Information for those undergoing heart surgery Information for patients Cardiac Surgery
Compiled by the Multidisciplinary Team, Chesterman Unit, Northern General Hospital, Sheffield. page 2 of 20
Introduction Heart surgery is now very common with many thousands of people having this type of operation. This booklet aims to: reduce some of the anxiety about your heart operation, by giving you and your family information, advice and support. help you understand certain aspects of your care before, during and after surgery. It will trace your course from the initial clinic appointment with your surgeon, through admission to hospital for the operation, your stay in intensive care, recovery and discharge home. It is hoped that this information will reinforce that given to you by all members of the team. However, as everybody is different, your stay in hospital and your care may vary. If you think of any questions you may wish to ask, just write them down on the blank pages at the back of the booklet and don't hesitate to ask them. page 3 of 20
Your outpatient appointment The surgeon will have discussed with you the benefits and risks of having heart surgery. You may have been told how long you can expect to be waiting for your operation. If your surgeon brought any of the following to your attention it is important that they are dealt with before your surgery: Dental health - please read the letter/leaflet that you have received. Lose or gain weight - Information and support is available from your own GP / practice nurse. Give up smoking - Information and support is available from your own GP / practice nurse. Whilst waiting for your surgery, please make sure you inform your surgeon's secretary: of any changes to your address or telephone, even if temporary. if you are going on holiday, or will be away from home at any time whilst on the waiting list. If you have any worsening heart symptoms or changes to your medical condition during the waiting time, you should see your own family doctor (GP). page 4 of 20
Pre-operative education and information session An appointment will have been made for you and a family member / friend to attend a session which will help you to prepare for your surgery and recovery. This covers a lot of practical advice about your hospital stay and recovery at home afterwards. Your consultant and hospital staff recommend that you attend this session. Below is some information which you may find useful in preparing for this session. Anything that needs more effort than lifting a kettle of water should be avoided for the first 6 weeks to allow the breastbone to heal. This specifically applies to: moving yourself with the help of your arms, for example getting out of a chair or the bath. driving carrying heavy items, including shopping vacuuming You will also be required to wear strong elastic support socks for the first 6 weeks after surgery (unless advised not to by a doctor) to help prevent deep vein thrombosis. You will not be able to apply these yourself and will need assistance from someone such as a relative or friend. If you foresee any difficulties, for example you might live alone, or are the main carer for someone, then you should discuss this with the nurses as soon as possible. Please be aware that if you do need practical help from social services there may be a fee to pay for this. It may be that your admission to hospital causes many anxieties for you and/or your family, if you wish to discuss anything the contact number for the nurse specialists is at the back of this booklet. page 5 of 20
Pre-admission clinic Some tests may have already been done, eg blood tests chest x-ray ECG (heart tracing) breathing test At this pre-admission clinic appointment you will be seen by one of the pre-operative assessment staff. They will ask you about your medical history and perform a physical examination. You will also speak to the nursing staff, be measured for anti-embolism stockings, have swabs taken and your urine will be tested. This appointment may take all morning or all afternoon. You are welcome to bring someone with you if you wish. When will I receive information about my date of admission? Patients are usually informed of their admission to hospital and operation date by letter. Your heart surgeon's secretary will also phone you. Where possible you will receive approximately 7 to 10 days' notice of your operation. Some patients will be asked to come into hospital on the morning of their operation, whilst the majority of patients will be asked to come into hospital the day before their operation. You will be informed which of these routes you will take, nearer the time. page 6 of 20
Admission to hospital Whenever you attend the hospital, please bring all the medications you are taking in their original boxes. Your bed may not be available immediately on your arrival on Chesterman 4 (heart surgery ward) and you will normally be asked to wait in the ward day room. Waiting there will not affect your preparation for surgery and be assured that if any of the hospital staff need to talk to you, they will be aware of where you are. A relative or friend is welcome to wait with you. Please be aware that Chesterman 4 has both male and female patients, but you will be looked after in single sex bays or a separate cubicle. The hairs on your skin will be shaved/clipped to decrease the risk of infection after your operation. Please do not do this at home as it is a source of infection if you were to cut yourself. If you are admitted the day before surgery then you can eat and drink as normal. You will be asked to stop eating and drinking from midnight. If you are admitted on the day of surgery, you will already be fasting. page 7 of 20
