Cardiac Surgery Pre-operative Instructions

Before your heart surgery you will receive extensive education by the doctors, nurse practitioners, physician assistants, and nurses about how to prepare for surgery. You will be given written instructions from our nurses and receive verbal instructions from the cardiac surgery office. If you have any questions or concerns please do not hesitate to call your surgeon’s office at:

GETTING READY FOR SURGERY

  1. Follow the instructions carefully. If you are coming in from home on the day of your operation, there are some things you’ll need to do to prepare. Please follow these instructions carefully. This will help make sure things go as smoothly as possible. If you are already in the hospital waiting for your surgery, your nurse will take care of all of this for you.
  2. Do not smoke. Please do not smoke. If you smoke, make sure that your surgeon is aware. You will be asked to stop smoking permanently at least one week prior to surgery.
  3. Nurse Case Manager. Some people find it helpful to talk with a nurse case manager before surgery. A case manager is someone who can help you think about what your needs might be following surgery, and talk with you about making appropriate plans for your discharge and recovery. Please call our office to find out more.

THE DAY BEFORE SURGERY

A nurse from our office will call you late in the day. Someone from our office will call you the evening before your surgery to let you know what time to arrive at the hospital in the morning. We often do not know the final operating room schedule until the evening before. Please be advised that your surgery may be postponed if an emergent patient needs to go first.

THE NIGHT BEFORE SURGERY

  1. Pre-operative scrub. Before surgery you can play an important part in your health. Because skin is not sterile, we need to be sure that your skin is as free of germs as possible before surgery. You can reduce the number of germs on your skin by carefully washing before surgery. You will need to shower with the special antiseptic soap called chlorhexadine gluconate (CHG) given to you in pre-admission testing or by the nurse in the hospital.
  2. a) Wash and rinse your hair first using your normal shampoo.
    b) Make sure you completely rinse the shampoo from your hair and body.
    c) Wet your entire body.
    d) Turn the water off in the shower or move away from the water spray to avoid rinsing the antiseptic soap solution off.
    e) Apply the antiseptic CHG soap solution to your body starting at the neck and lather your entire body from the neck down.
    f) Never use the antiseptic solution near your eyes, ears or mouth.
    g) Gently wash your body.
    h) Scrub the areas where the incision(s) will be located for about 3 minutes.
    i) Avoid scrubbing you skin too hard.
    j) Once you have completed the scrub, rinse the CHG soap off your body completely using shower water.
    k) Do not wash with regular soap after you have used the antiseptic CHG soap solution.
    l) Do not shave any areas where surgery will be performed (chest, legs).
    m) Pat yourself dry with a clean freshly washed towel.
    n) Do not apply any powders, deodorants or lotions.
    o) Dress with clean, freshly washed clothes.

  3. Do not eat or drink anything after midnight.

THE DAY OF SURGERY

  1. Pre-operative scrub. Shower again using the antiseptic CHG soap solution following “The Night Before Surgery” pre-operative scrub procedure above. Do not use regular soap.
  2. Pre-Surgery Do’s:
  3. a) Keep your stomach empty. Do not eat any food, including mints, gum or candy, or drink any liquids. This is for your safety.
    b) Brush your teeth. You may brush your teeth or use mouthwash without swallowing.
    c) Only take medications you were instructed to with a very small sip of water. You should have been given instructions as to which medications to take in the morning prior to your surgery.

    • Please take your aspirin and beta-blocker if you have been prescribed one. Beta-blockers include medications such as atenolol (Tenormin), labetalol, metoprolol (Toprol, Lopressor), nadolol.
    • Do not take any diuretics. Diuretics include medications such as Lasix (Furosemide) and hydrochlorothiazide, and are also in combination medicines like Quinapril-HCT.
    • Do not take any ACE-Inhibitors. ACE-Inhibitors include medications such as lisinopril, captopril and enalapril and are also in combination medicines like Captopril-HCT.
    • If you take coumadin or plavix, you should have received instructions as to if and when to stop these medications. If you didn’t please call.
    • If you are DIABETIC:

