The cardiac surgical intensive care unit (CTCU) provides a high level of medical monitoring that is necessary immediately after heart surgery. Usually there is one nurse for every two patients. You will be in CTCU the day of your surgery and probably transfer out of the intensive care a day or two after surgery.

An intercom/phone is located in each waiting room on the second floor in the northwest corridor near the unit and also directly outside of the intensive care unit. Your family must use the phone before each visit.

Information is provided by the intensive care unit regarding visiting policies and hours. The patient's designated contact person may call CTCU anytime, day or night, to check on your progress. Phone numbers for CTCU, pay phones and lounge phone are also provided.

IV's:
The nurse may insert an IV for antibiotics. IV fluids may be ordered prior to surgery.

Heart Monitors:
The heart monitor gives continuous readings of your condition. The heart monitor leads are attached to the skin with small adhesive pads. Portable heart monitor boxes fit into a pocket of the patient gown.

Heart-Lung Bypass Machine:
heart surgery is often done with use of the heart-lung machine. This machine pumps blood for the heart and adds oxygen for the lungs while the heart surgery is being done. When surgery is finished, the heart resumes its work of pumping blood throughout the body. Sometimes your surgery can be performed off the heart-lung machine. Your surgeon will determine what is best for you.

Ventilator:
Waking up after surgery is a gradual process. Your family may notice the presence of many lines or tubes. You will have a breathing tube connected to a ventilator to help you breathe during surgery and may remain in you for a short period of time. Try to relax and let the machine breathe for you. You will not be able to talk while the tube is in place. Medication is often used during this time to help you remain comfortable and calm until the tube is removed.

Temporary pacer wires:
Temporary pacemaker wires may be attached to your heart as a precautionary measure. These are "fine wires" that come through the skin just below the chest incision and can easily be attached to a pacemaker if needed. If not needed, they will be covered with a dressing until removed.

Urine collection catheter:
A catheter is placed in your bladder, after you are asleep in surgery, and allows close monitoring of kidney function. It is removed 1-2 days after surgery.

Chest drainage tubes:
Chest drainage tubes will be placed in your chest near the bottom of your incision during surgery. These tubes drain the fluid that collects in the chest after heart surgery. They are usually removed 1 to 2 days after surgery.

Elastic stockings:
During the recovery phase, some patients may need to wear elastic stockings to increase blood flow and reduce swelling in the ankles. Your physician will decide what is best in your case.

Waking up after surgery is a gradual process. Your family may notice the presence of many lines or tubes. Remember, these were used in surgery and remain for a relatively short period. Refer to "equipment" section for specific details.

When the breathing tube is no longer in place you should ask for pain medication whenever you need it. A successful recovery depends on your being comfortable enough to cough and breathe deeply and participate in cardiac rehabilitation activities.

Some patients find it helpful to take pain medication approximately one hour before cardiac rehab exercises begin.

Medications may be given to help "get rid" of extra fluid. It may be necessary to limit the amount of fluids you take the first day or two after surgery. Your family should check with the intensive care nurse before giving you any fluids.

Although you are able to resume a normal diet, you may find that you don't have much of an appetite. Anesthesia and some medications temporarily affect the taste buds and the appetite.

Anytime general anesthetic is used, the lungs collect extra fluid. After surgery, your lungs need to be re-expanded and the air sacs opened. You will begin using your incentive spirometer as soon as you no longer require the ventilator.

Use the spirometer 10 deep breaths every hour while you are awake. Consistent, faithful use of the spirometer will allow the oxygen to be discontinued sooner. You will need to continue to use the spirometer for at least a month after you go home.

Coughing and deep breathing exercises are very important after surgery. Sore chest muscles cause you to take shallow breaths. A "Heart Hugger" is provided for you and it is highly recommended. It is very helpful in supporting your chest.

After surgery, walking and the level of self-care will be increased progressively. You will be encouraged to be up in a chair and walk. Both activities assist the lungs to re-expand as well.

