Moving to a ward
Heart surgery and what to expect
After heart surgery, patients stay in the overnight intensive recovery (OIR) unit to be closely monitored. After 12 to 48 hours patients are moved to a high dependency unit (HDU) or to Doulton ward. Sometimes patients go to the intensive care unit (ICU) after their operation for extended intensive therapy.
When you wake up you may feel a little confused about where you are and what time it is. It can be quite noisy as there are monitors and bleeps going off. Do not worry. This is all part of the equipment used to monitor your progress and your nurse will be there to reassure you.
You will be given strong painkillers into your veins during and after your operation through a drip. Once the drain in your chest is removed, you will no longer require strong painkillers through the veins and you will be able to take oral (by mouth) tablets instead.
As people recover at different rates from heart surgery, you will be transferred when we are sure you are well enough. Then you will either move to Doulton high dependency unit (HDU), or to Doulton ward.
There is no set time when patients are transferred to Doulton HDU but it is usually the day after your operation. When you are well enough you will be transferred to Doulton ward.
You will stay for about 3 to 5 days. We take the privacy and dignity of our patients very seriously.
You will be encouraged to walk around the ward and the physiotherapist and nurses will advise you on the amount of exercise and rest that is best for you. If you feel well enough you will be encouraged to start caring for yourself.
Visiting
In OIR and ICU
You can nominate 1 person, preferably your next of kin, to call us and they can call at any time. Your nominated person can share the information with your family and friends.
Usually close family can visit you in OIR or ICU and your visitors should call 020 7188 5617 to arrange a visit. However, we cannot guarantee your visit will go ahead if we are very busy. You can have a maximum of 2 visitors. Children under the age of 12 are not allowed. We do not allow visitors in the first 2 to 3 hours after your surgery.
On the ward
Visiting hours are 2pm to 7.30pm. It is important that you get plenty of rest so we have a rest period for all patients from 1pm to 2pm. We ask friends and relatives not to visit during this time.
Recovering on the ward
Your recovery will be managed by a team which includes your surgeon and medical team, nurses, anaesthetists, pharmacists, and other clinical nurse specialists. If required you will also see dietitians and physiotherapists.
To help with your recovery, the team will support you to get up and move about. You will be helped to get out of bed, sit in a chair and start walking as soon as you can after your surgery. Moving around will:
- maintain muscle strength and improve circulation
- help you take deep breaths so you spend less time on oxygen
- aid your digestion and help to prevent constipation
Ideally you should be sitting out of bed on the first day, and beginning to walk from the second day, although you may feel weak and wobbly at first. After this you should try and increase the distance and the number of times you walk every day.
The physiotherapists will see you before you leave hospital. They will show you how to exercise using movements that protects the sternum while it heels. This exercise is known as ‘keep your move in the tube’.
You can read more about physiotherapy for heart surgery which also explains more about 'keep your move in the tube'.
Once you have reached certain milestones in your recovery, you can be discharged from hospital with detailed plans of how to continue your recovery.
It is important that you eat and drink as soon as possible after your surgery as this will help with your overall recovery (unless your surgeon has told you otherwise). Eating too little may delay your recovery and may affect your energy levels.
Drinking is extremely important for your hydration. You should aim for 6 to 8 glasses of water each day (unless your surgeon has told you otherwise).
You may find eating little and often easier than eating 3 larger meals a day, especially If you:
- have a poor appetite
- are finding it difficult to eat
- have any unexpected weight loss before surgery, or during your stay
If you have not returned to a normal appetite by day 5 after surgery you should be referred to the dietitian for further support.
Once you have left hospital, and your appetite is back to normal and your weight is stable, a healthy balanced diet is recommended. This means eating a wide variety of foods in the right amounts.
A rough guide is to base your meals on starchy foods like potato, bread, rice and pasta to make sure you are getting enough energy. Include protein rich foods, such as meat, fish, eggs, beans and pulses in your diet as these are very important for building and repairing our muscles. Also include 5 portions of fruit and vegetables each day to make sure you get enough vitamins and minerals for recovery.
Feeling sick (nausea) is a very common problem, especially in the first few days after surgery. This is due to the side effects of the anaesthetic and other medicines. These can also cause a dry mouth that may last for several days.
The team looking after you will do their best to ease these feelings. If you have sickness or vomiting at any time after the surgery let someone from the medical or nursing teams know so they can give you further medicine to manage this.
Patients who wear a bra should wear it for a few hours during the day to begin with, and at night for sleeping. By the time you leave hospital you should aim to wear it for 20 hours a day.
You may feel changes in your mood, such as feeling depressed, tearful and irritable. These mood changes can last for several months but they are normal as your body recovers and will gradually go away.
If you are worried you can call the cardiac rehabilitation advice line at the hospital on 020 7188 0946, Monday to Friday, 9am to 5pm, or talk to your GP.
It is usual to find your sleep pattern changes and you are unable to get into comfortable position. You can try sleeping on your back and sitting up slightly. Limit the number of visitors in the first couple of weeks and make sure you get rest during the day.
In the early stages after surgery it’s usual to be more aware of your heartbeat, especially when you are in bed. This is nothing to worry about.
Managing pain
It is normal to have some pain after surgery, especially when you begin to stand or walk. The healthcare team will give you medicine to control the pain. It is important that you take it as instructed to prevent pain from building up and so that you can move as advised.
You can read more about different types of pain relief.
It is very important to take enough pain relief so you can take deep breaths and cough effectively. Coughing up mucus keeps your lungs working well and can prevent you from getting a chest infection. A physiotherapist will give you specific breathing exercises to show you how to cough well.
Infection
Good hand hygiene is one of the best ways to prevent the spread of many infections. Please remember that even if hands look clean, they can still carry many germs. Make sure your visitors clean their hands when visiting you. Hands should be thoroughly washed:
- whenever they are visibly dirty
- after using the toilet or commode
- after contact with blood or body fluid
- after sneezing or blowing nose
- before and after handling food
- before and after touching your wound(s) or dressing(s)
If you are not sure if a staff member has cleaned their hands, it is OK for you to ask them to.
Keeping a cannula and IV line clean
You may have a cannula or intravenous (IV) line in your arm. It is important that you keep this clean and dry. A clear sterile dressing will cover the intravenous line.
If you take a shower ask the nurse to help you cover it to avoid getting it wet. If the dressing becomes loose or dirty it will need to be changed. Please ask the staff to do this for you.
Your cannula needs to be changed every 72 hours to reduce the risk of infection. However, if you have very poor veins that are difficult to access, staff may leave the cannula in longer. We will replace your cannula before 72 hours have passed if there are any signs of redness, heat, coolness, swelling, or pain.
Signs of an infection
Let a nurse or doctor know immediately if you think you might have an infection. Things to look for are:
- a high temperature (fever), which might come and go
- a wound that becomes more swollen, or red in appearance (this might be harder to see on darker skin)
- excessive fluid drainage or oozing from the wound
Resource number: 5455/VER1
Published date: December 2023
Review date: December 2026
