Patients are usually admitted to a cardiac surgery ward the day before their operation, where they are assessed by the anaesthetic, surgical and nursing teams. They are told if they will be going to theatre in the morning or the afternoon.
On the day of surgery
• Patients having surgery in the morning are collected by the theatre staff and a porter. The afternoon patients are escorted by a porter and a nurse from the ward.
• Patients return to Cardiac Intensive Care on the afternoon or evening of the day of surgery. They are usually sedated and on a ventilator. During this time they will receive one to one nursing care.
• Most patients will have a central line, arterial line, urinary catheter, chest drains and external pacing wires.
• Chest wounds will be dressed, as will leg graft sites if used.
• Once the patient is warm and stable, the nursing staff gradually reduce the sedation and start to wean the support from the drug infusions and the ventilator.
Day One
• Most patients will step down to High Dependency Care as they are now awake, off the ventilator and requiring minimal support from drug infusions.
• Following the morning medical ward round, patients are encouraged to stand and transfer into a chair. They may be moved to another area within ICU to enable one nurse to care for two patients.
• As the day progresses the central line, arterial line, urinary catheter and drains will be reviewed and potentially removed
• The patient will be reviewed and assessed regularly. If they meet the high observation bed (HOBS) criteria they will transfer up to the HOBS bay on the cardiac surgery ward. This is a bay with additional monitoring and a higher ratio of nurses than the rest of the ward.
• If the patient does not meet the HOBs criteria on day one, they stay on ICU/HDU for another night.
Day two
• Patients continue to improve, mobilise and work with the physiotherapist.
• Following the morning ward round, patients are assessed as fit for the ward or requiring a slightly higher level of observation in the HOBs bay.
Day three
• Most patients are continuing their recovery on the ward.
• Each patient will have a daily medical, nursing and physiotherapy review aiming to increase confidence in mobility.
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