Contents: Welcome Varicose veins Our expectations Preadmission clinic The day of your operation In preparation of going home Discharge advice following varicose veins surgery Contacts Varicose Veins Welcome At Perth Vascular Clinic we understand that being in hospital can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients needs. It explains briefly the events that may occur during your visit and the things to expect when you are discharged from the hospital. It is, however, only a guideline as each person may require differing treatments. If you have any questions about your treatment please ask Dr Garbowski, Perth Vascular Clinic Staff or hospital nurses following your admission. SJOG Subiaco pastoral care team offers a caring support network to all patients. The dedicated embers of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 1
Varicose veins Varicose veins are veins that have become enlarged and twisted. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That s because standing and walking upright increases the pressure in the veins in your lower body. For many people, varicose veins and spider veins a common, mild and medically insignificant variation of varicose veins are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes the condition leads to more serious problems. Varicose veins may also signal a higher risk of other disorders of the circulatory system. Expected length of hospital stay The day following your surgery you will be prepared for discharged at the pre-arranged time. Usually this occurs during the mid-morning but always depends on patient s condition and can be delayed if necessary. Our expectations Prior to discharge: you will have minimal wound ooze your pain will be well controlled you will tolerate diet and fluids you will be able to mobilise freely. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 2
Preadmission Service St John of God Hospital in Subiaco provides a preadmission service. You will have received this service in any of the following ways: from the specialty clinic to the preadmission clinic at the preadmission clinic over the phone(most commonly). The preadmission service gathers information, initiates investigations to prepare you for your surgery, provides information regarding your specific operation and identifies discharge needs. Things to do before you come to hospital It is important for you to have completed all the tests which Dr Garbowski has ordered prior to coming to hospital. Please bring X-rays, any ECG reports and all your blood test results with you to hospital along with your medications. Your medications need to be in their labelled containers or Webster pack. If you have are taking any blood thinning or arthritis medications please follow instructions provided by Dr Garbowski, Perth Vascular Clinic staff, pre-admission nurse or pharmacist. Sometimes it is important that these medications be stopped in preparation for your surgery. It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. Please follow instructions provided by your doctor or preadmission nurse. It is important for you to shower and dress into clean clothes prior to coming into hospital. No skin products such as deodorant, perfume, body lotion, powders are to be used following your shower. St John of God Hospital in Subiaco is unable to accept liability for losses. It is highly recommended that you leave your valuables at home for safety and security purposes. Please bring essential items only. While the hospital does not take responsibility for your personal belongings our Security Office will hold any lost property that is handed in. Read this booklet and have it ready to bring with you to hospital. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 3
The day of your operation Before your operation When you come to hospital proceed to the Day of Surgery Admissions Unit, on level 2 at SJOG Subiaco, where you will be admitted and prepared for surgery. At different times throughout your hospital stay and as a safety requirement, staff will request confirmation of your name, DOB, allergies and procedure. The assessment form completed at the pre-admission service will be reviewed and your health team will plan for your individualised care while in hospital and any support you may require after discharge. Your nurse will also check that your consent form has been signed or organised to be signed before your operation. Your nurse will discuss with you any concerns that you may have about your surgery and needs that you may have when you are discharged. It is an Infection Control requirement at SJOG Subiaco that you will be required to have swabs taken if you have transferred from, or worked at another health care facility, or you have had previous resistant infections. This is usually identified and attended at the pre-admission clinic. Your admission nurse will check if these three swabs have been taken and will complete the test if there are further swabs required. The medications you brought to hospital will be collected. These will be returned to you when you leave the hospital. Please inform the nurse admitting you if you have been taking any blood thinning or arthritis medications prior to your admission, as these may have needed to be stopped before your operation day. It is usual for you to continue taking your other prescribed medications. You may walk as much as you like. Please notify staff if you leave the ward. You will have an identification armband applied. This will stay on for the duration of your stay for identification and safety reasons. For your safety, if you have allergies, you will have a red armband applied. Your nurse will take a set of baseline observations (temperature, pulse, blood pressure etc), weigh you and may ask you to provide a urine sample for routine testing. Your groin and leg will need to be clipped prior to surgery to reduce infection. You will be asked to dress into theatre clothing. You may be prescribed a medication before you go to surgery. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 4
