Cardiothoracic Surgery (CVTS)

Diet
Eat your normal diet unless instructed otherwise by your consultant. DO NOT EAT OR DRINK anything after midnight before your surgery.

Medications
You will be instructed by your consultant on which medications to continue or stop on the morning of surgery.

Shower
You will be required to shower with one antimicrobial liquid soap like chlorhexidine the evening before surgery and one antimicrobial soap on the morning of surgery before you are taken to cardiac recovery.

The antimicrobial soaps will be provided to you on the preoperative day.

Nothing by mouth" means you are not allowed to eat or drink anything unless you are told otherwise on your pre-op day. Your consultant will instruct you on which medications you should take the morning of your surgery.

You will be received at the cardiac recovery room one hour before surgery by a healthcare team member who will assist you in the preparation for your surgery. Preparation includes vital signs, starting intravenous lines, and medications.

The anesthesiologist will also visit you and give you medication to help you relax before taking you inside the operating room.

The following tubes and drains will be inserted during surgery after you are asleep.

• Breathing tube insertion: This procedure involves the placement of a tube in the patient's airway that is then connected to a breathing machine, which helps the patient breathe.
• Central venous access catheter placement: This procedure involves placement of a tube through a large vein that will allow for administration of fluids and/or medications.
• Arterial catheter placement: This procedure involves placement of a tube in an artery to measure blood pressure.
• Nasogastric or oral gastric tube placement: This procedure involves placement of a tube either through the nose or mouth into the stomach.
• Foley catheter: This procedure involves inserting a tube into your bladder to drain urine.
• Chest tube placement: This procedure involves placement of a tube between the lung and the chest wall to drain air or fluid from the chest cavity by the end of operation.

Generally, the surgery may take three to six hours or longer depending on your procedure. Discuss with your surgeon on the specific nature of your surgery.

When the surgery is completed, the surgeon will speak with your family.

Most of our patient population does not require blood transfusion during surgery. Our goal is not to transfuse blood unless necessary. The need for a blood transfusion varies from patient to patient. Therefore, you may choose to discuss the need of transfusion with your surgeon during your consult visit.

After your surgery, you are transferred to the cardiac recovery You are closely monitored by doctors, nurses, and staff as you recover. You will be asleep due to anesthesia and sedations given during surgery.

The goal is to remove the breathing tube within six hours. However, this may vary due to factors such as:

• Vital signs
• Lab work
• Lung function
• Chest X-ray
• Smoking history
  

  Other history of respiratory disease like:

  • Asthma
  • COPD
  • Emphysema

After your breathing tube is removed, an incentive spirometer is a device that helps you take deeper breaths and decreases your risk for pneumonia after surgery. You should do this exercise ten times each hour you are awake, while you are in the hospital.

How to use an incentive spirometer:

• Place the plastic mouthpiece into your mouth
• Blow out gently to empty your lungs
• Take a very deep breath in (like sucking a straw)
• Hold your breath as long as you can
• Let your breath out
• Follow each deep breath with a strong cough. If possible, cough up sputum.
• During the cough, hold a pillow firmly against your incision to help lessen the pain. This will help support your incision and may help decrease the pain.

You are given pain medications during surgery and in your recovery process. These include:

• Pills
• Intravenous medication
• Pumps
• Post-operative pain is caused by injury to your skin, muscles, bones, and nerves during the operation. It is important to manage your pain because it will interfere and slow your recovery process such as breathing, sleep, appetite, and activity.

For example

Breathing: Pain can prevent you from taking deep breaths. Shallow breaths increase risk for pneumonia.

Sleep: Inadequate pain control affects your comfort and rest.

Appetite: Inadequate pain control may affect your desire to eat.

Activity: Inadequate pain control may affect your ability to get out of bed, move, and walk.

The amount of pain medication you need depends on your pain tolerance and your response to the medication given. For your safety, your doctors and nursing staff monitor the amount of medications you are given.

Although significant amount of pain medications are given, they may not completely stop your pain, but it should keep the pain at a level that allows you to move, eat, and breathe easily.

Once the breathing tube is removed, you may start with swabs to wet your mouth and slowly advance to ice chips, water, and sugar-free liquids for the first 24 hours.

Due to anesthesia and pain medications given to you during surgery, your risk for aspiration will be monitored by your nurse who will appropriately manage your ice chips, clear liquids, and solid food as you tolerate it.

The average length of stay for our cardiac surgery patients is one to two days in the ICU. Your actual length of ICU stay may vary depending on your vital signs, activity, and bed availability on the intermediate ICU.

The average length of stay of our cardiac surgery patients is five to seven days. Your actual length of stay may vary depending on your vital signs, lab work, dietary, and activity.

• Sternotomy
  A sternotomy is an incision made through the sternum or breastbone.
  After surgery, it is important to watch out for your sternum, called "sternal precautions." The sternum is your breastbone that is divided to gain access to your heart during surgery.
  Surgical steel wires hold the sternum together after surgery after surgery. Over the next six to eight weeks, it is important to let the area heal.
  It may take two to three months for you breastbone to heal. Overexertion or straining the sternum before it heals increases the risk of opening, draining, and infections.
• Thoracotomy
  A thoracotomy is an incision made on the left or right side of the chest to gain access to your heart.
• Sternal and thoracotomy precautions
  Do not lift objects more than five to ten pounds
  No bending, pushing, pulling, and stretching for six to eight weeks
  Hold a pillow firmly against your upper chest when coughing or taking deep breaths
  Avoid placing pressure on your arms to support your upper body
  Keep your arms close to your body. Avoid extreme reaching with your arms.
  Do not place both hands behind your head
  Avoid twisting in your upper chest
  Do not drive for four to six weeks, or until cleared by your surgeon

You may not drive for four to six weeks. Also, you may not drive if you still experience chest incisional pain or if you are still taking medications that may impair your judgment.

Please discuss with your surgery team about your driving privileges.

The goal is to walk three to four times daily after your surgery.

The day of your surgery, the nursing staff or physical therapy may assist you with simple activities such as bed exercises and sitting at the edge of the bed if appropriate.

The first day after your surgery, you will be assisted to sit up in a chair and to take a short walk if appropriate. Every day we will increase your activity. You will be given an activity checklist to monitor your progress.

Physical therapists and the nursing staff will teach you about sternal precautions during your activities such as:

• Using a pillow to splint your chest when you cough
• Deep breathing or activity
• How to get out of bed safely
• How to safely use your body for everyday activities
• A physical therapist will help you determine if you need equipment for your safety such as a walker.

Your nurses and therapists will let you know when you are safe to walk independently. Until then, always ask for help to get out of bed.

The cardiac rehab nurse will discuss the Walking Program to assist you and your family in your recovery process to transitioning to home.