OR Setup
Initial Equipment Grab
- Core:
- 3 pairs of gloves
- 2 blue towels
- AAA closet: (these now can also be found in the OR in the cabinet)
- Central line kit (9 Fr MAC)
- Swan-Ganz catheter
Setup:
- Place central line + 2 pairs of gloves on table (for circulator)
AAA “Shopping List”
- 2 cerebral oximeters
- Triple transducer setup
- 2 pressure bags
- Manifold (or 5 stopcocks if unavailable)
- 60-inch microbore extension tubing
- Tegaderm for A-line
- Hotline setup:
- Tubing, extension, stopcocks, warmer box
- Fluids:
- 2 × 500 mL NS
- 2 × 1 L NS
- 6 Plum pump tubing sets
- 3 stopcocks
- 50 mL syringe
- Ultrasound probe covers
Notes:
- May need free-flow setup (ICU patients often already have one)
- Dump supplies on bed → organize after
Room Setup — MSMDAIDS
Standard Checks
- Machine check
- Suction
Monitors (usually dont need NIBP due to pre-op arterial line)
- Temperature probe
- ECG leads
- Pulse oximeter
- Continuous cardiac output monitor
- Mixed venous monitor
- Cerebral oximetry:
Airway Setup
- ET tube
- 10 mL syringe
- DL + VL setup
- Oral airway
- Tongue depressor
- Eye tape
- Consider have McGrath available
IV / Lines
- Usually arrives with IV (especially from day surgery)
- Turn on Hotline
- Manifold:
- Connect to free-flow for induction
- Switch to Swan infusion port after CVC placement
Drug Setup
- Pick up meds ~0500 from control desk
- If missing → call pharmacy
- Pump setup:
- Trident (9 pumps) → LVAD/transplant
- (6 pumps) → most cardiac cases
Standard Infusions
- Insulin
- Epinephrine
- Norepinephrine
- Precedex
- TXA (bolus + infusion)
- Acetaminophen
- Magnesium
- ± Antibiotics
- Case dependent: Milrinone, Dobutamine
Cardiac Drug Syringes
Syringes (this can be variable but decent baseline):
- 5 × 20 mL
- 5 × 10 mL
- 2 × 5 mL
- 3 × 3 mL
- 1 × 50 mL
Core Drugs
- Heparin (50 mL)
- Epinephrine
- 4 mg / 250 mL (16 mcg/mL)
- Start ~0.02-0.04 mcg/kg/min
- Push: dilute to 8 mcg/mL
- Norepinephrine
- 4 mg / 250 mL
- Start ~0.04 mcg/kg/min
- Push: 8 mcg/mL
- Propofol
- Rocuronium
- Fentanyl (250 mcg vials)
- Nitroglycerin
- 2.5 mL (200 mcg/mL) + 7.5 mL NS → 50 mcg/mL
- Esmolol
- Etomidate
- Succinylcholine
- Cefazolin
- Midazolam
- Lidocaine 2%
- Sugammadex
- Ondansetron
- Dexamethasone
Extras
- Nicardipine:
- 25 mg / 250 mL → 0.1 mg/mL
- Insulin:
- Start ~2–4 units/hr
- Phenylephrine stick (optional)
- Dexmedetomidine:
- 400 mcg / 100 mL
- Nitric oxide:
- Up to 40 ppm (post-bypass)
Line Setup
A-line
- Tegaderm, chlorhexidine, arm board
- Arrows, tape, gauze
- US probe cover
- Lidocaine (1% or 2%)
Tips:
- Use cardiac ultrasound machine
- Bring full pressure bag setup (use later for femoral line)
Triple Transducer
- Prime each line individually
- Mount and zero together
Color setup:
- Red = arterial
- Blue = CVP
- Yellow = PA
Swan-Ganz
- Connect PA (yellow) + CVP (blue)
- Attach balloon syringe (3 mL)
- Connect monitor cables
- Attach flush to white port (do not flush yet)
- Enter patient data into monitor
General On-Pump Flow
Pre-op
- A-line
- Consent: CVC, TEE, GA, Regional, Sedation
In Room
- Monitors → Induction (fellow/attending usually pushes meds) → Intubation
- CVC → Swan
- Labs, antibiotics, TXA, TEE
Key Phases
Sternotomy
- SBP: 90–100
- May need NTG or fentanyl
Aortic Cannulation
- Maintain SBP 90–100
On Pump
- Heparin → 3 min → ACT/ABG
- MAP > 65
Off Pump
- Magnesium, calcium
- Protamine (from perfusion)
- Labs + product decisions
- Cell saver / ANH
Transport to ICU
- Handoff sheet
- Transport monitors
- ABG within 30 min
- Emergency meds ready
- OG tube → suction → secure
- Cap all ports
- Consolidate lines
- Ventilation:
- Jackson-Rees or transport vent
- Call RT if nitric oxide