After surgery

You will be in the CVICU normally between 12-24 hours. You will be transferred to D3 once you are medically fit.

The visitor's waiting room is located to the left of the 2nd floor, M wing elevators.

The special needs of cardiac surgery patients require a visiting policy different from other areas of the hospital. We ask that visitors to the CVICU respect the following guidelines:

1. Use the desk phone in the visitor's waiting room to call CVICU at Ext. 6090 and let them know you would like to visit.
   A volunteer may be present to assist you.
2. Visits are limited to immediate family or significant others
3. Two people at a time are able to visit in the CVICU
4. Visiting hours are unrestricted, however your visits may be limited:
• During shift change (7:00am - 8:00am & 7:00pm - 8:00pm)
• For patient rest & privacy

While in the CVICU, we recommend:

• Designate one family member to be the primary contact and to obtain information on your progress (Others will be referred to that person for information).
• Keep unit visits short (5-10min) to accommodate your rest & recovery
• Family members return home in the evening to rest.
• Information on your progress may be obtained at anytime day or night by having your designated contact person telephone the CVICU 416-480-6090.

Visiting D3

Once you are moved to the cardiovascular ward (D3), visiting hours begin at 11:00am and end at 8:30 pm, with a quiet time recommended between 2:00-4:00pm for patients to rest. We try to limit activity during this time as the patients may be tired from the activities required to prepare them to go home. Radios, TV's, flowers, clothing, food or other gifts are not permitted in the CVICU.

• There will be a lot of special monitoring equipment.
• Your eyes will be closed at first, until you wake up
• You will look pale and feel cool to touch
• Your face will look swollen
• You may shiver
• Your family can expect to see an improvement within hours following the surgery

You will be attached to many different machines which will help your nurse give you the special care you need. When you wake up, you may hear alarms and bubbling noises from the equipment. Please do not be concerned with this as your nurse will be tending to you and the equipment.

Breathing tube (Endotracheal tube, ETT)

The doctors will put this tube in your mouth while you are asleep. The breathing tube passes down your windpipe and is attached to a machine (ventilator) which will help your breathing. You will not be able to speak. This is only temporary while the tube is in place. This tube will be secured with tape on your cheeks. You will not be able to talk, eat or drink until the tube is removed. When the nurse asks you questions you will be able to communicate with her by nodding yes or no.

The removal of the breathing tube occurs as soon as you are awake enough and strong enough to breathe on your own after surgery. After the tube is removed your voice will be a little hoarse and your throat may be a little sore. This is only temporary.

Intravenous catheters (I.V.)

An intravenous (I.V.) catheter is a small tube that is put in your arm before you are asleep in the operating room. It allows us to give you fluid and medication. The I.V. stays in for approximately 3-4 days.

Arterial line
An arterial line is a small tube that will be put in your wrist. It is used to monitor your blood pressure continuously, and allows for blood samples to be taken easily. This line is removed before you are transferred to the ward.

Swan-Ganz catheter
A Swan-Ganz catheter is a small tube placed in your neck vein to measure the pressures in your heart. It is removed the morning after surgery.

Heart monitor

A heart monitor consists of electrodes (sticky round pads) placed on your chest, which are connected to a monitor. It shows your heart rate and rhythm constantly. Alarms may go off when you move. Don't worry about these alarms. Your nurse will be checking you constantly.

Chest tubes

Chest tubes are placed under your incision during surgery. These tubes drain blood and fluid that collect in your chest after surgery. The chest tubes are normally removed 12-24 hours after surgery when drainage slows/stops.

Bladder catheter

The bladder catheter is put in when you are asleep, during your operation. It is a small tube placed in your bladder to drain urine. The bladder catheter is normally removed when you are able to get up to walk to the bathroom with assistance.

Pacemaker

All patients having heart surgery have temporary pacemaker wires inserted during surgery. They may be temporarily attached to a small pacemaker box outside of your body. Swelling and irritability of the heart muscle tissue occurs during surgery. Your heart may need temporary assistance with a pacemaker while the healing of this tissue is taking place. Pacemaker wires are removed before you go home.

After your surgery, you may feel pain and discomfort in the chest area and wound sites. Decreasing the amount of pain will help with your recovery. You will be given pain medications by mouth or injection. You may also be given a PCA pump (patient controlled analgesia), which will let you give yourself pain medication when you need it. Receiving regularly scheduled pain medication will decrease the severity of any pain you may have.

Several types of pain medications may be prescribed for you, such as Tylenol®, antiinfl ammatories (like Advil® or ketoprofen) and narcotics (like codeine, hydromorphine or oxycodone). Gabapentin, a drug used to treat nerve-related pain may also be prescribed for you.

For the first two days after surgery these will be given regularly. As the days go by, your pain or discomfort should begin to decrease. Staff will routinely ask you about your pain (scale 0-10) and you will receive pain medications only when you ask for them. If you are having pain and need narcotics to control it, there is very little risk of becoming addicted to these, so do not hesitate to ask for them. Good pain control will lead to an easier and maybe faster recovery.

Learn more about pain following surgery

Why exercise?

Exercises done soon after your surgery help prevent some common complications following general anesthetic and prolonged bed rest; such as, pneumonia, partial lung collapse, blood clots in the legs, and muscle weakness and stiffness.

When do I begin?

A physiotherapist will assist you with your exercises the first day after surgery. You may feel quite tired during these first few days. However, physiotherapy in the early postoperative phase is very important to your overall recovery.

