A Guide to Open Heart Surgery
This is a general guide, your individual needs and condition may vary
Medications to hold prior to surgery
Do not take any anti-inflammatory medications such as ibuprofen (Advil, Motrin), Diclofenac (Zorvolex, Voltaren), Naproxen (Aleve), Meloxicam (Mobic), etc. for 2 weeks prior to surgery
Stop all herbal or vitamin supplements 2 weeks prior to surgery
If you are on warfarin (Coumadin), Plavix, Eliquis, Brilinta, or any other blood thinner– be sure you discuss with the office nursing staff the day you are scheduled for surgery to know when to discontinue
If you are on any chemotherapy or suppressant medications for cancer, lupus, arthritis, etc. ask for directions regarding when to stop taking before surgery
PAT (preoperative admission testing)
Will be scheduled from our office staff 1-5 days prior to your surgery date. You will meet your anesthesiologist, cardiothoracic nurse practitioner, and have several tests that include: blood tests, urine test, chest x-ray, a lung evaluation by the respiratory therapist, and possibly an ultrasound of the vessels in your neck and/or legs. Occasionally your surgery is postponed if there is an abnormality on these tests, but we will let you know as soon as possible to reschedule if necessary.
Bring all medicines or a list of medications that includes the name, dose, how often taken, and last time taken. Be sure to include over the counter medications as well.
Please know what medications you are allergic to and what reaction you had. Be sure the surgical staff is aware if you have any metal allergies as well.
Your preop nurse will give you supplies for the special wash the night before surgery.
Day before surgery
You are not limited on your diet the day before surgery, however we suggest not eating foods with a lot of salt or that are very heavy/dense
Take all of your medicines as you normally would the day before surgery (unless you have been told to stop taking them as above)
Do not eat or smoke after midnight, you can drink Gatorade or clear liquids until 4 am the day of surgery
Insulin management: This will be determined at your PAT visit
Shower the night before, use Hibiclens wipes, change sheets before going to bed
Day of surgery
Do not take any of your home medications the morning of surgery
Repeat shower and Hibiclens wipes
If you wear a BiPAP/CPAP machine at night, bring it with you to the hospital
If you have difficulty hearing and use aides, bring them with you to the hospital
If you wear glasses, bring them with you to the hospital
Preop: After you are registered, you will be taken to the preop holding area or the operating room and your family will be shown to the waiting room. An IV will be placed and you will be given sedation medication prior to monitoring lines placed in your wrist and neck. You will be under general anesthesia for the remainder of the surgery. Your family will be notified during the surgery periodically about where they are with the surgery and how you are doing.
Post op: After the surgery is complete, your surgeon will go to the waiting room to discuss the surgery with your family and you will be transported to the cardiothoracic recovery room/unit. You will probably have:
- 2-4 chest tubes to drain any excess blood from your chest. These will be removed as soon as drainage is minimal, usually 24-72 hours
- A catheter in your bladder to monitor your urine output. Will be removed as soon as possible usually 24-48 hours
- Temporary pacemaker wires. These are in place in case your heart beat is too slow or irregular, these will be removed usually 48-72 hours
- You will be on the ventilator (breathing tube), we allow you to wake up enough to breathe without help, follow some simple commands, and all bloodwork is within normal limits. Once all criteria is met, the tube will be removed, usually 6 hours after surgery (if there are no respiratory issues such as COPD, asthma, or emphysema).We give a low dose of medication to keep you calm as you are waking up, many do not remember this part of the process
- Insulin delivered into your IV, this does not mean you have become diabetic (blood sugar often rises in response to stress from surgery)
After you are off the ventilator and are stable, the staff will have you sitting on the side of the bed (around 2 hours after breathing tube is out), and 2-3 hours after that will have you stand at the side of the bed.
Visitors are limited in the recovery room. Usually the first visit is 1 to 2 hours after you’ve arrived to recovery room and is limited to 5 minutes. We ask that only immediate family visit in recovery and no one under the age of 16 years old. After that is dependent upon the care you need. The nursing staff will let your family know when it is okay to come back to see you. There is no visitation after 7 pm unless there are extenuating circumstances, be sure your family gives a phone number for staff to call.
Post op day #1
After you are evaluated by the nurse practitioners and/or your surgeon, you will be either moved to a step down unit or your room will no longer be classified as recovery (dependent on hospital) and visitation will no longer be restricted.