Who will I see before my operation? Doctor / Nurse Practitioner The doctor will briefly review your notes and the results from pre-admission clinic, making sure that everything is in place for the operation. If not already done, they will explain your surgery and talk to you about the risks of the operation and ask you to sign your consent form. Anaesthetist The anaesthetist will wish to know details of any previous anaesthetics you have had and any problems you may have encountered, for example nausea and vomiting. They will also prescribe a pre-medication to be given on the morning of surgery; this is an injection or tablets that will help you to relax. They will also confirm the time of your operation on the following day. If you have any worries or concerns about any aspect of your anaesthetic, please don't hesitate to ask. SHOC Volunteer (Sheffield Open Heart Club) These are former patients who make themselves available to answer any questions from a lay person s point of view. This visit is optional and if you would prefer not to speak with them, that is fine. They are also available to speak with you before your admission to hospital if you wish. They can be contacted via the number at the back of this booklet. page 8 of 20
What will happen on the day of my operation? Before being taken to theatre you will be helped into a gown and given your pre-medication. This will make you feel drowsy and relaxed. Because of this it is very important that you do not attempt to get out of bed by yourself. You will be taken to theatre on your bed where the anaesthetist will give you your anaesthetic. Cardiac Intensive Care Unit (CICU) / Theatre Recovery / Progressive Care Unit (PCU) It may be that you remember very little about your stay here but the following information may be more helpful for your visitors. When you are awake you will only be allowed sips of water or ice cubes to start with. Normally, you'll be allowed to start eating and drinking properly the next day. After your operation you will have some drips and tubes; you may or may not be aware of them. The nursing staff will remove these as you make your recovery and most will be gone by the time you leave the Intensive Care area and return to the ward. Once you are asleep in theatre a tube (urinary catheter) is inserted into your bladder to drain urine. This will be removed after a day or so. It is extremely unlikely that you will need to have your bowels opened in the first few days after your operation. The Intensive Care areas can be quite noisy and busy owing to lots of people being around and there are also alarms on much of the equipment. Because of all the activity going on around you, you will feel tired. It can take a few days before you begin to feel a little better. page 9 of 20
The nurses will be giving you pain relief on a regular basis. However, if the pain or discomfort prevents you from coughing, taking deep breaths or moving your legs, then please ask for more pain relief. Some patients may need to stay here longer than others. You and your relatives will be told why if this happens in your case. Visiting the Cardiac Intensive Care Unit / Theatre Recovery / Progressive Care Unit Not everyone wishes or is able to visit on the day of the operation, but you may have visitors if you wish. We advise that visitors are restricted to family or close friends whilst you are in the Intensive Care areas and only 2 at a time at the bed space. Back to the ward When the doctors and nurses are happy with your initial recovery, you will be moved to the ward. Your belongings will be returned from safe keeping to you. Most of the drips and tubes will have been removed by now although you will probably still have the urinary catheter and an oxygen mask in place. The nurses will remove these, along with any remaining drips, usually on the second day after your surgery. Getting up and about The physiotherapist will see you throughout your hospital stay to help with your recovery. At first they will work with you to keep your chest clear, helping you to cough and deep breathe. You will normally get out of bed the day after your surgery and gradually increase your walking distance. Your confidence will increase as you become more independent. If you had problems with walking before your operation, you should let the physiotherapist know. page 10 of 20
It is important for your safety that you have some supportive and comfy footwear. Please bear in mind that your feet may be slightly swollen and new or tight footwear may not fit you at first. Some people find older slippers or adjustable sandals work well at this time. You may be ready to have a bath or shower after a day on the ward. The nurse will help with this until you feel able to do it on your own. You will be assessed going up and down stairs before you go home, unless you were unable to manage the stairs before your operation. This is often a useful 'test' and lets you know how you will cope with any stairs or steps at home and also requires slightly more effort on your part. Some people feel quite tired and sore after their operation. This is to be expected. However, there is no reason for you to be in pain. Your nurse will be giving you pain relief on a regular basis but if you need it, you should ask for more. If you feel nauseous and sick it may be from the effects of the anaesthetic and the drugs. If this is the case, the nurses can give you something to help take this feeling away. Caring for your wounds Your wound(s) will be covered by a dressing whilst you are in hospital. They will be removed just before you go home. If your wound is healing well, further covering will not be required. You may wash/shower as normal on returning home. Most wounds are now closed using dissolvable stitches. If you do have any stitches or clips that need removing, the nurses on the ward will do this or a district nurse will be arranged for when you are at home. There is more information about wound care in the accompanying booklet What to expect after your heart surgery. page 11 of 20
