Cardiac Intensive Care Unit/ Cardiac Care Unit
Description of the Unit
The Cardiac Surgery Intensive Care Unit (CICU) / Cardiac Care Unit (CCU) is a 30-bed in-patient unit that provides complex invasive hemodynamic monitoring and treatment of adult patients during the critical phase of recovery from cardiac and thoracic surgery, STEMI, and exacerbation and treatment of endstage heart failure. The unit is comprised of five 6 bed pods. Monitoring capability is available at each bedside. There are a total of 4 negative air-flow isolation rooms and 6 barrier isolation rooms. Each isolation room is fully monitored with a remote alarm system to the center island station of the pod.
The average bed occupancy is 88.3%.
Monitoring capabilities include Hewlett-Packard bedside cardiac monitor at each bedspace capable of EKG, pulse oximetry, NIBP, 5 invasive hemodynamic pressure signals, cardiac output, and advanced arrhythmia detection. The bedside may be equipped with a CCO/SvO2 monitor, BIS monitor, Cerebral Oximetry monitor, Flotrack monitor and ScO2 monitor.
Patients with special requirements are placed strategically to provide optimal nursing care to meet individual needs.
The unit remains operational 24 hours per 7 days per week.
Description of Patient Populations
Patients are admitted to CICU following cardiothoracic surgery for:
- Coronary Artery Revascularization
- Heart Valve(s) Repair or Replacement
- Surgical Repair of Congenital Cardiac Anomalies
- Cardiac Transplantation
- Lung Transplantation
- Heart-Lung Transplantation
- Thoracic Aortic Repair (both open repair and deployment of Endostents)
- Lung Resection
- Ventricular Assist Support: HeartMate XVE II, Heartward, Centrimag and Impella for both bridge and destination therapy.
- Trans-aortic valve replacement (TAVR)
Patients are admitted to CCU following:
- Congestive Heart Failure Exacerbation
- Therapeutic Hypothermia following ROSC
Ages of patients admitted to CICU range from adult to elderly. The average LOS is 6.58 days.
Common medical procedures and therapies performed in the unit include: arterial, central venous, and pulmonary artery line placement, chest tube placement and removal, intubation and extubation, temporary cardiac pacing, mechanical ventilation, intra-aortic balloon counterpulsation, continuous veno-venous hemofiltration, hemodialysis, percutaneous tracheostomy, hypothermia for patients s/p cardiac arrest and support with a ventricular assist device.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of preoperative and post- operative surgical patients with emphasis on Cardiovascular Surgery and Cardiac ICU care including rhythm interpretation, hemodynamics, airway management, pain management, medication management, safety precautions, patient/family education and support, and initiation of the rehabilitation process. Registered nurses in CICU meet the basic requirements for Registered Nurse staff, and function in accordance with the nursing department job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for registered nurses include temporary epicardial pacing, open cardiac arrest management, PA catheter removal, Pleural chest tube removal (selected nurses) external cardiac defibrillation, CRRT (selected nurses) and VAD(selected nurses).
Health Care Team
The Medical Director for CICU is a Cardiothoracic Surgical Attending physician. The Cardiothoracic Surgery faculty, Residents, and Physician Extenders (physician assistants & nurse practitioners) provide 24-hour medical care to the patients 7 days per week. Interdisciplinary, comprehensive care is provided by the medical and nursing staffs, social services, case management, rehabilitative services, food and nutrition services, cardiopulmonary services, pharmacy, pastoral care, and other health care providers as indicated by the patient’s health status and identified needs.
The nursing management structure consists of a Nurse Manager and Clinical Leader with support from a Unit Assistant and Nurse Educator. The management team provides training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the departmental education plan.
Unit staff includes registered nurses and support techs. Support techs meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for Nursing Care. Their job responsibilities are performed under the direct supervision of the registered nurse.