    - If you take oral agents (pills for diabetes), DO NOT take them the day of surgery.
    - If you take Metformin, stop it 2 days prior to surgery.
    - If you take NPH insulin, take ½ of your normal dose the morning of surgery.
    - If you take Lantus/Glargine insulin, take your normal dose up until the time of surgery.
    - If on an insulin pump, do not change the basal rate.

    d) Leave your personal belongings at home. Your family may bring you a small suitcase the day after surgery. Please do not bring more than toilet articles (toothbrush, comb, etc.), your slippers and a robe. If you wear glasses, contact lenses, or dentures, you may wear them to the hospital, but please send them home with your family before you go to the preoperative area.
    e) Leave jewelry and valuables at home. Please leave all jewelry and valuables, including wedding rings, at home. Your hands and fingers will become swollen during and after surgery. When rings are left on, they can interfere with circulation and may have to be cut off.

  4. Pre-Surgery Don’ts:
  5. a) Do not eat food or drink liquids. Do not eat any food, including mints, gum or candy, or drink any liquids.
    b) Do not wear make-up or nail polish. Do not wear any make-up, nail polish, or toenail polish.
    c) Do not bring personal or valuable items. Please leave your personal belongings and valuables at home. Please do not bring more than toilet articles (toothbrush, comb, etc.), your slippers, and a robe. If you wear glasses, contact lenses, or dentures, you may wear them to the hospital, but please send them home with your family before you go to the preoperative area.
    d) Do not wear jewelry. Please leave all jewelry, including wedding rings, at home. Your hands and fingers will become swollen during and after surgery. When rings are left on, they can interfere with circulation and may have to be cut off.

SURGERY

  1. Preoperative Area. You will be taken to a preoperative area from the reception desk. One family member or friend may come with you.
  2. Preparation Area. You will then be brought to another preparation area in the operating room suite. The nurse can show your family where to wait during your surgery or, if they prefer, they may wait at home. Either way, the surgeon will call or speak with them when the surgery is over. In the preparation area, someone may clip the hair around the area of the surgery. Also, intravenous (IV) lines and other lines that are used during surgery will be inserted.
  3. Operating Room. You will then be brought to the operating room, and the anesthesiologist will give you your anesthesia through the IV line. You will fall asleep quickly and will not be able to hear or feel anything during your surgery. After you are asleep, a breathing tube will be placed in your windpipe, and a catheter will be placed in your bladder. Your surgery will then begin. Surgery usually takes about four to six hours.
  4. Surgical Liaison Service. While you are in surgery, your family can receive general information from the Surgical Liaison Service, Monday through Friday, 9 am to 8 pm. A nurse from the surgical team will also provide periodic updates to your family spokesperson.

MEDICATIONS

  1. Only take medications you were instructed to with a very small sip of water. You should have been given instructions as to which medications to take in the morning prior to your surgery.
  2. Please take your aspirin and beta-blocker if you have been prescribed one. Beta-blockers include medications such as atenolol (Tenormin), labetalol, metoprolol (Toprol, Lopressor), nadolol.
  3. Do not take any diuretics. Diuretics include medications such as Lasix (Furosemide) and hydrochlorothiazide, and are also in combination medicines like Quinapril-HCT.
  4. Do not take any ACE-Inhibitors. ACE-Inhibitors include medications such as lisinopril, captopril and enalapril and are also in combination medicines like Captopril-HCT.
  5. If you take coumadin or plavix, you should have received instructions as to if and when to stop these medications. If you didn’t please call.
  6. If you are DIABETIC:
    • If you take oral agents (pills for diabetes), DO NOT take them the day of surgery.
    • If you take Metformin, stop it 2 days prior to surgery.
    • If you take NPH insulin, take ½ of your normal dose the morning of surgery.
    • If you take Lantus/Glargine insulin, take your normal dose up until the time of surgery.
    • If on an insulin pump, do not change the basal rate.

WHEN TO CALL YOUR DOCTOR

  1. Feel ill or have a fever. If you should feel ill or have a fever within 48 hours of surgery, please notify us immediately.
  2. Symptoms get worse. Call your surgeon if any of your symptoms (such as chest pain or shortness of breath) get worse in the weeks before your surgery.)
  3. Questions or concerns. For any questions or concerns, please feel free to contact us at