After Surgery

Dr. David Adams rounding on patients with Ellen Hughes, MA, RN, Clinical Director, Cardiothoracic Surgical Services.

After surgery you will be admitted to the CSICU (Cardiac Surgery Intensive Care Unit) usually still under the effect of anesthesia, so fully sedated. You will still have the breathing tube down your mouth connecting you to the ventilator. You will be connected to several monitors and there will be several alarms and buzzers sounding repeatedly to continuously alert intensive care staff to changes in your condition. It is important to remember that a focus on pain avoidance and optimization of your sedation is one of the primary objectives of the nursing and physician teams following you during this time.

You will be closely monitored and expertly cared for by our team of physicians and nurses, so there will be a lot of activity around your bedside as nurses and doctors make adjustments on a minute to minute basis.

You will also be connected to other special medical equipment, including some of the following:

• A breathing tube, connected to a ventilator. You will not be able to speak until the tube is removed. This resembles breathing through a straw. Try to remain calm and understand the breathing tube will be removed as soon as you are able to breath without support.
• Chest tubes, to drain fluid from the surgical site.
• A urinary catheter, to drain urine from your bladder.
• Multiple intravenous lines, to administer fluids and medications.
• An orogastric tube which is removed with the breathing tube.

Nearly all postoperative patients, with or without diabetes, in the intensive care unit will be treated with an intravenous insulin infusion, in order to maintain their blood sugar levels in the normal or near-normal range. This medical treatment is associated with improved outcomes due to decreased inflammation and better wound healing. This treatment is monitored very closely by the nurses, intensivist, and endocrinologist, Dr. Jeffrey Mechanick. Also, during this time, any other metabolic disorders are investigated by the endocrinologist and discussed with the intensivist.

Once it is established that your heart function has remained optimal and stable, that you are not bleeding and that your body metabolic functions are performing adequately then we will allow you to wake up and then take you off the ventilator. For some patients, this process will begin the night of surgery.

Most patients will remain on intensive care for one or two nights after which they will be transferred to the general telemetry floor. The majority of patients will be ready to leave hospital within 5 to 7 days of surgery. About 1 in 10 patients will have unique situations or complication that will require they stay in ICU or hospital for longer periods, but these are usually self limiting and do not have any lasting implications.

It is important to remember that each patient will recover at a different pace. Any questions about individual progress can be directed to the ICU medical and nursing staff.

Your family will be told when the surgery is over and will be sent to GP2W where the surgeon will meet with them.

Once you are admitted to the CSICU your family can visit you during standard visiting hours, 11:30am - 6:30pm and 7:45pm - 8:15pm.  Only 2 people at a time, at the bedside.

Post-Operative Day 1 and 2

Most patients will transfer to the 7th floor the morning after surgery. You can expect to feel tired and will sleep for short periods throughout the day. It is important to do deep breathing exercises every 2 hours. You will receive pain medication by mouth and you will start drinking fluids and progress to soft food. Your IV, monitoring lines, and Foley catheter will be removed. The chest tubes will be removed when the drainage is low. Your activity will increase. You will be out of bed to your chair and walking to the bathroom. By the 2nd day, you should walk around the unit at least 2 times each day.

Metabolic and nutritional aspects of recovery are diligently managed: first, the intravenous insulin infusion is usually tapered off and, if needed, subcutaneous insulin is used to continue to keep the blood sugar levels in the target range; second, nutritional status is evaluated, liquid and then food intake is gradually introduced based on how well the recovery is, and if there is a higher risk for nutritional problems (those who have lost too much weight prior to surgery, have other medical conditions that affect nutrition, or are thought to require longer intensive care), then specialized nutritional care is provided to enhance physiology and recovery, including feeding through tubes into the stomach or intestine (“tube feeds”), and/or feeding through an intravenous catheter (“TPN”). These decisions are carefully and thoroughly discussed with the endocrinologist, intensivist and the surgeon as part of a comprehensive “team” approach to nutrition.

You will continue walking around the unit 2-3 times each day. As your appetite improves, you will begin to feel less tired.

Insulin, nutrition support, and/or other metabolic treatments are continued, optimized, or tapered off as medically needed. These decisions are still discussed on a daily basis with the surgical team.

Your blood work and chest x-ray will be reviewed by the care team in preparation for discharge. The team will review how you are doing and let you know if you are ready for discharge in the morning.

Post-operative teaching and discharge planning will continue. We encourage your family to participate and ask questions. Your discharge instructions will include information on wound healing, disease and risk factor modification, your medications, your home exercise program, stress management, and specific restrictions.

Your pacing wires will be removed at least 24 hours before your discharge.

You should make arrangements for transportation home and have you family/friend bring your clothes to the hospital.

You will be given a discharge notice to sign.

Your family/friend should arrive at the hospital before 9am.

You will be given prescriptions for medications, your discharge instructions, and follow-up care information. All of which will be reviewed with you by your nurse.

Any endocrine, metabolic, or nutritional interventions are discussed with the patient and family by the endocrinologist and/or surgical team to assure a smooth transition to outpatient care. If outpatient follow-up visits are needed with the endocrinologist, these are arranged with the patient.

Our goal is to discharge by 9:30am. There is a discharge lounge on the second floor.

Things to Remember at Home

See your cardiologist 7-10 days after discharge.

Make a 4-week follow-up appointment with your surgeon.

You can shower. Towel dry lightly.

Do not lift more than 5 pounds for the first 6 weeks; no more than 12 pounds for the first 10 weeks.

No driving for 6 weeks.

Signs and Concerns

Report redness, swelling, increased drainage or excessive pain at the surgical incision.

You should also call us if you are not sleeping or have shortness of breath.