Cardiac Surgery Post-operative Instructions

When you first awaken from the anesthesia, don’t be alarmed if you experience a certain amount of disorientation and discomfort. For a brief period of time your arms or legs may feel numb, or you may feel some confusion and anxiety. These effects of anesthesia should be short lived. CTICU nursing staff will be on hand to assist you as you regain consciousness.

While your body is at rest during surgery, a variety of medical equipment does much of the body’s work for you. Upon waking, you will also notice that you are still connected to a variety of medical equipment which was attached during your operation. These tubes and wires may seem awkward and uncomfortable, but it is important for you to know that they are used routinely in open-heart surgery. You should be able to move around in bed with the assistance of a nurse even though you are still connected to these devices.

  • Until you are awake and strong enough to breathe on your own, you will be attached to the ventilator. While on the ventilator you will be unable to talk, but the nurses are trained to assist you in communicating. The endotracheal tube (ETT) was inserted into the windpipe through your mouth while you were asleep. The tube is attached to the ventilator that breathes for you during and after surgery.
  • The ETT is generally removed 6-24 hours after surgery. After the tube is removed you may have a sore throat. This is not uncommon and can be relieved by throat lozenges.
  • Intravenous (IV) lines provide nutrition and medication through your veins until you can take food and liquid by mouth.
  • Pacemaker wires may be attached to your heart through the skin to permit your doctor to adjust your heart rate when needed.
  • The heart monitor connected to your chest by electrodes records your heart rate and rhythm at all times.
  • A Foley catheter drains the urine from the bladder, via the penis or vagina, and is usually discontinued the second day after surgery. Please be aware that there are often significant weight shifts around the time of surgery. You may gain fluid weight before and during the operation, and lose it afterwards.
  • A Swan Ganz catheter is inserted through a vein in your neck, into your heart, and is used to measure volume status and pressure in your heart’s chambers. This line is generally removed the day after surgery.
  • All patients will have one to three chest tubes which are used to drain excess blood or fluid which may be present after surgery. The chest tubes are generally removed on the first or second day after surgery.

In order to prevent lung complications and help you clear your lungs you will receive chest physical therapy. This consists of percussion or clapping on your back followed by deep breathing and coughing. This will be done by your nurse and physical therapist.

It is important at this time to frequently use the incentive spirometer (and continue use at home), a device that will measure your progress in taking deep breaths. You will continue to use the incentive spirometer throughout your hospital stay.

While recovery time varies from person to person, most patients are able to breathe on their own the first day after surgery. At the time the breathing tube is removed, you will be able to drink sips of liquids. Your diet will be progressed to clear fluids when your nurse and doctor feel you are ready. Other foods will be added as your tolerance increases. By the second day after surgery, many patients are eating solid food. Following surgery your body needs more sustenance than usual, so it is important during this period to try to eat a healthy diet and make sure your protein and calorie intake is as high as possible, as recommended by your dietician and doctor.

EATING

Good nutrition is essential for healing. While your physician and registered dietitian will plan a diet that is tailored to your special needs, it’s up to you to follow these recommendations conscientiously. Don’t worry if you are unable to eat everything you are served; just try to eat something at every meal. Let your nurse know if you experience nausea or do not feel like eating; your health care team may be able to offer some assistance in relieving your discomfort.

SHIFTS IN WEIGHT

Please be aware that there are often significant weight shifts around the time of surgery. You may gain fluid weight before and during the operation, and lose it afterwards.

POST OPERATIVELY

Once you are ready (approximately 24-48 hours after surgery), you will be transferred from the Cardiothoracic Intensive Care Unit (CTICU) to the Stepdown Unit or a regular bed on the surgical floor. The Stepdown Unit is a 4 bed unit (female and male mixed). In the Stepdown area you will continue to have a heart monitor and frequent treatments (i.e. Chest physical therapy and vital signs). This area is located on 5 Hudson North (5HN) or 7 Hudson North (7HN) of the Milstein Building.

Individual patients experience varying degrees of pain and soreness after heart surgery. Your doctor will prescribe pain medication which can be requested every three to four hours depending on the amount of pain you experience. Please advise your doctor and nurse if the medication is not effective. It is suggested to take pain medication prior to chest physical therapy.

When you do your required exercises you can literally cushion the pain caused by breathing and coughing by holding a pillow or the teddy bear provided by the CTICU staff firmly against your chest, over the incision. This serves as a splint or brace to reduce movement and pain associated with these activities.

As you are feeling stronger, you will be encouraged to stand up and move around. You will continue deep breathing and coughing exercises to clear your lungs. While they may be uncomfortable, these exercises are essential to prevent complications arising from the build-up of secretions in your lungs.