The Cardiovascular Intensive Care Unit (CVICU) at the San Francisco Kaiser Permanente Medical Center and the Cardiopulmonary Unit (CPU) at the Oakland Alta Bates Summit Medical Center are specifically designed to care for you after your open heart surgery. In these units, you will get around-the-clock medical care and nursing attention.

Special electronic equipment is used to monitor your body's response to your surgery. This equipment, along with the staff's close observation, will alert us of any change in your condition.

You will be cared for by medical staff specially trained to take care of people undergoing open heart surgery. They will be at your bedside frequently to check your vital signs, take your temperature, take measurements, provide reassurance, and answer any questions you or your family may have.

After your heart surgery, you will be taken directly from the operating room to the Cardiovascular Intensive Care Unit (CVICU) or the Cardiopulmonary Unit (CPU). You will still be asleep for the first few hours after surgery.

The Breathing Machine (Ventilator)
When you wake up you will probably have a breathing tube in place. It may feel like you're breathing through a straw.

You will not be able to speak or drink anything while this tube is in place.

The breathing tube will be attached to a machine called a ventilator that will be assisting you to breathe until you are awake enough to breathe on your own. The machine and tube will then be removed. This is a normal and necessary part of major surgical procedures.

Try to relax as much as possible and let the machine do the work. Trying to talk or resisting the machine will make it more difficult for you to breathe.

If the breathing tube needs to stay in for a while longer, you will be kept comfortable with medication given through your intravenous (IV) catheter.

As you wake up, you may hear many different beeps, alarms, and other noises. This is normal for the Cardiovascular Intensive Care Unit (CVICU) and the Cardiopulmonary Unit (CPU).

• You will be attached to a monitor (looks like a TV screen) that records your heart rhythm.
• You will have several catheters (tubes) connected to your blood vessels, usually in your neck and arms. One of these monitors your blood pressure continuously. The other measures pressures in your heart.
• You may be aware of a cuff squeezing your upper arm intermittently. This cuff takes blood pressure readings.
• There will be two or three tubes coming from the lower middle of your chest area. It is normal to see bloody fluid coming from these tubes. These tubes are removed the day after surgery or as soon as the drainage stops.
• You will have a tube in your bladder to measure your urine and function of your kidneys. This tube is usually removed the day after surgery.
• In addition to the tube helping you breathe, there will also be a tube in your nose that goes to your stomach. This tube keeps your stomach empty and helps prevent vomiting which could cause complications. This tube is usually removed when your breathing tube comes out.

You will have a Registered Nurse (RN) to care for you alone for the first several hours. Once you are stable and taken off the ventilator, the nurse may be caring for you and another patient close by. As your condition improves, you will be moved from the CVICU or CPU to a transitional care unit. At San Francisco, this unit is located on the first floor and is called TCU. At Oakland, this unit is located on the third floor and called 3 North. Registered Nurses on these units will continue to closely monitor your condition and provide needed care until you are discharged from the hospital. In either of these units, your nurse may be caring for up to four patients.

Facts about Pain
• People experience pain differently. You are the best judge of how much pain you are feeling.
• Pain medication does not work the same for everyone. If your pain medicine is not working well, please talk with your doctor or nurse. There may be other medicines you can use that will work better for you.
• Remember, pain medication helps lessen pain. It may not take away all of the pain you experience.
• Pain medicine works best when taken as soon as the pain begins or as soon as very mild pain begins to worsen. People who take pain medicine regularly for several days after surgery (if needed), are able to be more active and more comfortable during recovery.
• It is very rare to become addicted to pain medication used after surgery.
• Having pain does not mean you must limit activity or therapy. Receiving pain medication before scheduled activity or therapy may improve your performance and comfort.

How Will My Pain Be Treated After Surgery?
As you wake up after surgery, you may have mild soreness or more severe discomfort in your chest and leg where the surgery was done.
• On the day of surgery, you will receive pain medications directly into your bloodstream through the through the intravenous (IV) catheter. Your nurse will check with you often to ask if you are having pain and to give you pain medicine as needed.
• The goal after surgery is to control your pain so you are comfortable, but not too sleepy to do your deep breathing exercises, talk with others, and move around.

Once your breathing tube is out and you are able to swallow liquids, you will take pills for your pain. Your nurse will ask you to rate your pain on a 1-10 scale (1 being mild discomfort, 10 being severe pain). This helps your nurse work with you to control your pain.

Tips for Controlling Pain
• Tell your doctor or nurse if you are allergic to any type of pain medicine.
• Take (or ask for) pain medications when pain first begins.
• Take pain medication regularly, around the clock for several days after surgery, if needed to manage your pain. Take (or ask for) pain medications 30 to 40 minutes before a scheduled activity such as getting up or walking.
• Ask about possible side effects of the pain medication you are taking.

Let your doctor or nurse know if your pain medicine is not working well for you.

• Your surgical incision will be down the center of your chest. If you are having vein graft bypasses, you will also have incisions down the inside of one or both of your legs.
• Hugging a folded pillow over your chest using both arms protects the bone edges from pulling apart and reduces the pain. You will be taught to do this when doing coughing and deep breathing exercises and whenever you need to change your position in bed or are being helped in and out of bed.

