Cardiac Intensive Care Unit CICU
Open Heart Surgery Handbook
Immediately following surgery, you will be transported to a room on the first floor of the Heart Center and be considered an intensive care patient. Under normal circumstances, you will remain in intensive care status from 8-48 hours, though everyone recovers at a different rate. Following is some important information concerning your stay while you are considered intensive care status.
Because your recovery is our first priority, the following guidelines will apply during your stay:
- On the day of surgery, immediate family may visit for a short time after the patient is settled into his/her room.
- We recommend your family go home after this brief visit and then return the following day later in the morning or in the early afternoon.
- From that point forward family is welcome to visit when it is convenient for both the family and the patient, keeping in mind that the patient needs to rest and heal and may not be up to entertaining a large number of people.
- We recognize the importance of family involvement in the healing process.
In your room, your recovery will be constantly supervised, both by heart monitor units and our cardiac care team. The first floor is a 20 bed unit which utilizes the universal bed concept. This means that you remain in the same bed from the beginning of your stay until the end of your stay. The appropriate personnel will move to you and you will not have to change rooms if the level of care you require changes. You'll enjoy a spacious private room with a special area for your family and friends.
Removing Your Tubes
Various tubes inserted during surgery are removed and respiratory therapy is begun to help prevent possible lung complications. Each of your surgical tubes plays a specific role in your recovery and will be removed before you leave the unit. Your tubes may include:
- Endotracheal (breathing) tube: connected to a respirator, this tube helps you breathe until you are fully awake and breathing normally. Due to its location, you will not be able to talk until this tube is removed. Once you are awake and breathing normally, the respirator will be weaned as expeditiously as possible depending on your respiratory conditions.
- Nasogastric (stomach) tube: used to suction stomach secretions to avoid gastric distention and nausea.
- Foley (bladder) catheter: used to empty your bladder and measure urinary output. Intravenous (IV) lines: these are used to give you fluid, medications, nutrition and blood when needed. Arterial line: measures blood pressure. In addition, this line is used to draw any blood samples needed during the initial post-surgical period.
- Chest tubes: used to drain your chest cavity of fluid and to collect blood from normal post-surgical bleeding. This blood is then re-infused.
- Pacemaker wires: these provide the temporary ability to connect a pacemaker, if needed.
Intra-Aortic Balloon Pump
In a small group of patients, the intra-aortic balloon pump is utilized to decrease the workload of the heart. When your heart does not have enough oxygen (this can be due to a variety of reasons) it must work harder to provide oxygen to the rest of your body.
The intra-aortic balloon pump consists of a thin balloon that can be inserted into a blood vessel in your groin and then attached to a machine that functions as a pump to inflate and deflate the balloon. During the resting phase of your heartbeat, the balloon inflates, enabling oxygen-rich blood to be pushed into your coronary arteries and therefore into the muscle of your heart, providing extra energy for the work phase of your heart. The balloon then deflates during the work phase of your heart, causing the blood pressure in your aorta to drop and reducing the force against which your heart must pump. These two actions markedly reduce the workload of the heart.
If, in your case, an intra-aortic balloon was used, you will be gradually weaned from the pump. You will need to remain in bed and not sit up while it is in place. Your nurses will help you remain calm and comfortable; let them know if you experience any numbness, tingling, pain or discomfort.
The removal procedure is simple, but you will have a sandbag on the insertion site and temporary limitations in movement, similar to those you may have experienced following cardiac catheterization. Your own heart will continually beat. The pump itself is designed to stop at pre-programmed intervals to fill and reset itself. Do not be alarmed. This will not affect your own heartbeat.
The open heart team is specially trained in the operation of this device and will continually monitor you.
A build-up of secretions is relatively common following surgery, due to anesthesia and decreased activity. While the breathing tube is in place, your nurse will clear these secretions by using a suction catheter. Once the breathing tube is removed, various exercises will be performed to prevent post-operative lung complications (i.e. collapsed lung, infection, pneumonia, etc.).
During the pre-operative teaching class, the nurse will instruct you on proper techniques for breathing exercises. Exercises will include: chest percussion, coughing and deep breathing, and use of an Inspirometer. Chest percussion is the gentle clapping on your back to loosen post-operative lung secretions. Once clapping is completed, the nurse will ask you to take a couple of deep breaths and cough as deeply as you are able. The deeper the cough, the greater the amount of secretions that can be removed.
You will also be taught how to use a deep breathing apparatus called an Inspirometer during pre-operative class. The Inspirometer will allow you to take deep breaths while measuring the amount of air you are inhaling by the movement of the dial.
It is normal to experience some pain after your operation. Once you have awakened from the anesthetic, your nurse in the intensive care unit will question you about pain. All you need to do is nod or shake your head to these questions. If you are having pain, the nurse will administer pain medicine through intravenous lines, offering rapid relief.