You will be assisted out of bed usually by the next morning after surgery. Getting out of bed is easier if you raise the head of the bed, move closer to the edge, and roll to your side. Swing your legs to the floor and sit up side-ways at the same time. You may use the side rails for support, but you should never pull yourself straight up using the side rails. Sit on the side of the bed for a few minutes to make sure you are not dizzy when you stand up.

You need to sit in a chair for each meal.

To help the staff determine when you are ready for discharge, it is important that you do as much of your own care as possible.

Most incisions are in the middle of the chest. They start approximately 2 inches below the base of the neck and end where the sternum (the bone that connects the ribs) ends. Usually there are no stitches or staples on the outside of the wound. There are two "stab wounds" that are approximately 1 inch long beneath the larger wound. This is where the chest tubes were placed.

Patients who have bypass surgery will have leg wounds as well. These incisions are commonly 3 to 4 inches long and on the inside of the leg. There may be 2 or 3 of these incisions on the leg. The leg incisions may be closed with staples or stitches that are under the skin. Commonly the leg will be discolored due to the trauma involved in harvesting the vein.

You will be transferred to 2 West when you no longer need intensive monitoring. Your care will be provided by registered nurses, licensed practical nurses, and nursing assistants working as a team. The focus of your care on 2 West will be to increase your independence in preparation for going home.

The physician, nurses, and cardiac rehabilitation staff work as a team to determine when, and if, cardiac exercise classes are appropriate for you.

The cardiac rehab staff will introduce you and your family to the exercise program. You will begin with assisted walking and may progress to low level arm and leg exercises. The exercises are designed to help improve circulation and lessen the discomfort of sore chest muscles. They are listed in your cardiac manual.

Cardiac rehab education will either be done individually or in the classroom that is located on 2W.

Rest periods, before and after exercise are recommended. You should rest in bed a half hour before and after you exercise.

If you are on oxygen treatment, the cardiac rehab staff will monitor the oxygen in your bloodstream before, during and after activity until the treatment is discontinued.

After discharge, many patients participate in Phase II and III of the Cardiac Rehabilitation Program. This program consists of increased, monitored exercises, along with educational classes. These sessions include discussions about risk factor modification, such as smoking cessation, controlling blood pressure, diet modification, coping with stress, exercising on a regular basis, watching your weight and controlling diabetes. Your doctor will refer you if it is determined to be appropriate for you.

If you, or your family, have any concerns about your home care needs, discuss this with your surgery educator or nurse as early as possible. Someone from social services may be contacted to help you make arrangements.

Medications:
Written discharge instructions will be provided by your nurse and doctor to guide you in your continued recovery at home. Your medication list will be reviewed and your doctor and nurse will provide you with instructions and a written medication schedule for home use.

Activity:
When you go home, you may feel tired at first. Gradually increase your activities and slowly resume a normal pace. If you feel tired, rest in order to let your body heal. Constant bed rest is not, however, a good practice, as it significantly lengthens recovery time.

Progressive Walking:
you should start with 5 minutes of "start to finish" walking the first day, and increase at least 1 minute each day until you are able to walk a 30 minute session each day. (See risk factor section for more information on the benefits of walking)

Assistance:
Someone should be with you portions of each day to assist you. Keep visitors to a minimum and avoid coming into contact with persons who have colds or flu for at least the first two weeks after you return home.

Lifting:
no lifting anything greater than 10 lbs for the 1st month.

Driving:
do not operate motorized vehicles for 1 month. Do not sit directly behind an airbag for 1 month. Please use a seatbelt.

Wound Care:
wash incisions with soap and water daily. Liquid soap is preferred. (See "when to call the Doctor" for further information.)

Refer to your (red) cardiac manual for more information about things you can do and shouldn't do immediately after you go home.

A temperature of 100 degrees for more than 2 days

A weight gain of 3 lbs from one morning to the next morning or 5lbs in a week

Redness, swelling, increased soreness or drainage from your incision. Some clear drainage from the leg is normal, but please report any drainage from your chest

Chest pain like you had before surgery

If you have questions about your medications

Or have changes in your heart beat that cause your heart to beat too fast or too slow or to skip around.

The staff at Kettering Hospital wants your stay to be as pleasant as possible.