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Cardiac Surgery Pre-Operative

Posted Tuesday, 31 December 2024

Date issued: December 2024

For review: December 2026

Ref: A-668/AMRM/Cardiology/Cardiac Surgery Pre-Operative

PDF: Cardiac Surgery pre op.pdf [pdf] 457KB

Heart Surgery

When you find out that you need heart surgery it is natural to feel overwhelmed and nervous, although a heart operation is still major surgery, techniques have moved on so much that it is now considered a routine operation. In the UK tens of thousands of people undergo heart surgery every year. At Derriford Hospital we conduct coronary artery bypass surgery, heart valve surgery and aortic surgery.

This booklet is for adults who are going to have, or who have just had heart surgery at Derriford Hospital. It explains what to expect before, during and after your operation. Information is also provided on why you are having the operation.

The Heart

The heart consists of two pumps (the left and right ventricles) side by side. The major pump takes blood from the lungs to supply the whole body with oxygen and other vital substances. The blood returns to the second pump of the heart and then to the lungs. Here, the waste products are breathed out into the air and oxygen is breathed in, completing the circuit. Thus, the heart is vital to your existence.

Waiting for your operation

If you have decided to go ahead with the surgery offered, you will be put on a waiting list. Waiting list times vary, most people will have their operation within a few months although some will have their operation much sooner depending on the patient’s condition. Whilst you are waiting for your operation it is important to keep in contact with your GP, informing them if your symptoms change or suddenly get worse.

For patient’s that are prescribed GTN: If you find that you are increasing the number of times you are using GTN, make an appointment to see your GP as soon as possible. It may be helpful to make a note of what, if anything, brought on the angina and if anything relieved it. This will help you give an accurate description of your symptoms to the doctor.

If you have taken 2 doses of GTN as per instructions and:

You are still in pain 5 minutes after the second dose.
Your pain is getting worse.
You feel unwell.

These could be signs you are having a heart attack, and you should call 999

While you are waiting for surgery you can use the time to get yourself as healthy as possible. There are several things you can do such as:

If you are a smoker, quit smoking. Smoking increases the risk of complications and can affect your breathing in the days after your surgery.
Eat a balanced diet, and aim to lose weight if you are overweight, reduce alcohol intake.
Keep as physically active as your condition allows.
Practice mindfulness and meditation to reduce stress and anxiety.
Prioritise sleep

Visit your dentist to make sure your teeth and gums are as healthy as possible to reduce the risk of infection. Poor dental hygiene can introduce bacteria into the bloodstream which can cause an infection called endocarditis. This is especially important if you’re having a heart valve operation. If you are struggling to get an appointment with your dentist let them know you are awaiting heart surgery, and they should prioritise an appointment for you.

If you feel unwell when you have a date for surgery with a cold, chest infection or other infection, please contact your consultant’s secretary.

Pre-operative Assessment

You will be asked to attend a pre-operative assessment a few weeks before your surgery. This is to ensure that you are optimised for surgery.

A team of Surgical Care Practitioner’s (SCPs) conduct these assessments. Surgical Care Practitioners are senior healthcare professionals working at an advanced clinical level to provide surgical and clinical care throughout your patient journey. They work independently in theatre to harvest veins and arteries for coronary artery bypass surgery and assist the surgeons throughout your operation.

During your pre-operative assessment, the SCP will review your history ensuring all investigations are complete for surgery to take place.
Review your medications identifying any changes which need to be made before surgery.
Assess for any potential anaesthetic problems and liaise with a consultant anaesthetist if required.
Discuss the surgery and post-surgery phase ensuring you have a good understanding of the process.
Answer your questions and address any concerns you, your family, carers or friends may have.

The tests you’ll have include:

Blood tests.
Routine MRSA/MSSA swabs.
Electrocardiogram (ECG) and Chest X Ray.

Depending on your assessment you may also require a Pulmonary Function Test, a scan of your neck arteries or an Echocardiogram.

If there are any abnormal test results that need further investigation the SCP will contact you. You can also contact them if you have any clinical questions before you go into hospital.

Surgical Care Practitioners Office: 01752 439180/439181/439182

Hospital Admission

For planned surgery, you may be admitted the day before, or the day of your operation. On your admission day please follow instructions according to your admission letter. Due to the nature of cardiac surgery, sometimes there are emergency operations that must be done at short notice. This means unfortunately, there is a possibility we may have to reschedule your surgery date. Please be reassured we try our best to avoid cancellations, but if this happens you will be given a new date as soon as possible.