What do I do?

Deep Breathing Exercises
Breathing deeply gets air down to the bases (bottom portions) of the lungs. The movement of air deep into the lungs helps to open up the air passages, and move the secretions out. This also makes coughing easier. Remember to practice these breathing exercises every hour on your own.

1. Breathe in deeply through your nose, continuing until your lungs feel full of air.
2. Holding the air in your lungs, take two sniffs in - as if to smell some flowers.
3. Do not let any air out between sniffs.
4. Hold the air in for one second.
5. Gently breathe out through your mouth.

To improve movement of air to all parts of your lungs, and to promote drainage of secretions, the nurses help you and encourage you to turn every two hours. With time, you will be turning on your own. The physiotherapist may make suggestions to you or your nurse regarding which positions are better for you, and for how long.

Coughing
After your breathing exercises, hug the pillow to your chest and have tissues ready:

1. Take a deep breath in and huff it out. (A huff is like pretending to create a mist on a pane of glass).
2. Repeat this up to three times, then take a deep breath, support your chest, and cough strongly.

Feel free to ask for pain medication if discomfort begins to interfere with effective coughing. Strong coughing will not cause any damage to the breastbone or affect the surgery.

Bed Exercises

1. While lying in bed, reach for the ceiling with one arm up over your head at a time. Without holding it in the air, return it to your side.
2. Shrug your shoulders and let them drop back down. Make gentle circular motions with your shoulders, forwards and backwards.
3. Slide your heel along the bed, bending your hip and knee, and straighten. Repeat with the other leg.
4. Ankle Pumping - To aid circulation and help decrease knee swelling, pump your feet up and down and make ankle circles. Pull your foot up toward you and then push down like on a gas pedal.

You will be sitting over the edge of the bed shortly after your surgery. Your nurse and/or physiotherapist will help you to move from lying to sitting safely and comfortably.

Sitting in a chair usually begins the first day after surgery. Walking usually begins the second day. Initially you will require some support or assistance, in some cases using a walker and/or portable oxygen. By the third day, most people are able to walk with minimal assistance, for short distances in the hall close to their room. At this time, walks last 3-4 minutes and are done approximately three times a day, at a slow relaxed pace. Most patients feel remarkably better after one or two days back on the ward.

Due to your surgery your chest and leg may be sore. If your incision is sore:

• Relax
• Change positions regularly
• Take pain medication as needed and use a pillow to support your chest incision when coughing

Good nutrition is important for your recovery after surgery. After your surgery, it is important to avoid any weight loss until you have fully recovered from your surgery and your incisions have healed.

You will be able to start taking sips of water when the breathing tube has been removed from your mouth in the CVICU. You will then start receiving clear fluids (broth, juice, Jello). Over the next couple of days, you will progress to full fluids (porridge, milk, pudding), and finally to heart healthy meals (low fat, low cholesterol, no added salt).

Many patients experience decreased appetite, nausea, and change in taste after surgery. If this is the case, it usually resolves in a few days. The dietitian can work with you to optimize your nutrition intake by meeting your food preferences, minimizing any food restrictions, and providing nutritional supplements as necessary.

The dietitian teaches group classes on nutrition three times a week, which you can attend before you go home. Topics that will be discussed include:

• Food choices for heart healthy eating and diabetes
• Heart healthy portion sizes
• Tips for heart healthy shopping and eating out

Written information will be provided, and the dietitian can be contacted by telephone after hospital discharge if you have further questions. The dietitian is also available to provide individual bedside teaching upon your request. Ask the nurse if you wish to speak with the dietitian during your hospital stay.

It is not uncommon to get the blues and become emotionally upset easily after any major surgery. It is related to:

• Anaesthesia
• Medications
• Lack or loss of sleep
• Stress of surgery

These feelings may come and go over a period of time and blues normally pass by the end of the usual recovery period (6-12 weeks). Do not be ashamed. When you get your strength back you will find you are feeling better emotionally as each day passes.

Discharge teaching is available in the form of counseling, a class with the physiotherapist and dietitian, and also written material to take home as references. You may be referred to the Toronto Rehabilitation Centre or given information about a centre close to your home for cardiac rehabilitation.

Before you leave the hospital someone will talk with you about what you should do in your first weeks at home. It is a good time to:

• Take frequent naps
• Build up your strength slowly
• Plan what you can do one day at a time

It is important to follow your doctors' instructions when taking your medications. Any medication not prescribed for you upon your discharge should be stopped unless you have been told otherwise by your doctor. If you are having side effects from your medication contact your family doctor.

Before discharge, ensure you have your doctor's letter, appointment cards, and prescriptions.

You will be given appointment cards but you must call for your own appointments.

• Family doctor - 1 week after your discharge
• Cardiologist - 4-6 weeks after discharge
• Surgeon - as instructed at discharge

The Cardiovascular Service also runs follow-up programs to assess the results of your surgery. You will be contacted by the Cardiovascular Database Manager or the Prosthetic Valve registry concerning follow-up appointments.

A normal recovery period when you are home is 6-12 weeks. You may experience a dramatic relief from angina and therefore feel like doing your usual activities. Relax. Do not rush.

It is important to maintain a healthy lifestyle to bring about the best health possible for you in the future. Continue to reduce your heart risk factors.
If you have any questions that you wish to discuss with any of the team members once you have gone home, please contact us.

Learn more about the what to expect during the recovery period