Transferring from the Intensive Care Unit

The Cardiac Services or Cardiac Stepdown unit is your bridge to going home. You will be spending time improving your coughing and deep breathing, increasing your activity level, managing pain, and preparing you to return home. You will remain in this unit until you are discharged from the hospital. You will be provided with an education booklet about caring for yourself after you are discharged.

What will be monitored in the Cardiac Services or Cardiac Stepdown unit?

  • You will continue to have IV lines, drainage tubes and small wires when you are moved to the step-down unit.
  • Your blood pressure, heart rate, oxygen level and temperature will be monitored every four hours or as needed.
  • Your heart rate and rhythm are monitored at all times.  It is not uncommon to have an irregular heart rhythm, called atrial fibrillation, after surgery. If your heart goes into atrial fibrillation, medications will be given to help try to regulate your heart rate. 
  • Blood sugar sticks will be monitored frequently even if you are not a diabetic. It is extremely important to keep your blood sugar in a normal range to help with healing and prevent infection. Insulin will be given as needed if your blood sugar is higher than normal.
  • Nurses will monitor and clean your incisions daily.
  • Lab work will be drawn and you will be weighed early in the mornings.

When will I get my chest tubes and pacing wires removed?

Your chest tubes may be removed the second day after surgery. You will receive something to ease the pain because this may be uncomfortable at first.  But, after the chest tubes are removed, you will be able to move and breathe easier.

Pacing wires will be removed closer to the date of discharge. Expect to be on bed rest for a specific time period such as 1-2 hours.

What activities will I do in the Cardiac Services or Cardiac Stepdown Unit?

As mentioned, the more active you are, the better your recovery will be.  You will be sitting in a chair for all of your meals with a specific diet ordered by your surgeon.

Your activity will progress from sitting in a chair, to assisting with your bath, to walking in the hallway three to four times a day.  Nurses, physical therapists, cardiac rehab nurses, and occupational therapists will assist with your activity. Do not attempt to get out of bed or walk by yourself – ALWAYS CALL BEFORE YOU FALL!

You will be encouraged and expected to use your incentive spirometer (breathing machine) and perform deep breathing and coughing exercises every hour. This will help clear your lungs so that you will have a decreased risk of getting pneumonia, improve your breathing, and prevent you from going home with oxygen.  You may require oxygen after surgery for a specific length of time at home; however, this requirement is usually temporary.

When can family and friends visit?

Your family may visit you at any time during normal visiting hours when you are in this unit. In most cases, someone can spend the night in your room if you or they wish to. We do suggest that no more than two people visit at one time because you need time to rest between the activities you will be involved in throughout the day.

What is an incentive spirometer?

Incentive spirometry is a method of deep breathing to help you inhale slowly and deeply to to maximize lung capacity.  Deep breathing and coughing exercises will help open your airway, expand your lungs, and clear mucus.  These exercises may help prevent lung complications such as pneumonia or respiratory infection.

You will be using your incentive spirometer after surgery and when going home.

How do I use my incentive spirometer?

  • Sit in an upright position.
    • Bed: Raise the head of the bed until you are in a sitting position.
    • Chair: Sit with your back supported and feet on the floor.
  • Place the mouthpiece of the spirometer firmly between the lips and take a deep breath in. Hold your breath for 3 seconds.
  • Exhale slowly.
  • Cough during and after each session.
  • Use your heart pillow or hugger to protect your incision when coughing.
  • Use your incentive spirometer for 10 slow and deep breaths every hour (while you are awake) in the hospital. When discharged, continue breathing exercises 2-3 weeks at least five times a day.

Your nurses and respiratory therapists will set your individual, specific volume goal.

How do I deep breathe and cough?

  1. “Hug” your heart pillow or heart hugger firmly against your incision.
  2. Breathe in slowly through your nose counting to two.
  3. Breathe out slowly though your mouth.
  4. Breathe deeply several times. Open your mouth and cough three times as you breathe out.