Please do not have anything to eat or drink from midnight the night before your procedure.

Your relatives/friends/carers can stay at Hearts Together which is a short walk from the hospital (5-10 minutes).

For information and accommodation charges please call Hearts Together: 01752 315 900

Please bring one bag containing the following:

Tablets or medicines that you take at home.
If you have been prescribed treatment for MRSA or MSSA please start this 48 hours before your operation and bring the treatment to hospital.
Toiletries including non-scented shower gel, toothpaste and toothbrush.
Dressing gown, pyjamas that button at the front.
Slippers which are a loose fit or one size up to allow for feet swelling (make sure they have a good grip).
Loose comfortable clothes to go home in.
Supportive non wired bras as appropriate.
Book, headphones, iPad if desired. Please note that the hospital takes no responsibility for any personal items that are lost or stolen.

Where do I go when I get to hospital?

Please follow the instructions given to you on your admission letter. Whilst we try to accommodate all patients on Clearbrook ward the day before surgery, on occasion a bed may not be available. In this instance we may require you to be admitted the day of surgery. Please wait for a phone call so that we can confirm we have a bed before you start your journey. If you live locally, we can give you the option to return home. Arrangements will be made with you to do this.

Where do I go when I get to the ward?

As soon as you arrive on the ward, go straight to the nurse’s desk. All your tests and information will have been collected at your pre-assessment appointment, but we still need to confirm the information remains the same.

We will also want to take your blood pressure, pulse and temperature. We will re-weigh you and take a urine sample.

Once admitted a member of the surgical team and the anaesthetist will come and see you in preparation for your surgery.

What else do I need to know?

It is important that you eat and drink normally on the day before your surgery. We only ask you to not have anything to eat or drink from 12 midnight that day.

Visiting hours are:

Clearbrook ward: 8am to 8pm

Torrington Ward CICU and CHDU:

10am to Midday

3pm to 6pm

Skin Preparation prior to surgery

It is important that your skin and hair are clean before surgery, this reduces the risk of infection. You will be asked to have a shower on the morning of your operation, with non-scented soap before putting on a theatre gown.

Please do not shave prior to your operation, we will remove hair from the chest/arms/legs/groin as needed once you are asleep using clippers.

What will happen the day of my operation?

You will be asked to have a shower on the morning of your operation with a non-scented soap and put on a theatre gown.

The theatre staff will come and collect you from the ward and take you in your hospital bed to the anaesthetic room, this is adjoins the theatre. You will then move onto a different bed. Once you’re in the anaesthetic room the anaesthetist will put a small needle into the back of your hand so that you can receive the anaesthetic medicine that will send you to sleep and a small tube into an artery in your wrist for continuous blood pressure monitoring throughout your procedure. Once you are asleep a line is inserted into a vein in your neck for giving medications throughout the procedure, and a catheter is inserted into your bladder.

What is it like on the Cardiac Intensive Care Unit and the Cardiac High Dependency Unit? (CICU and CHDU)

CICU is a twelve bedded unit, CHDU is a smaller six bedded unit. Each patient has their own nurse to look after them. You will be observed closely using special machines. Because of the equipment used and to help us monitor patients after surgery, it is a mixed sex unit. We aim to always maintain privacy and dignity.

Torrington Ward CICU and CHDU

10am to Midday

3pm to 6pm

Please note that we only allow two visitors per bed space

What is Delirium?

Delirium is a name for acute confusion. The patient who is delirious is often experiencing a world that makes no sense to us but is very real to them. For instance, they may:

Not know they are in hospital.
Experience visual disturbances.
Disorientation

Whatever it looks like, delirium is a sign that the brain is not working properly because the patient is ill and still recovering.

Where can I get help?

There is more information and links on the website www.icudelirium.co.uk which was set up by Valerie Page, an Intensive Care Consultant at Watford General Hospital.

ICU steps is a charity for ex-ICU patients and relatives. They have information on their website, including a booklet called ‘Intensive Care: A guide for patients and relatives’.

Go to ICU steps an intensive care patient support charity

In summary, delirium is a temporary but very distressing condition for patients and relatives. If you have any concerns about your relative, or would like more information, please talk to our staff and we will do what we can to help.

