What should I pay attention in postoperative course?
You should not lie at flank position, and you should avoid stand or stand up bearing all load of body to one arm and you should not raise your arms above your head. Other recommendations include use of medicinal products regularly, being ambulatory as much as possible and walking at regular intervals as well as breathing deep, blowing up balloon or use of tri-flow device.
When can I start walking in postoperative course? How long can I walk?
Being transferred to intensive care unit in postoperative course, all patients are mobilized several hours after mechanical ventilation is stopped, while they are assisted by nurses. There is no contraindication for ambulation, even after they are discharged to inpatient clinic the other day. Patients may and should walk regularly at intervals, subject to their discretion, after they are discharged to home; however, patient should avoid getting tired. The issue is absolutely a matter of patient's condition.
When can I get out?
Patients may get out whenever they want, after they are discharge to home. Of course, clothes should be worn, considering weather conditions.
When can I take a bath?
There is no contraindication for taking bath, unless wound site is coarsely rubbed and as long as wound is immediately dried after bath. However, patients are recommended to avoid taking bath, until purulent wound heals and wound dressing is stopped. Those patients may wash only head, or body can be cleansed with soap and a clean towel.
Should I have wound dressing?
Wound will be left open on Day 2, if incisions are clean and dry. A disinfecting preparation, Opside, is sprayed on wounds. Meanwhile, a protective layer is created on the wound. Wound will be kept closed, if wound is wet or leakage or bleeding is observed. You will need wound dressing, if such complaints occur after you are discharged. Otherwise, wound dressing is not required.
What should I do to keep wounds clean?
You should frequently change your clothes, and especially, female subjects should wear bra and keep intermammarian zone clean. You should strictly avoid scratching wounds. If you are diabetic, you should have your blood glucose checked at regular intervals and you should avoid everything, which can elevate blood glucose. You should consult to an Endocrinologist, if required, to regulate your blood glucose. Especially, female subjects may supply clean gauze from a pharmacy in order to keep inframammarian folds and intramammarian zones dry.
When will I have follow-up visit?
You will attend follow-up visit I month after you are discharged. Date of follow-up visit is also written on a report, also known as epicrisis, which will be delivered to you before you are discharged.
May I lie at supine position?
All patients should avoid lying at flank position for I month, if chest cavity is opened on mid-line (median sternotomy); patients may lie at supine position or at beech chair position. Patient should be assisted while getting out of the patient or a strap should be wrapped to footboard to get support, if patient lies supine.
May I accept visitor?
Crowded visitors should be always avoided, if you leave in a small room. Microbes will highly appreciate you, if your room is poorly ventilated. Risk of contamination will be high. Visitors should stay for a short time, while they should also avoid hugging and kissing the patient; room should be always ventilated well (maximum I visitor per day). You should especially stay away from any one with infectious disease. lt is not unnecessary to stay away from residents of the house. We recommended your family members washing hands frequently rather than use of disinfectants.
There is leakage at lateral side of the chest wall? What should I do? Should I fear?
Drop-like clear or hemorrhagic leakage is not a sign of infection in postoperative course. If the fluid is very viscous, you should better visit a doctor. Leakage can be observed at puncture sites of drains, which are placed to control bleeding, after drains are withdrawn in postoperative course. This leakage is not an abnormal condition. Wound dressing can be performed, at daily intervals, using gauze.
I feel irritation, prickling and pain on chest wall, but not on incision line. Is there any problem?
Your sternum, breastbone, is divided during surgery in order to expose heart. Next, bilateral chest walls are opened to the level of bilateral breast using a device, also known as retractor. Therefore, muscles on anterior chest wall and ribs are impinged, and accordingly, you may feel pain on your chest wall. Moreover, vascular grafts are obtained at left side of the chest wall or even at both sides of the chest wall in some patients, and therefore, it is totally normal to feel numbness on anterior chest wall. Even if you cannot see them, those wounds will heal, resulting with pains similar to stretching, retraction, pinprick or stabbing. They are all expected conditions in postoperative course. They will alleviate over time. Regular use of pain killers will assist you overcoming this period easier.
I feel pain and numbness in my arm. Why?
An incision is carried out on skin of your arm to obtain arterial graft in coronary bypass surgery. Therefore, pain on incision line is an expected outcome. Numbness is originating from injury of tiny nerve ends, while vessel graft is obtained. It will regress over time. Doing proper exercises (opening and closing hands) will facilitate recovery. You can also use stress balls.
Will I take medicines, which I use before surgery?
You will use only medicinal products, which are prescribed. You can use medicines for other conditions (diabetes, asthma, insomnia, depression, panic attack, epilepsy etc), along with medicinal products you are prescribed.
I cannot get medicines in absence of a report. What will I do?
Medicinal product report allows you get medicines, which will be sufficient for 3-month therapy, without paying patient share. Such reports are valid for 2 years. You can get all medicines, which are prescribed. Exceptions are Plavix, Karum and Pingel. You should pay full price of those medicines. However, if you have an angiography report, which documents implantation of stent within 6 months, those medicines will be also covered by your insurance. Your medication therapy will be planned when you attend follow-up visit. Therefore, a report will be issued for medicines, which will be used continuously.
How long I will use those drugs?
You will take your medicines regularly, until you attend follow-up visit. You will be prescribed medicines again, if your stomach medicine (Omeprol) and blood thinner (Plavix) are exhausted.
When can I drive?
You will be informed whether union is achieved in breastbone, when you attend follow-up visit. You may drive at short distance, if union is verified for breastbone.
May I have sexual intercourse?
You may have sexual intercourse, if you are informed that union is achieved in breastbone and you are allowed to lie at flank position at follow-up visit.
May I have journey in postoperative course?
You may travel to your residence with vehicle, train or plane, immediately after you are discharged. You should have breaks at 2-hour intervals and have a short walk, if you travel in car. There is no need to transfer patients to home with ambulance.
Pain, chest pain; back pain?
Muscle stiffness and bone pain are possible outcomes secondary to limited mobility in postoperative course. You should walk and move as much as possible to alleviate those pains. You are recommended Novalgin, a pain killer, when you are discharged. However, if there is no response to the medicine or if you feel tired, you may take Voltaren or similar preparations (Diclomec, Cataflam etc.) instead, provided high doses are avoided. You may apply hot towel on back and flank region along with recommendations written above. If pain persists despite all those measures, you should better visit a doctor?
How long will I use Triflow?
You should use Triflow, which is supplied for pulmonary exercise, for one month in postoperative period. You do not need to use the device, if you can walk outdoor without any complaint.
How long will I wear compression socks? You should wear socks up to I month in postoperative course; you will not need them after limited mobility disappears and you start walking outdoor.
Why are my feet swollen?
Swollen feet and ankle are transient conditions, which are secondary to limited mobility of legs and various medicines (i.e., Diltizem). You may place one to two pillows under your feet to alleviate swelling, when you go to bed at night. Swelling may occur again at night. This method is not valid for serious swelling, which may lead to concerns and may require diuretic therapy.