Coronary artery bypass grafting, often called CABG or simply open-heart surgery, is a procedure that reroutes blood flow around blocked heart arteries using a graft, or a section of blood vessel sewn into place. It is a major operation, and patients are typically sent to an intensive care unit afterward so their heart, blood pressure, and bleeding can be closely monitored.
Chest tubes are placed during that recovery to drain blood and fluid from around the heart and lungs. How much comes out of those tubes tells the care team whether the surgical site is bleeding, which is why surgeons set specific limits and require a phone call when drainage crosses them. In this case, the surgeon’s order was to be notified for drainage over 200 ml per hour for two consecutive hours.
Most people expect that a patient recovering from open-heart surgery in an ICU is being watched constantly, and that a doctor will be called the moment something changes. In this case, that did not happen, and our client ultimately lost his life. The Townsley Law Firm represented his family and recovered over $550,000 in a settlement.
What Were the Early Warning Signs?
Our client underwent coronary artery bypass grafting and was moved to the ICU for close monitoring. His surgeon left written orders to be notified if the patient’s blood pressure dropped or if chest tube drainage exceeded the set limit.
Within about an hour in the ICU, the patient became hypotensive, with blood pressure dropping rapidly. Minutes later, his chest tube had drained 750 ml of blood, past the threshold in the surgeon’s orders. Together, those numbers pointed to active bleeding at the surgical site.
The physician was not called. Instead, the nurse started a levophed drip without a physician’s order, then increased it as the patient continued to decline. Despite the decline, our client’s physician still was not called. Levophed is a powerful intravenous drip used to push blood pressure back up. It treats the symptom, not the cause. Raising a bleeding patient’s blood pressure with medication can mask the underlying problem while the bleeding continues, which is why it is a physician’s decision, not a nurse’s.
Our client’s pressure kept falling through the night, until he was eventually found to be in pulseless electrical activity, meaning his heart had electrical signals but was not pumping blood. A code blue was called, and our client’s chest was opened by a surgeon at the bedside.
Cardiac function was restored with internal cardiac massage, internal defibrillation, and intracardiac epinephrine. In the operating room, the surgeon found bleeding at a graft site and repaired it.
Did the Warnings Stop There?
Our client survived that night, and days later his family was told he would be moved to a regular room, out of the ICU. Then he began to decline again. He was disoriented, drowsy, and had slurred speech, and for the first time since admission his heart sounds were muffled, a finding associated with fluid building up around the heart. His blood pressure dropped again, and an epinephrine drip was restarted. His chest tube put out 960 ml in eight hours. His breathing grew rapid through the afternoon and evening.
The records do not show that the physician was notified about the decline or the increased drainage. No further blood gas studies were drawn despite his lethargy and labored breathing all day.
That evening, his nurse found him unresponsive in ventricular fibrillation. He was pronounced dead less than an hour after that.
A patient who had already coded from bleeding and cardiac tamponade, whose chest tube output had jumped by 960 ml, who was lethargic, disoriented, and newly tachycardic with muffled heart sounds, went twelve hours without a single nurse calling his doctor. Notifying the physician when a patient’s condition changes is one of the most basic duties in hospital care, and our client was failed at almost every turn.
