Patient Handbook for Cardiac Surgery

This is a small information booklet that will guide you through your stay with us. We hope that information provided here will answer some of your queries.,

Admission

After registering at the admission office of the hospital you will be admitted one or two days prior to your operation to the room you have opted for. Usually a patient is admitted to the hospital with enough time before the operation date to allow diagnostic tests to be done. These routinely include blood and urine tests, electrocardiogram (ECG), chest x-ray and so on. Cardiac catheterisation with coronary angiogram if required may be done during pre operative hospital stay unless it has been done before.
A nurse will escort you to your room and will take and record your temperature, heart rate, respiratory rate, blood pressure, height and weight. Blood and urine samples may also be obtained. The surgical staff will visit to examine you, discuss the details of the operation and answer questions. The nursing staff will also evaluate your needs, make you as comfortable as possible, provide information and answer questions. In addition, the anaesthesiologist will evaluate you and discuss plans for the care of vital body functions during the operation. Other members of the technical staff may come to draw blood, insert intravenous catheters, instruct you about how to breath and care for your lungs after the operation.
You will also be told when the operation will occur. Heart operations are usually scheduled in advance and begin on time. Occasionally an operation may be delayed because other patients have emergency needs. If this happens, your operation will be rescheduled as soon as possible. At times the initial examination and the investigations reveal the need for revised preoperative medications and therapies. In such situations surgery may have to be postponed for a day or two.

Preparation

Before your operation much of your body hair will be shaved off, specially from your chest and legs. You will probably be asked to shower and wash with antiseptic soap to remove bacteria from the skin. This reduces the chance of infection. You should remove personal items such as glasses, contact lenses, dentures, watches and jewellery and give them to family members for safe keeping.
You will be served a light meal, given the pre anaesthetic medications prescribed and will be asked to rest. A good night’s sleep is important, your body needs to be fresh and strong. Ask the doctor or the nurse any last minute questions, tell them if you are feeling any discomfort or symptoms you may suddenly develop at this stage.

Operation day

Medications that will make you relaxed will be given about an hour before the operation. The medication will make you feel drowsy, so remain in bed and try not to move around too much.
You will be taken to the operation room at the pre appointed time, the anaesthesiologist will give you an anaesthetic that brings sleep and freedom from pain during the operation and then the operation will be performed.

How long do these operations usually last ?
  • Coronary artery bypass graft operations/ Open Heart Surgeries usually last from three to six hours. Their length depends upon what has to be done. Each operation varies in complexity, so its duration can only be estimated.
Arrangements for the family members
  • Hospital has places where a patient's family and friends can wait during surgery. Be sure the reception knows where your family will be waiting during the surgery. Patient's relatives can wait in the reception lobby or in relatives’ dormitory or in the respective rooms (in case of Deluxe and Suite room patients). As soon as operation is over relatives will be informed about it and about the progress of the patient, but no patient's relatives will be allowed to visit the patient till patient is in the Surgical ICU.
Surgical ICU - Recovery Room
  • When your surgery is over you will be taken to the recovery area for your post operative care. You will remain in this area until your condition is stable and you are ready to be transferred back to the ward. This usually takes two or three days. In this area your heart function, lungs and urine output and other vital parameters are carefully monitored.
  • As soon as the operation is over, relatives will be informed about it and about the progress of the patient. One relative will be invited by the sister in-charge in the intensive care unit to visit the patient and for direct first hand viewing. Most patients at this stage would be unconscious, paralysed and on ventilator and therefore only viewing the patient and first hand conversation with the intensive care doctor about the patient’s clinical condition is possible. When ever the patient regains consciousness (usually within 4-6 hours), and when he is taken off ventilator (6-24 hours), the sister in-charge will invite one relative to interact with the patient. Every day at 7'O Clock in the morning, patient's relatives can meet the intensive care doctor on duty, who will brief them about the progress of the patient. Any time if the relatives are uncomfortable, they can contact the reception desk, who would organize their meeting with the doctor on duty.
  • When you awake in the recovery room you will hear the sounds of equipments and be aware of activity within the unit. There will be a number of tubes and pieces of equipment attached to your body which are essential for your proper treatment.
  • An endotracheal (or breathing tube) will be in your mouth and passes through the vocal cords into the windpipe. While this tube is in place you will not be able to talk but the nurses are specially trained and will anticipate your needs. This tube is connected to respiratory machine (Ventilator) which assists you with your breathing. When you are fully awake after the operation and no longer require assistance with your breathing, the tube will be removed.
  • The nurse will help you sit up in bed and cough vigorously to clear your lungs of secretions. For the next day or two you will receive oxygen through a mask. In addition you will have several tubes in your veins to administer fluid, blood and medications. These tubes will be removed one by one in next one or two days.
  • A urinary catheter will drain your bladder continuously and enable the nurse to keep an accurate record of your urine output. Sometimes it may give you a feeling of pressure in your bladder and make you feel as if you need to urinate. This will usually be removed two days after surgery.
  • Drainage tubes are placed around your heart at the time of surgery and passed through the skin near the lower end of your chest incision. The drains prevent blood from accumulating around the heart during the postoperative phase. Sometimes small wires are taped on your lower chest. They have been placed at the time of surgery to control your heart rate. These wires will be removed before you go home.
Visiting Hours in Recovery Care

Free access to relatives is not permitted in recovery room. However relatives will be kept informed about the progress of the patient. Everyday at 7 AM duty doctor will brief your progress to your relatives. Relatives can sit in reception lobby.

