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Preparing for Surgery

What tests and education do I need before the surgery?

Your surgeon may order tests and ask you to attend an educational class prior to your admission. This is done in the pre-admission testing department. You will receive a packet of information personally tailored to your health care needs. A 15 minute educational summary videotape or CD is available and you can tour the facility. You are encouraged to attend with a family member. If you are hospitalized and have not attended the educational class, the staff will offer education at the bedside.

Do I avoid anything before Open Heart surgery?

Patients should refrain from smoking and drink no alcohol for 48 hours before surgery. Don't eat or drink anything after midnight prior to surgery.

Do I need special soap?

Your surgeon will prescribe an antibacterial soap called Hibiclens® (Chlorhexidine gluconate 4%). You can find this soap at any pharmacy and a prescription is not necessary to purchase. Bathe or shower two times the day before the surgery. Wet the skin, step out of the stream of water (if showering), work soap into a good lather paying special attention to cleaning your chest, arms, groin areas and legs.

ONLY USE THIS SOAP FROM THE NECK DOWN. It can cause serious injury to the eyes or ears if used inappropriately. Bring the rest of the soap with you to the hospital as you will use it in the hospital before going into surgery.

What about hair removal?

The hair from your surgical incision and IV sites will be removed before surgery at the hospital, using special clippers. Do not remove the hair yourself.

Can my family visit before my surgery?

Family members planning to visit you before early surgery, should arrive 90 minutes before the scheduled time.

How long will the surgery take?

While the total time can vary, surgery usually takes four to six hours.

Where will my family wait?

Your family will be directed to a surgery waiting room. A pager may be given to your family in case we need to contact them during surgery. Updates on the progress of the surgery may be given to your family by the chaplain, surgical nurses, surgery liaison personnel, or by telephone. Volunteers are present to assist families in all waiting rooms.

What happens right after surgery?

Following your surgery, your surgeon speaks with family members. Your family is told when to proceed to the family waiting room of the Cardio Thoracic Care Unit, known as CTCU. The first one-two hours is the post-anesthesia phase and no visitors are allowed. About two hours after you transfer to CTCU, your entire family will be allowed to visit you.

What if my waiting family members have special needs?

Special needs items such as interpreters, hearing devises, closed captioning, TTX phone, and communication picture boards are available. Please notify the staff of any special needs you or your family may have.

Arrangements for interpreters are made through patient relations. TTX phones can be obtained for use from ER or the Nursing Supervisor.

What is the CTCU?

The cardiac surgical intensive care unit (CTCU) provides the high level of medical monitoring necessary immediately after heart surgery. You will be in CTCU the day of your surgery and probably transfer out of the unit a day or two after surgery.

When can my family visit me in the CTCU?

Information is provided by the intensive care unit regarding visiting policies and hours. Your designated contact person may call CTCU any time, day or night, to check on your progress. Phone numbers for CTCU, pay phones and lounge phone are also provided.

What equipment will be used in the CTCU?

Your care providers will choose the best equipment for your situation. They may choose to monitor and treat you with IVs, heart monitors, a heart-lung bypass machine, a ventilator, temporary pacer wires, a bladder catheter, chest drainage tubes and elastic stockings.

What about pain medication?

When the breathing tube is no longer in place, you may ask for pain medication when you need it. For a successful recovery, you should be comfortable enough to cough and breathe deeply and participate in cardiac rehabilitation activities.

Some patients find it helpful to take pain medication approximately one hour before cardiac rehab exercises begin.

What can I eat and drink?

Your family should check with the intensive care nurse before giving you any fluids. You are able to resume a normal diet, though many patients experience a decreased appetite. Anesthesia and some medications temporarily affect the taste buds and the appetite.

What will my incision look like?

Most incisions are in the middle of the chest. They start approximately 2 inches below the base of the neck and end where the sternum (the bone that connects the ribs) ends. Usually there are no stitches or staples on the outside of the wound. There are two "stab wounds" that are approximately 1 inch long beneath the larger wound. This is where the chest tubes were placed.

Patients who have bypass surgery will have leg wounds as well. These incisions are commonly 3 to 4 inches long and on the inside of the leg. There may be 2 or 3 of these incisions on the leg. The leg incisions may be closed with staples or stitches that are under the skin. Commonly the leg will be discolored due to the trauma involved in harvesting the vein.