Activity - Out of Bed
It is normal to be out of bed the morning after your surgery. A physical therapist, as well as the nursing staff, will help you become more active each day, until you are able to walk the hall with very little help.

Common activity after surgery
• Day of surgery - Sit up on the side of the bed
• Day 1 after surgery - Walk to your chair three times during the day
• Days 2 and 3 - Walk in the hall four times a day
• Days 4 and 5 - Walk for 5 to 10 minutes four times a day

Breathing Exercises
Deep breathing exercises with your spirometer are an important part of your recovery after surgery. By performing your breathing exercises, you will resume your normal breathing patterns much faster and reduce the possibility of respiratory complications.

How to do your breathing exercises:
1. Place your lips on the spirometer mouthpiece and breathe out completely.
2. Then, close your lips tightly around the mouthpiece.
3. Inhale slowly and deeply, keeping the small, yellow inspiratory coach as close to the happy face as possible.
4. Inhale as deeply as you possibly can.
5. When you can’t inhale any more, hold your breath for 6 seconds and look to see how high the top of the yellow piston reaches.
6. Repeat as many times as prescribed, usually 5 – 10 times every 1 to 2 hours.

Getting Out of Bed
Whenever you get out of bed in the hospital you should ask for assistance. It takes up to 8 weeks for the bones in your chest to grow back together, so we want to minimize the stress placed on these bones. Please follow these specific steps when you get out of bed:
1. Keep your shoulders and hips in line.
2. While lying on your back, scoot your hips to the edge of the bed.
3. Roll onto your side and bend your knees slightly.
4. Push up gently using your elbow underneath you and your other arm in front of your chest. Use no more than fingertip pressure. At the same time, swing your legs to the floor slowly.
5. Rest for a few minutes to prevent dizziness.
6. Then, using your thigh muscles, stand up. Have help close by.
7. You should do the reverse when you get back into bed.

Kaiser Permanente San Francisco Medical Center

CVICU Visiting Policy - 4th Floor
Family/significant others may visit you at any time during your stay in the Cardiovascular Intensive Care Unit (CVICU), at the nurse's discretion.

We respect the wishes of each patient in regards to selection of visitors. Please use the hospital phone (Phone Number is x33099) at the CVICU entrance for permission to enter the Unit. Cell phones must be in the off position.

Visiting hours are 11:30 AM to 3:00 PM and 4:00 PM to 7:30 PM.
Only two people may visit at a time.
Flowers are not permitted in CVICU.

Transitional Care Unit (TCU) Visiting Policy – 1st Floor
Only two visitors are permitted at a time. Cell phones must be in the off position.
Visiting hours are 11:00 AM – 8:00 PM.

MAIN HOSPITAL TELEPHONE NUMBER: (415) 833-2000

Alta Bates Summit Medical Center

CPU Visiting Policy – 3rd Floor
Family/significant others may visit you at any time during your stay in the Cardio-Pulmonary Unit (CPU) at the nurse’s discretion. We respect the wishes of each patient in regards to selection of visitors. Please use the hospital phone (Phone Number is 3990) at the CPU entrance for permission to enter the Unit.
Visiting hours are 10:00 AM to 8:00 PM.
Only three people may visit at a time. Visitors must be 12 and over.
Flowers are not permitted in CPU.

3 North – 3rd Floor – Visiting Policy
All visitors must be members of the patient's family or have been designated as acceptable to visit by the patient prior to surgery. 3W/3N visiting hours are 10 am to 8 pm daily.

MAIN HOSPITAL TELEPHONE NUMBER: (510) 655-4000

Prior to the day you actually leave the hospital, you and the medical staff will make plans for your discharge. Sometimes these plans can change, based on your medical condition. You will be involved in this planning and kept informed of any changes.

Here is some information to help you prepare for leaving the hospital:

• Have support people. You will need someone stay with you for the first one to two weeks after you leave the hospital. After surgery, you’ll require some assistance in order to care for yourself.

• Be prepared. We strongly encourage you to make arrangements before you come into the hospital for your spouse, family, or a friend to stay with you for the first one to two weeks after discharge. If you live alone and/or have no family or friends available, resources can be given to you for you to hire help. This is not a covered benefit. Please ask your discharge planner for more information. A skilled nursing facility placement occurs only when medically indicated and if you meet the guidelines/criteria. This will be reviewed by your discharge planner.

• Thermometer and scale. You will need a thermometer and scale at home so that you can take your temperature and weigh yourself every day.

• Check out at 11 a.m. You are expected to check out of the hospital no later than 11:00 a.m. on the day of discharge.

• A ride home. Be sure to make arrangements for a ride home. If no one is available to pick you up, you can hire a taxi or wheelchair van to take you home. To ensure prompt discharge from the hospital at 11:00 AM, please advise individuals responsible for transporting you home to be at the hospital by 10:00 AM. The cost of transportation home is not covered by your Kaiser Permanente Health Plan benefits.

If you have questions about any of these items, please speak to your discharge planner.