 Hi, welcome to nursing school explain in this video on coronary artery bypass graft or as it sometimes is also cold called cabbage now a coronary artery bypass graft does just that it bypasses a coronary artery think about a detour if you go in to drive somewhere There's a blockage for some reason because of some construction and so the detour takes you around the construction Where the construction site in this coronary artery is a blockage and so we're going to create a detour from other blood vessels So let's look at the indications here So typically the patient has coronary artery disease or has had episodes of acute coronary syndrome That I cannot be many medically managed So the medications that were giving the patient for outpatient treatment of acute coronary syndrome or unstable Angina or a stable angina for that matter are not working and When there is an occlusion to the left coronary artery or Three or more vessels are blocked then a coronary artery bypass graft is indicated Further if the patient on the wind an angiogram or a PCI Procudaneous coronary intervention and it failed to open up the blockage or it's not possible Because the location of the blockage is maybe in a spot that a stint cannot be placed or some other things impede The the opening of that artery then again the cabbage is indicated and furthermore Patients with a history of diabetes Chronic kidney disease or left ventricular dysfunction Also have a higher incidence of cabbage because they had such higher risk for developing other problems down the right on the line So let's look at what this procedure looks like so first of all It's a sternotomy sternotomy meaning that the sternum is going to be opened to expose the heart So that the surgeon can work on it The patient is also placed on a cardiopulmonary bypass So which means that the blood is pumped out of the heart into a machine where it is Oxygenated and then put back into the patient and what that does it kind of deflates the heart So that it doesn't have to beat and the patient still gets Oxygenated by the machine which is really the purpose and the function of the heart So the machine will do this function oxygenating and pumping of the blood while the surgeon can look at the heart and do the surgery and then there is what's called harvested vessels and so we need to create this detour by Using different blood vessels from different locations The most commonly used blood vessels are either the internal memory artery or the saphenous vein from the leg Because those are over time have just shown that they have the best success And so these harvested vessels are removed from their origin and then there is an Anastomosis or they are anastomosed to the coronary artery distal to the blockage Now it's easier to understand if we look at the graph here So here we have the heart and here we have the coronary arteries up here We have the aorta with the aortic arch and the three branches that go to the carotid arteries and then also the subclavian arteries So here in this blockage here if we have it here and remember that the blood gets ejected from the heart enters the aorta and then the first thing that the heart feeds right away is a coronary arteries because it needs to perfuse itself and so when the blood gets ejected here this Cabbage done with a saphenous vein basically this this harvested vessel is sewn in to the aortic arch and Then distal to the blockage. So now we have created this detour around our construction site of the blockage right here Similarly to the internal mammary artery What's a little bit different is that the internal mammary artery already originates in the subclavian vein here So we just kind of access it here anastomose it or suture it into this blood vessel and then create this detour again Distal to the blockage So now this blockage really doesn't matter because the lower part of the heart is being perfused by this bypass by this detour I hope the analogy with the with the construction site works Now as you can imagine this is major major surgery the patient's sternum is open The heart is exposed. We're putting them on a machine that will oxygenate and pump their blood So this patient after the procedure will need to remain in the ICU for 24 to 36 hours Depending on their comorbidities and how the procedure went how many arteries and so forth Now there will be some hemodynamic monitoring required because this is a patient who's very labile initially We have just manipulated their heart So they will need a central line and a pulmonary artery catheter to take a keep a close eye on their cardiac output The patient also will have a chest tube because we have opened up the sternum with the sternotomy And so the chest tubes kind of help to get the extra air that's now in that sternum in that chest cavity to get that out The patient will be intubated So we'll have to manage their ET tube and their ventilator in conjunction with our respiratory therapists Most definitely they'll need to be on a cardiac monitor to observe for any dysrhythmias There will be what's called epicardial pacing wires and these are wires that are attached directly into the patient's heart Because there is such a high incidence of dysrhythmias after the procedure that way We don't have to defibrillate them from the outside, but because the wires go to the epicardium itself, we can just shock the heart muscle by itself rather than having to shock the patient with the pads that we usually do through the chest wall With most certainly the patient will also have a catheter or a urinary catheter We'll need to check their urine output very closely to see how they are perfusing They will also have an NG tube to deflate the stomach because they're intubated And once they come out of this acute phase in the post-op period They will typically be transferred to either the telefloor or step down unit depending on whatever is available at the hospital Once the patient is hemodynamically stable and extubated So they might still come to a tele or a step down unit with an NG tube With some epicardial pacing wires with the chest tube and most definitely on a cardiac monitor And once the patient goes through that post-op period, they will be going to cardiac rehab Where they can now learn to to live with this new normal And it's usually a holistic approach where the patient can be taught lifestyle changes Because we don't want this from happening again And most definitely we don't want that bypass graft to get clogged or to have a blockage Like the previous or the original arteries did As for complications you can imagine there are many That can be bleeding because we're accessing the heart itself Which can lead to anemia and and other problems Certainly there can be dysrhythmias because the heart muscle itself is being manipulated and it certainly can get irritated from there We can also have fluid and electrolyte imbalances As well as infections and that ranges from catheter so urinary tract infection to maybe an pneumonia and of course incision site Can also be infected So um overall this is a very serious procedure And of course patient teaching pre-op will be very important also to prepare them for this and then also Tell them what's going to happen in the immediate post-op period And this is quite a long recovery until they get discharged from cardiac rehab So thank you so much for watching this video on the coronary artery bypass graft I hope the analogy with the detour of the traffic jam has helped you understand this Please give me the thumbs up if you've enjoyed the video and i'll see you right here pretty soon on nursing school explain Thanks for watching