How Long You Will Stay in Recovery Area ?

Usually on 2nd or 3rd post operative day, patients are shifted to the ward where under close observation, your mobility and activities will gradually increase. Doctors and Nurses will assist you in:

  • Coughing frequently, to ensure that your lungs remain clear and infection free
  • Walking about - care not to over do it, if you feel dizzy return to bed
  • Going to toilet Do not lock the door as it is better to have access to help near at hand
  • You will be asked to eat in spite of your not feeling hungry at all. Eat whatsoever you feel like. Concern at this time is to give your body as much nutrition as possible.
Returning Home

It is not at all unusual to feel apprehensive about returning home. Some times these feeling are prompted by concerns about leaving the security of the hospital, with its expert medical team and equipments. Remember that no patients are allowed to go home until the doctor thinks their condition is satisfactory for them to continue their safe recovery at home.
Depending on your recovery, the senior consultant attending on you will organise your discharge. Since you have been through a major operation, the preparation of the discharge summary may take some time as it has to be checked and rechecked to ensure that an accurate account of your treatment has been stated. If you feel it needs correction inform the doctor right away.

  • The hospital normally makes it possible to check out by 11 AM.
  • Transport will have to be arranged by your relatives or friends and it is perfectly safe for you to travel home, sitting in the front seat of car.
  • Long distance journeys should only be taken after another week or so. This is only to ensure that help is close at hand should you need it.
Diet

The Doctor, dietitian or nursing staff will explain how to modify your eating style. It is wise to reduce coronary risk factors as much as possible by reducing sutured fats, cholesterol and salt in the diet.
It is very important to avoid being overweight, obesity is bad for any heart patient. Generally the same food as the rest of family can be taken if tolerated. Avoid obviously salty foods such as potato chips, salt should not be added to your plate but normal cooking salt is all right.

Fatty foods are best avoided

Cholesterol - Nutrition experts generally agree that keeping blood cholesterol at normal levels reduces the risk of heart complications in persons who have coronary artery disease. It is a good idea to check your blood cholesterol periodically. If it is high you will have to reduce it by proper diet and exercise. If diet and exercise don’t do the job, medications may be needed.

Smoking

Smoking has a bad affect on the heart, as well as on other parts of the body. It is a major risk factor for additional heart disease after your surgery. If you smoke, quit and if you don’t, don’t start.

Alcohol

You may drink alcoholic beverages in moderation only, NEVER exceeding one and a half drink.(60-90 ml of 42% proof whisky or 200 ml. of wine or 375 ml. of Beer)

Medications

You should only take medicines which have been prescribed in the discharge summary. Don’t keep taking medicines that you took before the operation unless they are specifically prescribed. Before you leave hospital make sure you know which medications you have to take and what each tablet is for. This is most important. If you are to take anticoagulants you must understand how often follow up blood tests are to be done.

When should the doctor be contacted ?

Usually patient's are called for follow up in the OPD by prior appointment. But you can always contact us if there is any problem. Your referring cardiologist will wish to follow your progress, after your visit to the surgeon and in the long term make sure you have appropriate appointments. Call the Doctor on duty if there is any problem (phone numbers have been provided in the booklet and in discharge summary). Call the doctor if there is any sign of infection (redness or drainage at the incision), fever, chills, increased fatigue, shortness of breath, swelling on ankles, weight gain over five pounds (2 Kgs) in 5 days, change in heart rate or rhythm or any other sign or symptom that seems disturbing.

Returning to Work

For sedentary workers, the average is four to six weeks. For persons who must perform heavy work, the time is six weeks or longer.

Routine at home
Patients should follow these principles

  • Get up at normal hour
  • Bathe or shower if possible
  • Always dress in regular clothes (Don’t stay in sleeping clothes during the day)
  • Take a rest period in the mid morning or mid afternoon or after a period of activity
  • Here is a typical six week programme

Week 1

  • Light activities
  • Avoid any heavy lifting, stooping or bending
  • Limit visitors
  • Frequent 5-10 mts walks around house and garden
  • Stairs when essential go slowly and rest midway

Week 2

  • Gradually increase to moderate activities, more moving and for longer times
  • Walking 10-15 minutes twice daily at comfortable pace

Week 3

  • Continue increasing activities
  • Half day outing, small social outings, not too late
  • Walk 15-20 minutes twice daily

Week 4 & 5

  • Longer activity times, faster walking
  • Carrying light weight
  • Walking 20-30 minutes, aim to walk 1 mile twice daily
  • Social outing, such as cinema
  • Restaurant up to 3 hours

Week 6

  • Most activities, unless exceptionally heavy
  • Drive car
  • Normal sexual activities
  • Return to job