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North Florida Regional Medical Center
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Open Heart Surgery

This open heart surgery information describes the surgical procedure and the nursing care you will receive prior to, during and after your operation at North Florida Regional Medical Center. It is designed to inform you and your family members of critical information that will help you to prepare and recover successfully from your operation. Although patients having open heart surgery share many of the same experiences, each patient responds differently. Recognizing this and taking into consideration your specific needs and concerns, our staff will care and work with you to achieve a very important goal – a speedy recovery.

North Florida Regional Medical Center is a leader in the state of Florida in diagnosing and treating heart disease. The hospital’s cardiac care program is complete, offering both invasive and non-invasive diagnostic procedures.

Invasive procedures offered are cardiac catheterization, coronary interventions, pacer implants, internal cardiac defibrillator, electrophysiology, ablation techniques and surgery and cardiac rehabilitation.

Non-invasive diagnostic procedures include nuclear imaging, ultrasound of the heart, long-term ambulatory monitoring, computerized electrocardiograms and stress level testing.

Specialists in the cardiovascular laboratories perform more than 2,000 cardiac catheterizations each year. Statistics show our medical center is the most frequently used in this region for diagnosing heart disease. In fact, the first coronary angioplasty (non-surgical procedure to correct blockage in coronary arteries) in this area was performed in our cardiovascular unit.

An average of 10 cardiac patients from Florida and southern Georgia are admitted to the center daily. On average, the open-heart surgery team performs one to two cardiac bypass procedures each working day.

Our Cardiac Rehab Center, a pioneer in rehabilitation programs, individualizes care for patients recovering from heart surgery.

As a cardiac patient at NFRMC, you are under the care of highly experienced and skilled cardiac specialists who believe in individualized patient care.

The heart is a four-chambered muscle about the size of your fist. It pumps blood and oxygen to the rest of the body. Four valves lie between the chambers and act as one-way doors to control the flow of blood. The blood on the right side of the heart travels to the lungs through the vena cava – the largest vein in the body. The blood on the left side of the heart travels to the rest of the body through the – the largest artery in the body.

The heart muscle itself is supplied with blood by two main coronary arteries. These arteries lie on the surface of the heart and divide into smaller branches that send oxygenated blood to every portion of the heart.

Heart valves can be damaged by several factors such as infection or birth defects. These defects or infections can lead to scarring or thickening of the valves – thus affecting the proper opening and closing functions of the valves. The heart has to work harder to pump blood throughout the rest of the body when valves fail to open and close properly. Over extended time, the extra workload produces strain on the heart muscle.

Repairing or replacing damaged heart valves allow the heart to pump efficiently. At times, it is necessary to replace the damaged valve with an artificial or tissue valve. Your physician will inform you of the type of valve he or she will use.

The following is an example of mitral valve replacement.

Chest pain from heart disease, known as angina, is usually the result of atherosclerosis. Atherosclerosis is the slow build-up of fatty deposits in the walls of the coronary arteries that cause the arteries to harden. As a result of the build-up, the coronary arteries become narrow, making less room for the blood to flow through. Occasionally, as a result of this blockage, the heart muscle does not receive enough oxygen to function and causes one to have chest pain – or angina.

When one or more of the coronary arteries becomes blocked, the physician can perform a surgical procedure to bypass the blockage – thus a Coronary Artery Bypass Graft. The purpose of this surgery is to supply the proper amount of blood and oxygen to the heart muscle.

An internal mammary artery, one of the many arteries that carries blood to the chest wall, usually is used in place of a vein to bypass the first blockage.

A vein will be removed from the leg and will be used to bypass the second blockage. One end will be sewn (grafted) into the aorta and the other end will be sewn into the coronary artery bypassing the blockage. Oxygenated blood will travel from the aorta through the vein bypass graft into the coronary artery and to the heart muscle.

One or more vein grafts may be necessary depending upon the number of blocked coronary arteries.

The following is an example of a double vein graft.

