Although every patient’s situation is unique, the information below will give you a general idea of what you can expect throughout your admission and surgery at the Heart Institute.
Information for your family members and contact person is also included in this section so they know what to expect as well.
Some patients are admitted for surgery on the day of their operation because they have been assessed in the Pre-Admission Unit the week before. Other patients are admitted to the Heart Institute a day or two before the operation. Either way, the preparation is the same.
- Your family/designated contact person will be updated by the surgeon after your surgery is complete.
- After surgery, you will stay in the Cardiac Surgery Intensive Care Unit (CSICU). Once your condition improves, you will be transferred to a nursing ward (H3 or H4).
- Visitors must check in with the volunteers at the front desk to visit you in the CSICU.
The Evening Before Surgery
- Receive visits from your surgeon, a resident, the anesthesiologist and the nursing coordinator
- Have additional diagnostic tests if not already completed
- Shower with an antiseptic soap
- Not eat or drink after midnight
- Rinse your mouth with an antiseptic mouthwash
On the Day of Your Surgery
What You Can Expect
- Removal of hair on your chest, groin and legs with a clipper
- Another shower with an antiseptic soap
- Medicine to help you relax before you go to the operating room
- Rinse your mouth with an antiseptic mouthwash
- After you arrive in the operating room, two intravenous lines will be started. You will be asleep shortly after this.
What Your Family and Contact Person Can Expect
Your family members and designated contact person can stay with you before you go to the operating room.
Once you leave to go to the operating room, your family or designated contact will be expected to remove all your belongings from your room. You will stay in the intensive care unit at least overnight.
During your operation, your family and your contact person are welcome to wait in the Family Lounge on the main floor. Please check in with the volunteers at the front desk. Your family or designated contact will be responsible for keeping your other family members informed of your progress.
Like all surgery involving general anesthesia, you will be instructed not to eat or drink anything after midnight before your surgery. The anesthesiologist will review your current medications and inform you or your nurse as to which ones you should take with a small sip of water on the morning of your surgery.
Before you go to the operating room, you will receive medicines to help you relax and make you feel sleepy.
When you arrive in the operating room, you will meet several nursing and technical support staff in addition to your anesthesiologist. If you have any concerns about pain, angina, difficulty breathing, nausea or anxiety, please share these concerns with your anesthesiologist.
Before putting you to sleep, the anesthesiologist will insert several intravenous lines when you arrive
in the operating room.
Breathing Tube and Machine
After you are asleep, you will be connected to a breathing machine (ventilator) by a breathing tube placed in your mouth and down your trachea (windpipe).
Your anesthesiologist will take great care in inserting the breathing tube in your mouth. However, you should be aware that in extremely rare cases some minor chipping or grinding of upper teeth may occur. This is why we ask about dental caps, dentures or loose teeth.
The heart-lung machine has a tendency to damage red blood cells, clotting cells and clotting proteins. If this happens, you may require blood products from Canadian Blood Services. The current risk of contracting AIDS, HIV or hepatitis is very small. These blood products are given only when necessary and when the benefits outweigh the risks. You will be told before you go home whether you received these blood products. The blood bank leaves a card on your chart for your records.
Should you have any further questions regarding anesthesia, please ask your nurse to have the anesthesiologist come and speak with you.
After Your Surgery
After your operation, three pre-arranged contacts are made:
- The surgeon will see your designated contact person, if they are waiting in the Family Lounge at the Heart Institute, or phone them after the surgery. Unless you have been told otherwise, the operation takes four to six hours. One hour after your contact person has spoken to the surgeon, they may go see you in the Cardiac Surgery Intensive Care Unit.
- The nurse will phone your designated contact person between 9:00 p.m. and 10:30 p.m. the evening of surgery to give a progress report and again the morning after your surgery between 9:00 a.m. and 10:30 a.m. At that time, the nurse may be able to tell you about the plans for the day, for example, whether you will stay in the CSICU or be transferred to a nursing ward.
In the Cardiac Surgery Intensive Care Unit
After the surgery, you will be taken to the Cardiac Surgery Intensive Care Unit (CSICU). Typically patients stay in this unit overnight, but some patients may need to stay longer.
While in the CSICU, you can expect to have:
- A breathing tube in your mouth that is connected to a breathing machine (ventilator). You will not be able to talk until this tube is removed. Once you are awake, able to follow directions and breathing well enough on your own, the tube will be removed. There will be a nurse with you one-on-one until this tube is removed.
- Special monitoring equipment and intravenous lines
- A tube in one of your nostrils which goes into the stomach to keep it empty
- A tube in your bladder to drain urine
- Drainage tubes below your incision
- Temporary pacemaker wires
Once the breathing tube is removed, you will:
- Receive oxygen by mask
- Start deep breathing and coughing exercises and leg exercises
- Gradually start drinking fluids starting with ice chips
Your nurse will continue to give you pain medicine regularly. Let the nurse know if you are uncomfortable.
