Following your surgery, you will go directly to the Intensive Care Unit (ICU) where you will spend your next 24 hours. Your surgeon will speak to your family to answer any questions they may have.
Intensive Care Unit
When you wake up, you will be in the ICU. You may feel groggy, thirsty or cold. The nursing staff will be at your bedside often to check on you and keep you comfortable. You will remain in bed. The nurse will assist you in turning from side to side every two hours. To improve your circulation and prevent blood clots, you may have elastic stockings or sequential compression devices on your legs. A sequential compression device consists of an air pump connected to a sleeve, which is placed around each leg. The pump forces air into different parts of the sleeve in sequence, creating pressure around the calves.
You will have many tubes and wires attached to your body.
- A tube in your throat will help you breathe. While the tube is in place, you will not be able to speak. Do not try to speak. You will be asked "yes" and "no" questions so you can communicate with the nurse. The tube will be removed as soon as you are able to breathe well enough on your own.
- Chest tubes will collect fluid that may build up around your heart and lungs. These tubes often are removed the day after surgery; some chest tubes may stay in longer.
- A catheter (tube) in your bladder will drain urine. The nurses will check your urine output often. This catheter usually is removed after you leave the ICU.
- A monitor will record your heart rate, rhythm, and blood pressure.
- Pacing wires, placed during surgery, will be connected to a temporary pacemaker to assist with slow heart rates as needed. Most often these wires are removed the day before you go home.
- Intravenous (into the vein) lines will be used during and after your surgery to provide fluid, medicines and blood if needed. These intravenous lines will be removed when you no longer need them.
Once the breathing tube is removed, your nurse will have you begin deep breathing and coughing exercises. To be sure you are taking deep breaths, you will use an incentive spirometer.
You should take 10 deep breaths every hour that you are awake. Your nurse will show you how to do this and how to support your incision with a pillow when coughing. This, along with turning in bed, helps prevent mucus and fluid buildup in your lungs and avoid complications, such as pneumonia.
You will have a pain relief pump. This pump is connected to a thin catheter (tube) that rests inside your chest along the length of the incision.
One of the incision types below may be used by the cardiac surgeon when performing your heart surgery.
- Minimally invasive—this requires the cardiac surgeon to make a small incision (about 3 inches) in the upper or lower chest and open part of your breastbone (mini-sternotomy). The site of the incision depends on the location of the diseased valve. Using special instruments, the cardiac surgeon then repairs or replaces the valve, wires the breastbone together and closes the incision.
- Full sternotomy—this involves a 6- to 8-inch incision down the middle of your chest and requires the cardiac surgeon to open your breastbone. After surgery, the breastbone is wired together and the incision is closed with sutures.
- Thoracotomy—this involves a chest incision to be made between the ribs.
The pump delivers an ongoing flow of pain medicine directly into the incision site. A clear dressing and tape hold the catheter in place. A belt with a small pouch supports the pump and the tubing. Most patients have the pain relief pump for about 72 hours. This pump, along with either intravenous or oral medicines, should control your pain. Incision pain and tenderness will lessen over the next two weeks.
It is important that you take your pain medicine as needed. Good pain relief can help you become more active and speed your recovery. Let your nurses and physicians know how your pain medicine is working. Rate your pain on a scale of zero to 10, with zero meaning no pain and 10 being the worst.
After your breathing tube is removed, you will be able to eat ice chips. Slowly, you will progress to a liquid diet. When you are able to tolerate solids, you will resume a regular diet.
On the day after surgery, your activity will be increased. You will first sit at the side of the bed and in the chair. When you are getting out of bed, do not use your chest muscles or arms to pull yourself up. Cross your arms over your chest, sit up and swing your legs over the side of the bed. This will help your breastbone heal if you have had a sternotomy.
As you are able, your nurse will assist you with a short walk in your room and later, in the hall. It is normal to feel weak and wobbly at first. Always ask your nurse for help when getting out of bed.
You will be cared for in the ICU one to two days. Sometimes your condition may require a longer stay.
As you progress, you will be transferred to the Step-down Unit, where you will receive care until you go home. Your heart rhythm will be monitored while in the hospital. You will also play a more active role in your care.
The nurse will help you bathe. You will learn how to wash around your incision. Do not apply any lotions or creams to your incision. Once all of your tubes and drains have been removed, you may take a shower with help. Your chest incision may appear bruised and may be discolored from the soap used to wash your skin before surgery.
You will be encouraged to gradually increase your activity each day. You may begin walking in the halls three to four times each day and sitting in a chair for all your meals. Remember to increase the time and distance each time you walk. This light exercise will help you become stronger as you prepare to go home. A physical therapist or the cardiac rehabilitation staff will visit during this time. Be sure to follow their exercise guidelines.
As you recover, continue to use your incentive spirometer and to cough and deep breathe 10 times every hour while awake. A dietitian may visit to explain any specific diet guidelines. These may include a low-sodium diet to prevent fluid buildup, limiting the fluids you drink and a low-fat, low-cholesterol diet.
For more information regarding heart surgery, please contact the Bluhm Cardiovascular Institute at 1-866-662-8467 or request a first time appointment online.