General information Elasticated (TED) Socks - If you have been told to wear these socks, you will need someone else to put them on your legs for you as it pulls on the chest wound too much. Before you go home please ask the nurses how to put these on correctly. Ladies are encouraged to wear a soft non-wired bra to prevent drag on the chest wound. Once you are up and about you may prefer to wear your own light loose clothing. How will I feel? After your operation you might experience one or more of the following: easily tired / no energy. feel 'fed up' and down. have slightly blurred vision / focus problems. have poor concentration. weird dreams / seeing things (hallucinations). More information about early recovery and what is normal can be found in the accompanying booklet What to expect after your heart surgery. Visiting hours 2.00pm - 5.00pm and 6.00pm - 8.00pm every day. Please note: there is a rest period for patients between 1.00pm and 2.00pm, and meal time between 5.00pm and 6.00pm when there will be strictly no visiting on the ward. Please note: there should be no more than 2 visitors at the patient bedside at any one time. page 12 of 20
Mobile phones Mobile phones can be used in the ward areas but not in the ward bays. They remain the individual s responsibility and the hospital cannot be responsible for any loss or damage. Electrical items For safety reasons, we do not allow you to bring any electrical items into hospital with you. The exception to this is an electric razor. Hospedia The Hospedia system, an individual television, radio and telephone console which sits by the side of each bed, is available on the Chesterman Unit. It provides patients with free access to radio including the hospital s own radio station, a telephone which can be used to make and receive calls and a television which provides one hour of free viewing per day. To pay for use of the system, cards may be purchased from the machines located on most floors of the hospital. page 13 of 20
Before you go home Most people are reasonably independent by the time they are discharged home. You will not feel fully recovered from the surgery at this stage, as this can often take a few months, but you will be able to wash or shower, get dressed, move around reasonably easily and manage a flight of stairs on your own. Some people who have had surgery are ready for home as early as 3 days after their operation, but everyone is different and it might be different for you. On your discharge home you will be given: details of any district nurse appointments or blood tests (if required) 2 weeks' supply of tablets 2 pairs of elasticated (TED) socks to wear for 6 weeks (if required) a letter for your GP to inform them that you are at home following your operation. This should be handed in at the GP practice as soon as possible as it contains details of your operation and the tablets you should be taking. The accompanying booklet 'What to expect after your heart surgery' gives you and your family information about your recovery from this point onwards. Again, there are useful contact numbers at the back. Everyone will progress at different rates. The speed of your recovery can depend upon your level of fitness and severity of your illness before your surgery, the nature of your surgery and your early recovery in hospital. Information about individual surgeon's data can be found at: www.scts.org/patients/ Search under 'surgeon profiles' page 14 of 20
Useful contacts Northern General Hospital switchboard: 0114 243 4343 Chesterman 4 Nurses Station: 0114 271 4337 Cardiac Intensive Care Unit (CICU): 0114 271 4519 or 0114 271 4805 Progressive Care Unit (PCU): 0114 271 5774 Cardiac Theatre Recovery (CTR): 0114 226 6146 Nurse Specialists, Cardiac Rehabilitation (Karen Pearson & Jeanette Douglass): 0114 271 5395 or Bleep 2101 via hospital switchboard Physiotherapists (answerphone only): 0114 226 6173 Occupational Therapy (OT): 0114 271 4667 Medicines Information Help line: 0114 271 4371 Sheffield Open Heart Club (SHOC) (Contacts throughout the region) https://www.bhf.org.uk/about-us/find-bhf-near-you/sheffield-o pen-heart-club-shoc Other useful contacts British Heart Foundation: Heart helpline: 0300 330 3311 www.bhf.org.uk Yorkshire Smokefree Sheffield: 0800 612 0011 (from landline) 0330 660 1166 (from mobiles) NHS 111 (24 hour help line) freephone 111 page 15 of 20
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Sheffield Hospitals Charitable Trust Sheffield Hospitals Charity helps improve the care and treatment of thousands of local patients by investing in equipment, buildings, research and people. Our Heart Appeal was launched to support these areas of the South Yorkshire Cardiothoracic Centre and to help save lives across our region. To find out more visit www.sheffieldhospitalscharity.org.uk or call 0114 271 1351. If you would like to make a donation, please make cheques payable to 'Sheffield Hospitals Charity' and send to: Sheffield Hospitals Charity Fund 5720 FREEPOST NAT 15348 Sheffield S10 3ZZ Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more www.sheffieldhospitalscharity.org.uk Registered Charity No 1059043 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD1609-PIL796 v3 Issue Date: October 2016. Review Date: October 2018