For Visitors to the CSICU
Visitors should check with the volunteers at the front desk in the main lobby (Ruskin St. entrance). The volunteers will call the CSICU to arrange the visit. Your visitors must follow this procedure each time they wish to visit.
Your visitors may be asked to wait at times while care is being given to you. They may see you for short periods of time (two people at a time). No children, please.
Before entering, visitors must use the hand washing gel. Any family members that are sick should stay at home. Heart surgery patients are especially susceptible to infection.
There is no visiting between 6:45 a.m. and 7:45 a.m. and between 6:45 p.m. and 7:45 p.m., while the nurses are giving patient reports at the change of shift.
To protect your health, your family members cannot visit you if they have a cold, fever, diarrhea, cough or any other sign of infection.
Recovery on the Nursing Ward
You will be transferred to the nursing ward when you are awake and stable. This typically occurs the day after surgery. On the nursing ward, you will begin to return to your normal physical activities. For a short period, you may receive oxygen by mask or nasal prong as needed.
During your recovery time, we will concentrate on teaching you all the skills needed to help you prepare for recovery at home. Also, we will work with you on walking properly, deep breathing and coughing exercises. You will progress with your diet gradually. If you feel nauseated, let your nurse know. The monitoring equipment, drainage tubes and some intravenous tubes will be removed as you progress through your recovery.
You will notice a whiteboard on the wall in your room for each patient. This will have information about your nurse, your physician, and your progress. You and your family should feel free to read the board and ask questions if necessary. You may also make notes on the board so you remember to ask questions.
It is important to take your pain medication regularly during this time so that you will be comfortable while doing recovery activities. Make sure you let the nurse know if you are uncomfortable.
Before your discharge, you and your family should attend a discharge class, which will prepare you for going home. The class times for all Heart Institute education programs are posted in each room.
If you have any concerns about going home after your surgery, ask your nurse to refer you to a social worker. They can help you with:
- Home-based physiotherapy or nursing requirements
- Community resource information
- Coordinating any community care that you may need upon discharge
- Drug-related costs
- Any other concerns you may have with respect to going home
For Visitors to the Nursing Wards (H3 and H4)
10:00 a.m. to 1:00 p.m. and 2:00 p.m. to 8:00 p.m.
1:00 p.m. to 2:00 p.m.
Please do not visit during the rest period.
After surgery, patients are very tired, and finding times to rest during the day can be difficult. The rest time from 1:00 p.m. to 2:00 p.m. is very important to help in their recovery.
We ask that you not visit during this time.
Only two visitors at a time at bedside. Family members who are ill should stay at home.
The primary role of physiotherapy is to help you regain your strength and return to your normal level of activity after your surgery. Exercise will help prevent common problems resulting from general anesthetic and prolonged bed rest, including muscle weakness and joint stiffness. More serious medical issues include blood clots and lung infection.
Exercise will also promote a feeling of well-being and encourage you to add regular exercise to your daily life. It is necessary that you take an active role in your recovery.
Deep Breathing Exercises
It is important to take deep breaths after surgery to get air into the bottom of the lungs. This will help prevent lung collapse and pneumonia.
Take a deep breath in through your nose until you cannot take in any more air. Purse your lips and slowly blow out through your mouth (as if blowing out a candle). Your stomach should rise as you breathe in and fall as you breathe out. Repeat for a total of ten deep breaths per hour.
Coughing helps to clear phlegm from your lungs and will help to prevent lung infections. It is common after surgery to have extra phlegm in your lungs, especially for the first few days. When you cough, hold your pillow (“teddy”) firmly against your chest. Take a deep breath in and cough out. You should cough two to three times every hour that you are awake. Your “teddy” helps to support your incision and lessen the discomfort you may have when coughing.
For the first few days, you will be helped out of bed. Because of the incision in your breastbone, you will need to learn a special way to get out of bed and up and down out of a chair. Until you are comfortable with the technique, your nurse or physiotherapist will practise this with you each time.
Bend your hips and knees and hold onto your “teddy.” Roll onto your side.
Let your legs fall over the side of the bed, pull with your legs and push with your elbow to help you come to a sitting position.
While in bed, it is important to change your position every one to two hours (for example, lying on your right or left side).
The following exercises help to prevent muscle and joint stiffness and increase your activity level. They also promote circulation, prevent blood clots and reduce swelling.
straighten one arm and raise it up over your head while breathing in. Lower it slowly while breathing out. Repeat five times then repeat with the other arm, three times a day.
Gently bring one knee up towards your chest as far as you can, and then return to starting position. Tighten the muscle on top of your thigh and straighten out your knee. Repeat five times with each leg, three times a day.
Point your toes down as far as you can, then bring your toes up towards you. Make circles with your ankles in both directions. Repeat these exercises ten times every hour that you are awake.
Your activity level will be gradually increased during your stay. The day after your surgery, if you are able, you will sit in a chair and begin walking in the hallway with assistance. Before you go home, you will be able to walk around the ward and climb stairs if you are required to climb them to get into your house or up to your bed.
You will be given specific guidelines for exercise and activity at home, as well as information about cardiac rehabilitation.