Open Heart Surgery - What to Expect
So, you've discovered your family member is having open heart surgery. It isn't as bad as you might think, and hopefully this will prepare you for what you're going to see after they have surgery.
First, this guide is for typical, open chest heart surgery. By this, I mean they will make an incision completely through the sternum to open up the chest. This can include a CABG (what's typically thought of as open heart), valve repair/replacement or heart transplant. These surgeries follow (typically) a remarkably similar course.
So first things first. The day before, at some point, they're going to stop your family member from eating or drinking anything. This is called NPO. Your family member will also have quite a few labs drawn to prepare for surgery. These test blood levels such as your red blood cell count, hemoglobin/hematocrit (indicators of how much blood the person has), electrolyte levels (if electrolytes get out of balance, the heart can do funny things) and prepare multiple units of blood for use in the OR and recovery.
The morning of surgery, you should expect that it's going to be a while before you're able to see your family member again, and then it's going to be a brief visit. This day will be one of the hardest on you as the family. The time involvement for each surgery differs based on the patient, the speed of the surgeon, and any underlying problems your family member has. Be patient. It isn't easy to get information back and forth from the OR without distracting somebody, and that isn't something you want to do.
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This is the part where most families have a tendency to get angry and agitated. The operation is over, but chances are you aren't going to be allowed to visit for a while still. The recovery phase can be done either in a PACU or in the ICU itself where the patient will be staying.
Immediately following surgery, even if everything goes beautifully, your family member is going to require a lot of work from the nursing staff. Your family members body has been thrown out of balance, and during recovery the nursing staff with the surgeons and possibly anesthesia will attempt to bring them back to where they were before surgery. This typically includes giving fluid boluses (rapidly giving normal saline or lactate ringers through an IV), albumin (a protein that helps the body use its own reserves to add more fluid), and using drips (medicine that goes into an IV constantly) to moderate and maintain blood pressure, heart rate, and how hard the heart is beating. Bleeding is also a major concern at this point of recovery. A very close eye will be kept on the chest tubes (described later) to ensure the patient isn't bleeding too much, and to ensure they aren't bleeding internally.
The first 4-6 hours after surgery are very busy for the medical staff. You're being kept in the waiting room while they make your family presentable, and ensure they aren't going to go downhill while you're visiting. This takes time. They do realize that you're on pins and needles, but this is the hard part, and it doesn't last long.
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Your First Visit
So your family member has been recovered and the staff is ready to let you see them. Get ready, because this is going to be jarring. There's going to be a lot of equipment hooked up to them, and it will probably scare you if you haven't been exposed to it before. And, keep in mind, this one will be a short visit.
First, your family member will most likely be on a ventilator. This is the machine that breaths for people when they're unable to breath for themselves. It will be a tube coming out of their mouth and will be secured there with tape or a specialized device. This, in turn, will be attached to a large machine near the head of the bed that's breathing for your family member and providing extra oxygen. There will be another, small tube either coming out next to the ventilator tube, or from their nose, that's used to keep the stomach empty. This is just to make sure they don't throw up and aspirate (when anything that isn't supposed to goes into the lungs), which usually leads to pneumonia.
The next thing you might notice will be what is essentially a large IV in the persons neck. This serves several purposes. First, it provides secure access to give fluid rapidly, or to give medicines that can damage the skin and muscle if a normal IV messes up and it leaks out of the vein. Not all hospitals will use it for this second reason, but it can also provide access for what's called a SWAN. This is a type of sensor that can give medical personnel a closer look at what the heart is doing. This includes different pressures at different spots, as well as how much your heart is pumping. The details of what these numbers mean are beyond this article, and truthfully, beyond the layman. Trust the medical professionals on these.
Next up: chest tubes. These are simply drains that are placed close to the heart and the cavity that was operated in to drain excess blood and fluid. If the sight of blood bothers you, avoid looking too closely at these for the first day. The rest of the equipment you might not notice. These include an arterial line (usually placed in the wrist for constant blood pressure monitoring), EKG cables, a pulse oximetry sensor (to watch oxygen levels in real time), and a foley catheter.
Beyond simply the equipment, you should be prepared for the actual appearance of your family member. They are going to look pale to you, and swollen. Fluid builds up and causes edema (excess fluid in peripheral tissues) in cardiac surgery patients. This is normal, and will be most noticeable in the hands and feet. This will resolve over the next few days.
The Shock has Passed, Now What?
So now you've seen your family member, the shock of it has passed. Listen as the nurse or doctor updates you, and if it sounds like they did well, go get some rest. Typically, this first day/night, the patient will be kept sedated. That means you sitting with him is only going to make you tired. Grab a bite to eat or get a nap in the waiting room. Stay close in case something does go wrong, but at this point, your job is to be ready for tomorrow when they wake your family up to take the breathing tube out.
At most places, this will happen in a few steps. They'll wake the patient up. After this, while on the ventilator, they'll set it to a mode so the patient can breath on their own. After about an hour of this, they can check blood gases, and if all looks good, goodbye ventilator. This is the time when it's beneficial for you to be rested, as you can help to keep your family member calm. I have seen people who wake up calm and with it. This is not normal, though. Usually people wake up confused and a little scared, and reach to pull the ventilator out immediately. Because of this, they will be restrained, and keeping them calm for this short time period before the ventilator is taken out is important.
So now that they're extubated.. congratulations! You've survived your family members heart surgery. The next few days will still be busy, but your family member will quickly be sitting up, walking around, tubes and lines will come out almost daily, and then you're on the road to getting out of the ICU. Now just have to deal with that stubborn patient not following sternal precautions...
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