After your operation
When you wake up after your operation, you will be in the intensive care unit (ICU). When you are fit enough not to require continuous attention, you can be moved back to the ward. This decision is made by the doctors and nurses on the ICU, and really requires you to be breathing efficiently without help, and not to be on any mechanical or strong drug support.
Sometimes, if you are suitable, and your operation has gone really well, you will be woken up quite quickly and your breathing tube removed (extubated). If all is well, you can then go back to the ward on the same day, rather than spending a night on the ICU. This is known as ‘fast-tracking’, and is a useful process, because it creates an extra bed on the ICU, which means that another patient can have his or her operation.
INTENSIVE CARE UNIT
Some ICUs are specifically for heart surgery patients, and others are ‘general’ ICUs, which cater for a mixture of patients requiring intensive treatment.
Whichever type you are in, you will be looked after continuously by a specially trained nurse for whom you are the only patient, and by an anaesthetist who is in the ICU at all times. You will always arrive in ICU after your operation connected to the ventilator, and a number of other drips and monitors, depending on your condition (see table on pages 72–3). It should be stressed that all patients arrive back connected to a frightening array of equipment. This is entirely normal and does not necessarily mean that anything is wrong.
As soon as you are settled in and everything is stable, the nurses will try to ‘wean’ you from the ventilator. In other words, they’ll try to wake you up and get you breathing for yourself. They monitor the amount of oxygen in your blood and, when the time is right, will extubate you. This can take place any time from a couple of hours after your operation, to days or weeks later. The ventilator is the only part of the support system that cannot be provided anywhere other than the ICU, so you cannot go back to the ward unless you are extubated. All the other drips and devices will gradually be removed over the next two to three days if all is well, but this can take place on the ward.
WARD STAY
You will usually go back to the ward the day after your operation. If there have been complications you may stay on the ICU longer, and if you are fast-tracked you may return on the same day. When you arrive back on the ward, you will usually spend the first day or so in a special area called the high dependency unit (HDU). This simply means that the nurses can keep a closer eye on you until all your drips and tubes have been removed. As you get stronger, and continue to improve, you will be moved to the normal part of the ward. Your rehabilitation starts as soon as you reach the ward, and will be dealt with in the next section.
Most people go home about five days after their operation, as soon as the staff (doctors, nurses and physiotherapists) feel that they are capable.
