Immediately after surgery, you will be taken to the intensive care unit and cared for by a highly-trained group of nurses working under the direction of your heart surgeon and their physician assistants. Your team of nurses, nursing assistants and respiratory therapists will provide care for you while in the intensive care unit. Your surgeon will evaluate you daily and be available to speak with you and your family.
Ventilator (breathing machine)
You will be on the breathing machine (ventilator) until you are awake enough to have the breathing tube removed. The breathing machine is attached to a tube in your mouth that goes down your windpipe to help you breathe. This tube interferes with the vocal cord function, and you will not be able to talk while this tube is in place. Occasionally this tube also makes you feel like you are going to cough, which can be uncomfortable for a few minutes.
When you are stable and the nurse and respiratory therapist feels that you are ready, tests will be done on the breathing machine to determine if you are ready to come off of the ventilator. The tests make you take in a deep breath, and blow air out, all while still having the tube in place. This is to check if you are ready to breath on your own. The nurse and/or respiratory therapist will encourage you to cough and take deep breaths to ensure you are getting rid of any extra mucus.
How will I communicate my needs?
You may be fearful being on the breathing machine because you will be unable to speak. The nurse will be close by at all times. The nurse can read lips and ask you specific yes or no questions such as “Are you in pain?” The nurse can also monitor your heart rate, blood pressure, and facial expressions as measurement of pain and anxiety.
Will I hurt?
You will experience pain after surgery; however, every person is different. The doctor will order pain medication as needed to help manage pain. The pain medication will not completely take the pain away, but walking and breathing exercises will help work out the pain.
Tips About Pain Medication:
- Do not wait too long to ask for your pain medication. Let your nurse know that you are hurting, where you are hurting, and the severity of pain.
- Pain medication can cause an upset stomach when taken on an empty stomach. Take with food.
- Keep WALKING and MOVING.
- Use your incentive spirometer (breathing machine) every hour.
- Use a pillow to hold firmly against the incision.
- Use the following scale to help guide your pain.
Can I have anything to eat or drink?
After the breathing tube is taken out, the nurse will allow you to have small amounts of ice chips to evaluate your swallowing. Once it is safe to eat and drink, you will be started on clear liquids (which consist of Jell-O, popsicles, coffee, tea, juices, and some chicken or beef broth soup). The nurse will let you know the amount of fluid you can have because you may be on a fluid restriction.
Am I going to be connected to any monitors?
After surgery you will be connected to special equipment to monitor your blood pressure, heart rate, heart pressures, and other numbers that the physicians and nurses evaluate to care for you after surgery. The machines often make beeping sounds or noises, which is normal. You will also be connected to IV pumps and tubing. For your own safety and care do not pull at any tubes or wires.
What is a chest tube?
After surgery you will have one or more tubes inside of your chest cavity that were placed during surgery. These tubes drain excess air and blood from the chest. They are connected to a box-type container, called a Pleur-evac. At times the Pleur-evac may make a bubbling noise. The tubes remain in the chest until the surgeon feels comfortable that they can be removed.
Why do I have a pacemaker?
You may also have small wires in the lower portion of your chest attached to a pacemaker. These are called pacemaker wires and are inserted while you are in surgery. These wires are inserted because sometimes the heart beats slowly after surgery and needs a temporary pacemaker to ensure a healthy heart rate.
Will I have a catheter?
Yes, you will have a catheter in your bladder to measure your urine. You may still feel the sensation of having to urinate; however your nurse will remind you that this tube is still in place. The catheter will be removed at such time when your surgeon feels it is appropriate.
What is in my wrist?
You will have a small tube in the artery in your wrist called an “arterial line”. This line monitors your blood pressure, and assists with drawing blood for labs, glucose checks, and oxygenation monitoring. When the arterial line is removed, the nurse will hold pressure on your wrist and then a bandage will be applied on your wrist.
Why am I on insulin? I’m not a diabetic.
You may require insulin after surgery. The stress of surgery and current medications may make your blood sugar level increase, even if you are not a diabetic or do not have a history of diabetes. Because of how often the nurses have to check your blood glucose level, you may find it hard to sleep for long periods of time.
When will I get out of bed?
After the breathing tube is removed and your breathing is stable you will be assisted to sit on the side of the bed. We will help you to move to the chair for all meals when you are ready. It is extremely important for you to move and increase your activity as soon as possible. The cardiac rehabilitation nurse or physical therapist will show you how to increase your activity starting the day after surgery.
How long am I going to be in the ICU?
Most patients remain in the Critical Care unit approximately 24-48 hours. The time in Critical Care will vary depending on your needs, progress, and medications that you require after surgery.
What happens before I leave ICU?
Although a few of the monitoring devices will be removed before you are ready to leave the Critical Care unit, you may still have a large IV access remaining in your neck area. It is very important not to touch this IV or attempt to remove the dressing. Your heart will still be monitored with a small box that is able to fit inside your gown pocket.