmia<\/li>\n\n\n\n<li>Cardiac tamponade<\/li>\n\n\n\n<li>VAD placement<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Who is at risk?<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Elderly<\/li>\n\n\n\n<li>Complicated surgeries such as CABG plus a valve repair\/replacement<\/li>\n\n\n\n<li>Coagulopathies<\/li>\n\n\n\n<li>Long coronary pulmonary bypass time or cross clamp in the OR<\/li>\n\n\n\n<li>Pre-operative anti-platelet therapy<\/li>\n\n\n\n<li>Per-operative MI<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Management of patient<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Leave patient in the supine position,<em> however <\/em>you can gently tilt your patients. Consider using pillows, wedges, or foam for pressure ulcer prevention.<\/li>\n\n\n\n<li>These patients are commonly intubated and sedated until closure of the sternum.<\/li>\n\n\n\n<li>Treatment &#8211; AGGRESSIVE diuresis to reduce edema.&nbsp;<\/li>\n\n\n\n<li>The goal is to close the chest within 2 &#8211; 5 days.<\/li>\n\n\n\n<li>If the patient arrests, access the chest and internally massage and defibrillate. This will be managed by the providers.<\/li>\n\n\n\n<li>At a greater risk for sternal wound infections<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Nursing tips for caring for these patients:<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consider attending an Open-Chest Drill\/Simulation to help boost your knowledge and confidence. When you have to open your patient\u2019s chest, it is often very stressful and high pressure, so doing a run through can be so helpful!<\/li>\n\n\n\n<li>Consider getting your CALS certification &#8211; Cardiac Advanced Life Support for patients who have had cardiac surgery. It involves high fidelity simulation training to improve outcomes in patients who have cardiac arrest post cardiac surgery.<\/li>\n\n\n\n<li>Opening your patient\u2019s chest puts your patient at an increased risk for sternal wound infections.<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"576\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-1024x576.jpg\" alt=\"\" class=\"wp-image-3084\" srcset=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-1024x576.jpg 1024w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-300x169.jpg 300w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-768x432.jpg 768w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-1536x864.jpg 1536w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-370x208.jpg 370w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-270x152.jpg 270w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-570x321.jpg 570w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1-740x416.jpg 740w, https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/12\/Untitled-design-1.jpg 1920w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\">Two photos Nicole Kupchik, MN, RN, CCNS, CCRN PCCN took at a recent visit to Maine Health in Portland, Maine<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n<p>For more in-depth guidance on caring for cardiac surgery patients, including open-chest management, hemodynamics, complications, and test-focused review, you can explore Nicole\u2019s<strong> <\/strong><a href=\"https:\/\/www.nicolekupchikconsulting.com\/booksAndCourses\/online-courses\/117\/csc-online-course-book-bundle\">CSC\u00ae Online Course &amp; Book Bundle<\/a> which includes the <a href=\"https:\/\/www.nicolekupchikconsulting.com\/booksAndCourses\/online-courses\/116\/cardiac-surgery-certification\">on-demand course<\/a> and <a href=\"https:\/\/www.nicolekupchikconsulting.com\/booksAndCourses\/books-bundles\/4\/ace-the-csc-study-guide\">Ace the CSC!\u00ae Study Guide<\/a>.<\/p>\n\n\n\n<p>All these resources are designed to boost your knowledge, confidence, and exam readiness, AND they\u2019re <strong>on sale now through 12\/23!<\/strong><\/p>\n\n\n\n<p>References:<\/p>\n\n\n\n<p><a href=\"https:\/\/www.uptodate.com\/contents\/postoperative-care-after-cardiac-surgery?search=post%20cardiac%20surgery&amp;source=search_result&amp;selectedTitle=1~150&amp;usage_type=default&amp;display_rank=1\">Postoperative care after cardiac surgery &#8211; UpToDate<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.uptodate.com\/contents\/115472?source=NLP_SEARCH_BREADCRUMBS&amp;selectedTitle=1&amp;display_rank=1&amp;search=leaving%20patients%20chest%20open%20post%20cardiac%20surgery&amp;topicRef=115472&amp;anchor=H116644631&amp;passageDigest=000000124000001b800000080000001cc024a0f9c6109&amp;usage_type=NLP#H116644631\">Intraoperative problems after cardiopulmonary bypass &#8211; UpToDate<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.uptodate.com\/contents\/surgical-management-of-sternal-wound-complications?search=leaving%20patients%20chest%20open%20post%20cardiac%20surgery&amp;topicRef=115472&amp;source=see_link\">Surgical management of sternal wound complications &#8211; UpToDate<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>As a Cardiac Surgery nurse, every now and again your patient comes back with an open chest! It can seem daunting, so let\u2019s talk about it!&nbsp; Less than 5% of cardiac surgery patients come back with an open sternum.&nbsp; Also, in cardiac surgical post-operative patients, most patients will exhibit hemodynamic instability within the first 6 [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":3087,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[54,46],"tags":[63,57],"ppma_author":[62],"class_list":["post-3073","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nurse-certification-prep","category-nurse-education","tag-cardiac-surgery-certification","tag-nicolekupchik"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Caring for the Post-Op Cardiac Surgery Patent with an Open Chest<\/title>\r\n<meta name=\"description\" content=\"Caring for cardiac surgery patients with an open sternum? 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