Because of advances in technology, it no longer is necessary for all patients to spend the night in the hospital the night prior to their surgery. Therefore, NFRMC has adopted pre-admission procedures.

When the day for your surgery had been selected, your physician’s office will instruct you to visit the Business Office at the medical center. The pre-admission visit is very important and can be done up to 30 days before surgery. The Business Office is located near the front entrance of the Main Hospital and is open Mon – Fri: 6:00am – 6:00pm

After pre-registration in the Business Office, you will be escorted to the Surgery Center Waiting Room where you will be asked to complete a form that will give your doctors and nurses the information they need to make your stay as smooth and pleasant as possible.

We ask for your patience as you wait to be called by the Registered Nurse to finish the pre-admission process. We value the worth and dignity of every patient, and our staff will take the time necessary to provide personal, courteous service. We will make every effort to keep your wait as short as possible and will give you an undated time estimate should a delay occur.

When your name is called, the RN will review your form and ask for additional information as needed. The RN will do any testing (X-ray, EKG, blood tests, etc.) that you may need before surgery and will review your pre-operative instructions with you. You must follow these instructions exactly or your surgery could be delayed or even canceled.

The RN will provide a video for you and your family to view to help relieve any anxiety you might have concerning your post-operative care. This video explains the immediate post-operative period in the critical care unit. The usual length of stay in the CCU is from eight to 24 hours.

You will need to shower with a special soap the evening prior to and the morning of your scheduled surgery. The surgical shave is now completed within two hours of surgery to help prevent infections, so please do not do this (surgical shave) prior to arriving.

On the morning of surgery, you will be given an operative permit to sign that will have your specific surgeon’s name and procedure to be done.

For those patients who must spend the night in the hospital prior to their surgery, the afternoon and evening before surgery is a busy one.

You will be asked to fill out a questionnaire for the anesthesiologist. Family members and nurses can help you fill out the questionnaire.

You also will have several visitors. An anesthesiologist will visit you the evening before surgery to explain the medications that will be used to sedate you. Patients staying overnight also will receive an operative permit to sign with the specific surgeon’s name and procedure to be administered on it.

A critical care nurse will visit you sometime during the day before surgery to explain the immediate post-operative period in the Critical Care Unit. The average length of stay in the CCU is one to two days. You may request to visit the CCU before your surgery to familiarize yourself with the surroundings.

A respiratory therapist also will visit you to explain the use of the incentive spirometer. The incentive spirometer is a small device you will use to assist your deep breathing after surgery.

A critical issue during open heart surgery is smoking. If you are a smoker, now is the best time to QUIT. While in the hospital, you are absolutely prohibited from smoking. You will be taking pain medications for a few weeks after surgery that will have a definite relaxing effect on you, easing the nervous tension of quitting. There are a variety of nicotine withdrawal aids to assist you with this important lifestyle change.

The morning of surgery you will be shaved as ordered by your surgeon. You will be instructed to shower with a special soap and will be given a sleeping pill to ensure a good night’s rest. After midnight, food or liquids are not allowed.

The morning of your surgery you will be given another shower. You may brush your teeth or rinse out your mouth so long as you do not swallow the water. Please leave jewelry, glasses and other valuables at home. If you forget to leave them at home, give them to family members or have them put in the hospital safe.

The CCU has limited space for personal belongings – only immediate necessities are to be taken into the unit. IF you have been a patient in the hospital, please save your bath basin, bedpan, emesis basin and urinal so they can be sent to the CCU as well. Please send clothes and other luggage home with family members.

Nail polish must be removed from fingers and toes. Check with your anesthesiologist if you wear dentures. In some cases, dentures are allowed.

If you are taken to a semi-private room, family members may visit you the morning of your surgery. They can use the side entrance of the hospital if they come before 6:30 am Our staff suggests family members come as early as two hours prior to surgery because patients are usually admitted to the operating room one hour before the scheduled time. If you are in a private room, one member of your family may stay at all times.