Post-Op care

The first 24-48 hours following cardiac surgery will be spent in CICU. The nurse and physiotherapist caring for you there will guide you on how much you can do following the operation.

You will have a machine to breathe for you until your anaesthetic wears off and you wake up. This will be removed as soon as possible (usually 2-4 hours after the operation).

You will then be given an oxygen mask. You may then be transferred to CHDU. If not, you will stay overnight on CICU.

You will be made aware at pre-assessment that you will have 2-3 chest drains which are sutured following your surgery. These are tubes that drain fluid into a bottle and help your chest get back to normal after your operation.

You will have some temporary pacing wires to control any arrythmia complications post-surgery and you will be attached to a heart monitor so that we can watch your heart rhythm.

There will also be equipment so that we can give you fluids and medicines intravenously.

You will also have a urinary catheter which will drain your urine.

Pain relief will be given to you by the nurses until you are awake

Once awake you will be able to manage your own pain relief by using the Patient Controlled Analgesia (PCA).

Your pain can be controlled by using a handset with a green-lit button on it. When you press the button you will get a measured amount of painkiller. The machine will only allow you to have a certain dose so that you cannot overdose.

Physiotherapy following heart surgery is very important. After your surgery, your lungs are less inflated, and you may have more phlegm.

It is important that you aid re-inflation of your lungs and clear any phlegm to avoid breathing problems. This is done by early mobilisation (i.e. getting out of bed and walking) and deep breathing exercises.

Please remember to use your PCA.

Breathing exercises as soon as I wake up

Position yourself comfortably; it is important that you are not slumped in bed to do these exercises. The best positions are either sitting upright in a chair or lying on your side.

Keep your shoulders relaxed all the way through the exercises.

Breathe in slowly through your nose, as deeply as you can, hold that breath at maximum inspiration for 3-5 seconds then slowly breath out of your mouth.
Feel your ribs move outwards.
Gently let the air out again.
Breathe deeply like this 4 times.
Go back to breathing normally for about 30 seconds.
Repeat this cycle three times.

Do these exercises every 30 minutes that you are awake.

Leg exercises

Whilst in bed it is important that you move your feet and legs regularly to maintain good blood flow around your body after your surgery. Perform the following exercises every 30 minutes that you are awake.

Move your feet up and down then round in circles 10 times with each foot.
Slide one foot up the bed towards you by bending at the hip and knee; then straighten. Repeat with the other foot. 10 times with each foot.

The next day after your operation we plan to remove most of the machines that have been used to monitor you closely. This will help your recovery and help prevent complications that can happen with bed rest. Plans will be made to transfer you back to the ward.

The staff on the unit are experienced with caring for patients and their loved ones at this anxious time. Please ask if you are unsure of anything.

Once you can eat and drink normally, your pain relief will be changed to tablets. It is important that your pain is well controlled so that you can continue with your physiotherapy on the ward.

If after the operation you feel your pain is not controlled, do not be afraid to ask the nurse caring for you. There are alternative medications we can offer. We will also ask you to score your pain out of 10 where zero means no pain and 10 being intolerable. We will the re-score you to assess the pain relief given. Each person is different.

Some pain relief we give you can cause constipation, so we ask you to be aware of having your bowels open. It is important not to get constipated as we don’t want you to strain yourself when passing a motion.

If you have not opened your bowels or are prone to constipation, please tell your nurse so we can get you back to your normal pattern.

Mobilisation

Early mobilisation after heart surgery is essential for rapid recovery and lowers the risk of complications. You will be given pain relief to help you move freely. On the day after the operation, you will probably sit in a chair and take a few steps on the spot. The following day you will start walking a short distance regularly. The physiotherapist will supervise and encourage you whilst you regain your confidence. The distance you walk will be gradually increased each day. You will be advised on how to pace yourself. You should not feel unduly breathless and should be able to hold a conversation, without gasping.

Stair climbing will be practised before you leave hospital. This is safe for you to do and will help you get back to normal function as soon as possible. If you have any specific questions about exercise or daily activity, please ask your physiotherapist.

Please be aware that University Hospitals Plymouth NHS Trust has a no lifting policy, so we will help you to be as independent as possible with moving.

Nausea and loss of appetite

Nausea and loss of appetite are common after an anaesthetic. Please let your nurse know and we can give you some anti sickness medication. A good diet helps your wounds to heal. If you would like food brought in, that’s okay, but we are unable to reheat food due to the hospitals Food Hygiene Policy.