The nursing staff will have you stand and walk a few steps to the chair around 6:00 am, and physical therapy will walk with you in the hall a few hours after that. You will most likely be on oxygen delivered into a cannula that blows into your nose, it will gradually be decreased and stopped when you no longer need it. The most important thing is walking, coughing, and deep breathing with assistive devices. You’ll be expected to use your incentive spirometry and/or flutter valve every hour to help prevent pneumonia; your family can help you remember to use it.
Sternal precautions:
****Important goals while in the hospital include:
- Pain control
- Breathing exercises
- Walking without aid from others
- Understanding home care
Post op day #2-Discharge
Every day is expected gradual improvement, increasing walking distance, and removal of line and tubes. Expected length of stay in the hospital is around 5 days. If you are still too weak or unsteady we will discuss inpatient rehab prior to returning home, but our goal is for you to return home at discharge with home health visits. It is preferred that you have someone in your home for the first 2 weeks, if you live alone give some thought as to who you can stay with or who can stay with you.
Discharge
You should receive a list of medications at discharge, be sure you understand which ones to continue and which ones are new or changed. We suggest a button up shirt and loose pants to go home in, they are easier to get on with your incisions.
You should continue using your incentive spirometry at home and walking 3 times per day for 10 minutes. Continue sternal precautions with your heart hugger and/or pillow for 6-12 weeks.
If you have an incision on your leg, continue wearing compression hose during the day for 2 weeks to reduce swelling and assist with healing. These may be removed at night when sleeping.
You should ride in the back seat for 2 weeks after surgery
Home care
Shower daily with an antibacterial soap, wash but do not scrub incisions. Rinse thoroughly. No tub baths, pools, or immersion in bodies of water until incisions are completely healed. Always wash your hands prior to touching your incisions, do not allow animals or others to touch your incisions. Do not apply Neosporin, Vitamin E oil, scar creams, etc.
Do not add salt to your meals, and be aware of how much salt is in your foods, that can increase swelling and then shortness of breath. Weigh yourself every day, if you gain 3 lbs in 24 hours or 5 lbs in 72 hours notify our office.
You cannot lift over 10 lbs for 6 weeks after surgery. You cannot lift over 50 lbs or participate in activities with percussive motions to the chest (such as hard swinging motions/golf, fishing from a boat, shooting a gun, weed-eating, gardening, walking a dog, etc.) until 12 weeks after surgery. Remember: children and animals can weigh more than 50 lbs
If you are riding in the car for long distances, stop every hour and walk around for 5 minutes
Wait until after your check up to resume sex. Sexual activity is roughly equivalent to climbing 2 flights of stairs. If you can climb 2 flights of stairs without excessive fatigue or shortness of breath you can physically handle having sex. You should be on the bottom to prevent stress on your breastbone.
You can drive 2 weeks after surgery as long as you are not taking narcotics and you feel ready. Start with short drives, less than 20 miles.
Most people feel better about 3 months after surgery; however it varies for each individual, be patient with yourself and your progress
Pain control
You will be given pain medication through your IV until you are able to start taking medication by mouth. We will start oral pain medications as soon as you are not having nausea and are swallowing without difficulty. Our goal is to stop IV pain medications as soon as possible to decrease intestinal issues that can occur after open heart surgery. There are a variety of medications that we utilize to assist with decreasing your pain, and it is important to take pain medication periodically in order to cough, deep breathe, and walk in order to avoid pneumonia, blood clots, or other issues. There is going to be some pain after your surgery, we will do everything we can to assist with keeping it at a manageable level.
When to call after you are home
Call the surgeons office if you:
- Begin running a fever over 100.5
- Your chest or leg incision has drainage, redness, or swelling
- Have popping or clicking in your chest that is new
- Have shortness of breath that requires propping up with pillows
Follow up appointments
Your office appointment for incision check is 2-4 weeks after surgery, occasionally we will ask to see you in 6 weeks as well.
Depression after surgery
Depression after an open heart surgery is a very common occurrence. There is no set timeline for onset, it can occur from weeks to months after surgery. If you find yourself with feelings of sadness or hopelessness, loss of interest in activities, sleep disturbance, significant reduction in energy levels, changes in mood or appetite or thoughts of suicide it is important to follow up with your primary care physician or psychiatrist for assistance, often treatment can assist with symptoms and medications can be discontinued after 6-12 months.
Other precautions
You will need antibiotics for dental cleanings or procedures for 3 months after surgery