Before you leave for theatre a pre-operative check list will be completed with you by your nurse. This check-list will be repeated in the operating reception area. Apart from your wedding band, no jewellery or metal is to be worn to theatre. You will be escorted to the operating suite. Your varicose veins are marked by Dr Garbowski before you enter the operating theatre. Please indicate any special problem veins, or unanswered questions at this time. It is important to practise your breathing and leg exercises which you will need to commence once you have woken up from your operation. Breathing and circulation exercises The following exercises help prevent complications such as chest infections and blood clots in your legs. You should do these every hour that you are awake while resting in bed. Breathing Exercises: Take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs. Circulation exercises: Firmly move your ankles up and down to stretch and contract your calf muscles. After your operation You will stay in the recovery room within the theatre suite after the operation while you waken from the anaesthetic. You will be transferred on your bed to your room. Frequently patients are admitted to Ward 71 where they will remain until their discharge home. Your nurse will take frequent observations of your vital signs (e.g. pulse) and dressings for several hours after the surgery. These will become less frequent as you recover but remain regular until you leave hospital. Your legs will be bandaged from the toes to just below the groin. Your nurse will observe and monitor these bandages for wound ooze. You will be resting in bed immediately after your surgery. When you are ready to get out of bed for the first time following your surgery it is important that you have assistance. After overnight stay on the ward, your nurse will assist you to have a wash in the morning prior to discharge. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 5
You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated. If you have pain or nausea, please tell your nurse as there are medications which can be given to relieve this. It is important to be comfortable. The drip (IV) is necessary to maintain your fluid intake. This will be removed when you are tolerating adequate amounts of oral fluids. In preparation of going home Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you. Discharge information will be given to you and your nurse will discuss this with you. If you have any questions, please do not hesitate to ask. A full assessment will be made in preparation for discharge to ascertain your condition is safe for you to go home. You will be discharge anytime from 10 am on the morning following your surgery. Those picking you up will find you on the ward. For correct location please check with the front desk at the hospital main entrance ( Salvado Road entrance): It is still recommended to perform deep breathing, coughing and leg exercises while you are resting in bed. You will recommence your normal medications. Please tell the nursing staff if you have any pain so that they may give you medication to help relieve it. Your dressings will stay intact until you see Dr Garbowski or Vascular Unit Resident Medical Officer. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 6
Discharge advice following varicose veins surgery What to expect You may have some pain in your legs, for which you can take simple pain relieving medications e.g. Paracetamol, no more than eight tablets within a 24 hour period. Your leg or legs will be fitted with Graduated Compression Stockings from the toes to just below the groin for a period of 14 days. After five days, you will be able to remove any adhesive dressings applied in the hospital as well as small adhesive tapes (SteriStrips) securing surgical incisions. In majority of patients there are NO sutures that need to be removed. This may vary, depending on type of your surgery and you will be advised if any sutures require removal. Some bruising is normal. You have been advised to wear elastic support stockings. These should be worn during the next 2 weeks except when you have your shower and when you go to bed at night. Your follow up appointment with Dr Garbowski should have been organized at the time of your last consultation. It normally takes place between 4-6 weeks following your surgery. If unsure please contact Perth Vascular Clinic staff on 08 9382 9100 or via email at: reception@perthvascularclinic.com.au What to avoid sitting with your knees bent instead, sit with you legs elevated and flex your feet at regular intervals sitting with your legs crossed at the knee driving until you are pain free and confident to be in the full control of your vehicle lifting anything heavy for four weeks pushing or dragging anything heavy for four weeks wearing constrictive clothing on your legs eg. tights or garters. What to do take short frequent walks, increasing the distance gradually keep the dressings dry. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 7
Contacts Please contact either your Perth Vascular Clinic on 08 9382 9100, your General Practitioner (GP); the SJOG Subiaco Hospital on 08 9382 6111 (ask for Ward 71 Nurse Manager or After Hours Nurse Manager); or any hospital Emergency Department if you experience any of the following after your procedure: increased pain unrelieved by simple pain relieving medications e.g. paracetamol you develop a fever you have a discharge or blood coming from your wounds, particularly in the groin you have any other symptoms of infection. This may include excess redness around the wound site which is hot to touch. St John of God Hospital in Subiaco is one of Perth s leading health facilities for insured patients. It is built on a foundation of clinical excellence and a commitment to safe, compassionate care, that is: quality focussed technologically advanced customised to patients needs and lifestyles. For more information about your surgery please telephone Perth Vascular Clinic on 08 9382 9100 during business hours or Switchboard of St John of God Hospital in Subiaco on 08 9382 6111. If necessary you can discuss your concern with Ward 71 nursing staff or After Hours Nurse Manager who will contact Dr Garbowski if necessary. Varicose Veins Patient Information Booklet from Perth Vascular Clinic Page 8