Call your doctor if you have:

  • Temperature of 100 degrees for more than 2 days.
  • Weight gain of 3 lbs from one morning to the next morning or 5lbs in a week.
  • Redness, swelling, increased soreness or drainage from your incision. Some clear drainage from the leg is normal, but please report any drainage from your chest.
  • Chest pain like you had before surgery.
  • Questions about your medications.
  • Changes in your heart beat that cause your heart to beat too fast or too slow or to skip around.

Patients commonly do not require 24 hour care but someone should be with you portions of each day to assist you. Keep visitors to a minimum and avoid coming into contact with persons who have colds or flu for at least the first two weeks after you return.

If you have any problems with your wounds it is very important to call your surgeon as soon as possible. If you feel that you may have problems that might be related to your heart (example: rapid heart beat) you should call your cardiologist. If you have other medical problems you might want to call your family doctor.

Patients are commonly off from work about 3 months but that can change depending on what kind of work you do and the flexibility of your job. Patients who can work part time and have desk jobs or can return with light duty can commonly return to work earlier.

Your surgeon's office will do that for you.

How much will I be able to lift?
No lifting more than 10 pounds (a gallon of milk weighs 8 pounds) for 1-3 months.

When can I drive a vehicle?
Please do not operate a motorized vehicle for 1 month. It is important not to sit directly behind an airbag for 1 month as well. It is always important to use a seatbelt.

Can I walk upstairs?
Yes, prior to discharge from the hospital, the nurses from cardiac rehab can work with you on the steps.

Can I exercise?
Yes, prior to your discharge, the Cardiac rehab nurses will start you on a walking program. It is an excellent idea to continue walking when you go home. A "Progressive Walking" program works well. You should start with 5 minutes of "start to finish" walking the first day, and increase at least 1 minute each day until you are able to walk a 30 minute session each day.

When can I have sex?
Unless your doctor advises otherwise, you can resume having sexual activity as soon as you feel comfortable. Try to avoid positions that put weight on you breastbone or upper arms.

Can I take a shower?
You may shower as soon as you feel strong enough to do so. The use of a sturdy "shower" chair is beneficial for a short time. Please use the liquid dial soap to wash your incisions.

Will I be able to go on an airplane?
You will be able to fly on an airplane when you are up to it in probably 3-4 weeks. You might visit your doctor before making long trips.

Will I make the metal detector go off?
Since 9/11 it is possible that the metal detector will alarm.

Will I be able to go out in extreme temperatures?
It is a good practice to avoid going outside in extreme temperatures.

Your medications may change. A list of your medications will be reviewed and your doctor and nurse will provide you with instructions and a written medication schedule for home use.

What about blood thinners?
Most patients are on an aspirin every day but it is not uncommon that patients take other blood thinners as well.

It is rare that a patient needs a special bed. A recliner is often helpful because it is sometimes difficult to get out of bed and it allows you to easily elevate your legs.

A successful recovery depends on your being comfortable enough to cough and breathe deeply and participate in cardiac rehabilitation activities.

How can I control my pain?
During you hospitalization when the breathing tube is no longer in place you should ask for pain medication whenever you need it. You will be given a prescription for pain medications when you are discharged that you can take every 4-6 hours as you need it.

How long will I need to take pain medication?
As long as you have pain. Commonly you will need pain medications early in your recovery process. As time goes by you will need less. Usually within 3-4 weeks you will need little pain medication.

Yes, it is extremely helpful in supporting your chest and your incision while you heal.

What if I have to cough?
If you need to cough hold the two "handles" of your heart hugger to support your chest. If you do not have your heart hugger you can hug your chest by crossing your arms and grabbing your elbows (you always have your elbows).

How long will I need the Heart-Hugger?
Usually 4 weeks but you can wear it longer if you need to.

Usually 4 weeks or at least as long as you have swelling in your legs.

Cardiac rehab is highly recommended.

What do they do in cardiac rehab?
All patients are physician referred and are individually evaluated for a baseline activity level and target heart rate. The goal is to provide a safe; heart monitored and medically supervised exercise program tailored specifically to each patient's needs. The exercise and educational workshops are held in the outpatient department of Cardiac Wellness and Rehabilitation here at Kettering, on the ground floor of the Physician's Office Building.

How often must I go to Cardiac Rehab?
The first session is scheduled for you on a Tuesday or Thursday for your initial evaluation, then your program is generally set up for 2-3 times per week, up to a maximum of 12 weeks. The sessions generally last about 45 minutes.