Family members will be shown the location of the waiting room located next to the operating room. Open heart surgery takes three to five hours. Family members may want to visit the cafeteria or walk about the hospital grounds. Ask family members to inform the receptionist of their whereabouts if they leave.

Before you are taken into the operating room, the nurse will ask you to empty your bladder. The nurse then will give you one to two injections of medication that will begin to make you drowsy. After receiving the medication, the side rails will be put up and you will be asked to remain in your bed. Please use your nurse call light if you need anything.

You will be taken into the operating room one hour before your surgery begins. The anesthesiologist will meet you in the patient holding area and insert an intravenous line (a needle into your vein with tubing attached), then begin to prepare you for surgery. The surgical nurse will introduce herself or himself to you and answer any questions you might have. Several other patients may be waiting in this area as well.

After your surgery, you will be taken to the CCU. You will remain in the CCU for 18 to 24 hours, possibly longer, depending on your progress. While you are in the CCU we urge your family to stay in a motel, if they are from out of town, to ensure adequate rest.

On arrival to the CCU you will be sedated from the anesthesia. While in the CCU your nurse will take your temperature, measure blood pressure, heart rate and respiratory rate frequently. The nurse will ask you to move your arms and legs and squeeze his or her hand. You will be connected to a heart monitor through pads attached to your chest with electrode wires. This allows for your heart rhythm and blood pressure to be continuously monitored.

When you start to awaken, you will notice various tubes and machines connected to you. The first thing you will notice is a tube inserted through your mouth into your windpipe. This breathing tube is connected to a respirator that will ventilate your lungs until you are fully awake and able to breathe well on your own. Most patients remain on the respirator for four to six hours following surgery. Because most patients are not fully aware of their actions, due to the sedation, soft protective devices are applied to prevent accidental removal of this breathing tube. While on the respirator, you will be able to communicate through gestures or writing. You also will be unable to eat or drink, so you will be given fluids and medications through the established intravenous tube. During surgery, a tube will be placed into your bladder to drain the urine. This may give you the feeling of needing to urinate. The tube will remain in your bladder for approximately two days after surgery.

You will be aware of two drainage tubes that have been inserted into your chest during surgery. The chest tubes will be connected to a suction device that will drain excess fluid from around the heart. You may hear a “bubbling” noise that is produced by the suction device. Your chest incision will be covered with a large dressing. If you have a leg incision, it also will be covered with a large dressing.

After your vital signs have been taken and you have been connected to the monitoring equipment, your family will be permitted to visit you briefly. You may or may not be aware of their presence and you may not be completely awake. Some patients are able to open their eyes or nod their heads, but most are generally sedated from the anesthesia. Visiting hours for family members are every two hours on the odd hour with no visitors allowed at 7 am and 7 pm Two family members may visit at a time for approximately 15 minutes.

As with any surgery, you can expect a certain amount of pain. Pain medication will be taken frequently, but you should not expect to be completely free of pain. However, you will be able to move around with a minimum amount of discomfort.

You will have two nurses during a 24 hour period. Please be aware that the CCU may be quite noisy, because of machines and voices, but the CCU nurses will try to make the environment as quiet and comfortable as possible.

During the early or late evening following your surgery, the respirator and breathing tube may be removed if you are fully awake and breathing adequately on your own. You may experience some hoarseness and a sore throat following the removal of the tube, but talking should not be difficult. You will be given an oxygen mask to wear to help increase the oxygen level in your blood and loosen secretions in your lungs. The tube in your stomach and the wrist restraints will be removed after the breathing tube is removed. You may be allowed to drink small amounts of liquids.

Your nurse will continue to check your vital signs every hour throughout the night and will also assist you every two hours with deep breathing and coughing using the incentive spirometer. Deep breathing and coughing is critical in order to clear your lungs of secretions. Your nurse will instruct you with how to splint your chest in order to minimize incisional discomfort when you cough.

The following morning, your surgeon will visit you to check on your progress. A liquid breakfast will be given to you after the surgeon’s visit. Once finished with breakfast, your nurse will help you to sit and dangle your legs over the side of the bed and to sit in a chair.