Can I go to one close to home?
Absolutely! Patients are strongly encouraged to attend a program that is convenient for them- we are just one of their options.

May I use my treadmill and stationary bike at home instead?
Our program provides guidelines for patients to follow safely at first, and we offer telemetry monitoring, and blood pressure checks with exercise, to also determine each patient's responses to exercise. Your cardiologist may give you some general home exercise guidelines to start, but it is recommended that you are monitored at first.

Will insurance pay for cardiac rehab?
Most insurance plans will cover a portion of the costs for cardiac rehab. It is recommended that each patient contact their carrier for coverage and eligibility, prior to beginning any outpatient services. We also have financial counselors on staff to assist our patients with payment arrangements, possible discounts, etc. so please let us know if you have questions.

Who must order cardiac rehab?
All patients who attend cardiac rehabilitation must be physician referred, the physician's cardiologist is preferred as we communicate with the cardiologist on the patient's plan of care.

A temperature of 100 degrees for more than 2 days should be reported to your physician.

You should be able to eat you usual heart healthy diet when you get home.

Commonly you see the cardiologist in 1 or 2 weeks and the surgeon in 2-4 weeks after you go home. The information should be in your discharge instructions.

Patients are all different but it should look healed in 4weeks.

You will probably be ready to get out within the first week. Plan your first time out at a time when you can avoid crowds. Your comfort level should improve and you should be able to get out more after the second week.

While you are in the hospital the social worker can arrange a visiting nurse for you. If you go home and find that you need help, call your doctor's office and they can help you arrange for a visiting nurse.

What does a visiting nurse do?
A visiting nurse can evaluate and monitor your progress after your hospitalization. Home care nurses (visiting nurses) can also teach any dressing changes, draw lab work and monitor any medication as needed.

How much would a visiting nurse cost? Will insurance cover it?
There is no cost for visiting nurses for Medicare patients. There may be a cost if you have private insurance. It would depend on your specific plan coverage for out-patient services.

Is a visiting nurse able to draw blood?
Yes a nurse can draw your blood.

If you experience pain that feels like your heart pain (the pain you had before your surgery) it is important to call your doctor. Hopefully you can tell the difference between the pain you are having that is a result of your surgery and heart pain. If you are unsure call your doctor.

Call your doctor if it is mild. If you have a more severe problem with breathing go to the emergency room.

It is not uncommon to feel lightheaded when you first get out of bed; take your time and sit at the bedside before you get up. If symptoms persist call your doctor.

Your wound should continue to heal. Commonly there is slight redness along the incision line. That should fade. There may be scabbing along the wound edges which should heal and fall off.

How do I take care of my wound after surgery?
Wash your wound with soap and water every day.

If my wound is not healing who should I contact?
Contact your surgeon's office as soon as you have any questions regarding the wound. Your surgeon should be notified immediately if you have any increased redness, drainage or increased pain.

Patients who have mechanical heart valves will need blood thinners. Other patients may need them due to irregular heart rhythms or problems unrelated to the surgery. Your doctor and nurse will instruct you at the time you are discharged from the hospital if blood thinners are needed.

For how long will I be on blood thinners?
Some patients with mechanical heart valves will need coumadin for the rest of their lives. Other patients may need it for 3-6 months. Your physician will make the appropriate recommendation before you are discharged.

How often will I need to have my blood drawn?
Usually you will need a blood test weekly at first. Eventually as your dose is determined blood tests can be done monthly.

What complications do I need to watch for?
Watch for any unusual signs of bleeding or increased bruising. It is common that it will take longer to stop an accidental cut from bleeding. It is important to be very careful with shaving and using sharp objects.

The Incentive Spirometer is the "breathing exerciser" that was provided to you in the hospital after surgery. You should use it 10 times every hour while you are awake especially when you are inactive. As your activity level increases you can use it less frequently.

It is very natural to feel nervous about surgery-but a positive attitude can help. It's your best prescription for a speedy recovery after surgery. The better prepared you are, the more relaxed you will be. So, be sure to discuss your questions and concerns with your doctor.

Most patients respond after surgery in like manner as prior to surgery. However some medications and anesthesia can effect patient's emotions. A small percentage of patients experience some anxiety or depressions for a short period after surgery. It is good to discuss all aspects of your recovery with your doctor. Medications and support are available to help you transition through this time.