Your nurse will continue to guide you in deep breathing and coughing exercises throughout the day. Your vital signs will be checked less frequently and you will have longer periods of rest.

As the day continues, your intravenous fluid administration rate will be slowed and/or discontinued as you drink adequate amounts of liquids. Eventually, you will have a heparin lock (a needle remaining in your vein with a short tube connected to it) in place.

Solid food may be given to you at lunch. Your appetite will increase as you continue to eat. An adequate nutritional intake is critical for the healing process.

By early afternoon, you will be walking short distances in the CCU. Pain medicine will continue to minimize the discomfort. The walking distance will gradually be increased and by evening you may even be walking the length of the hall. The purpose of moving about so soon after surgery is to ensure that circulation, lung expansion and bowel function return to normal as rapidly as possible.

Your surgeon will visit you again in the early morning. Your chest tubes may be removed at this time. Your nurse will remove the catheter from your bladder and provide instructions for your transfer to the 2nd floor.

On your arrival to the 2nd floor, the nurse will connect you to a telemetry monitor (pads and electrode wires connected to a small box) that transmit your heart rhythm to a monitor screen in the nurses station telemetry area. This telemetry monitor box is worn for a few days and enables a specially trained (telemetry) nurse to monitor your heart rhythm as it continuously appears on the monitor screen.

While you are on telemetry monitoring, you will continue to have a heparin lock (vein access route for medications) in your arm. Your nurse will also record your urine output and all the fluids you take in. You will be advised if your fluid intake and urine output need to be measured. Each day you will be weighed early in the morning.

The nurses on the 2nd floor will continue to encourage you to cough and breath deep using the incentive spirometer. This will help you to avoid the complication of pneumonia.

You may experience mild constipation following surgery due to the slow, decreased movement of your stomach and intestines while sedated during surgery. You will be given a laxative and/or stool softener to promote normal bowel function. Please notify your nurse if you have not had a bowel movements for two to three days after receiving the laxative.

You will not be allowed to take a shower until your stitches/staples have been removed (approximately five days after surgery). Until then, you will be assisted with your morning bath.

After a few days, you may have only vague memories of being in CCU or you may not recall the events in CCU at all. This is normal and is due to the anesthesia effect after surgery and the pain medication you received while in CCU.

Once you have been transferred out of the CCU your doctor will want you to walk in the hall three or four times each day. The Cardiac Rehabilitation nurses will see you once each day to monitor and assist you with your walk then will provide instructions for the distance your other walks should be that day. They also will inform you if you need to wear oxygen while ambulating.

All activities should be done slowly and only for short periods of time. Each activity should be followed by a period of rest. Be sure to breathe normally throughout each activity and don’t hold your breath. Be sure to avoid the following:

  • straining with bowel movements
  • bending over to pick up something off the floor
  • lifting or moving furniture
  • lifting
  • isometric exercises (contracting or tensing muscles without moving your body while lying or sitting)

If you have any shortness of breath, palpitations, dizziness, pain or perspiration, stop whatever you are doing and notify your nurse.

It is not unusual for you to notice some swelling in your hands, legs and ankles after this surgery. In order to decrease swelling, elevate your feet on a stool while sitting. Moving your feet while lying or sitting will also aid in reducing swelling. Remember not to cross your legs since it is bad for circulation.

As part of the normal healing process, you might feel a tight, drawing-in sensation in your incisions. While walking, keep your back and shoulders straight and let your arms move naturally at your sides. To prevent a stiff neck, bend your head from side to side three or four times several times a day.

Prior to your hospital discharge, Cardiac Rehabilitation nurses will provide you and your family with educational instruction on your:

  • incision scar
  • activity limitations
  • signs to report to the doctor
  • risk factors of heart disease
  • progressive walking at home

The dietitian will provide information on the cardiac diet. These instructions will assist you and your family in your care once you are home. Please follow all instructions carefully and ask questions when necessary.