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ADELAIDE CARDIOTHORACIC Your Surgery and Beyond Cardiac Surgery

The purpose of this booklet is to give you and your family a basic understanding of your hospital journey As a patient you are an individual with special needs so this booklet is only a guide Your health team will include your surgeon an anaesthetist other doctors nurses physiotherapists pharmacists and other health care professionals as required They will all do their best to include you and your family in the planning of your care so you feel well informed at all times ADELAIDE CARDIOTHORACIC HEART AND LUNG SURGEONS Assoc Prof Jayme Bennetts Dr Gareth Crouch Suite 3 Anzac Medical Suites 41 Anzac Highway Ashford SA 5035 Telephone 08 8375 5950 Dr Greg Rice Julie Pick Nurse Practitioner Level 6 Flinders Private Hospital 1 Flinders Drive Bedford Park SA 5042 Telephone 08 8204 5626 Email contact adelaidecardiothoracic com au ________________________________ Website www adelaidecardiothoracic com au _______________________________ Disclaimer The information contained within this publication is for general information only Readers should always seek independent professional advice where appropriate Adelaide Cardiothoracic will not accept any liability for any loss or damage arising from reliance upon any information in this publication Please refer any questions about this information to your treating medical officer and or nursing staff This booklet was written and compiled by Adelaide Cardiothoracic and Bronwyn Krieg Adelaide Cardiothoracic and Bronwyn Krieg Version 2 0 dated June 2020

Contents ha e een r eon and need to ha e heart r er hat ha en ne t o r o ital o rne ontent Day of dmission Day of surgery hat needortosurger do hen re do aring Day after surgery arri e at the ho ital Day after surgery re aring or os ital Day after surgery Day after surgery os ital sta hat lan ho ld a e or Day after surgery di ontrolling char e ro ho ainital a ter m o eration Discharge ill a e deci ion iaving cannot hat can do the ti e a nhoormation a out a loo trans usion hat do need to rin to ho ital hatodowillneed on the da i matoedo ecisions leadin to r er os ital ourne a cannot a di char ed oin ho e Can r er e o t oned or hat can e ect a ter r er at can o t e time am isc arge or cancelled hat i e erience de re ion hat ha ome en in theatre oing hen can re e al haten cancan e ect i ediatel itie resume m usual activities acti a ter r er o r di char e ro ho ital s t ere an t ing nee to watc out or A ter hat do need to no a o t the hat no nten at i eare Carem nitrigC ts an res onsi ilities hat are ri ht and hat can e ect once a re on i ilitie tranontact erred in to aormation ard Contact in or ation erences ana terac nowle gements o e do control lin sain o eration erence A and A aa a e aeien n lin aand i n ac no led ent arl o e ent a ter r er 40

a e een m r eon an nee to a e r er at a en ne t ou ma ave een given a ate or our surger our surgeon ou eel ou are getting worse w ile awaiting surger contact our surgeon as soon as ossi le re aration for o r ou will e a vise letter regar ing t e ate o our surger an will receive instructions regar ing w at me ications ou nee to sto an w en r er e ore our o eration ou ma nee some tests er orme our surgeon will organise t ese or ou aving valve surger ou nee a ental learance to surger is is ecause an loose teet ma ar our acteria w ic coul in ect a new eart valve etai of m a mi ion o eration is e ate o m surger is am eing a mitte to a mission ate is e time o m a mission is o nee to to ta in an me i ation efore m r er en o to t em ar arin lo i ogrel rasugrel a igatran i a an ivaro a an icagrelor s irin nti in lammator ta lets ia etic me ication ar iac me ication iuretics t er atural t era ies inclu ing is oils re t ere an ot er s ecial instructions nee to remem er age

What do I need to bring to hospital If applicable please bring the following cards to hospital with you Private health details Veterans Affairs Pension Clothing Ambulance cover Safety net Pacemaker identification Alert information Medicare Remember Non slip footwear is always a good idea Both men and women can wear pyjamas jacket opening down the front or a loose tracksuit so that the upper body wounds and tubes can be cared for while maintaining lower body privacy However for the first couple of days wearing a hospital gown will protect your clothing from potential staining Ladies if you are large breasted bring a bra into hospital with you as this helps support your chest wound You will also require slippers dressing gown not too long and clothing to wear home remember comfortable loose clothing is best over a chest wound Toiletries Remember Please label your toiletries bag Your toiletries bag should contain a toothbrush toothpaste soap or body wash shampoo and conditioner deodorant a brush comb and any other personal items you may require for example lipstick moisturiser or shaving gear Medications Please bring your medications or a list of your medications with you Is there anything else I might like to bring to hospital If you use CPAP at home you may like to bring in your CPAP machine If you use a walking aid e g frame at home you may also like to get your family to bring it to the hospital ready for your recovery You may like to bring a book or iPad to keep you entertained in hospital Don t forget to label your bags and reading glasses Please label your bags as they will need to be stored in a secure location while you are in theatre and the Intensive Care Unit ICU Also remember to label your reading glasses as they can be easily misplaced during your time in hospital Please do not bring any valuables or large amounts of money into hospital While every care is taken we cannot be responsible for the safety of your belongings Ask your nurse if you require a small number of valuables to be kept in the hospital safe Adelaide Cardiothoracic Patient Information Booklet June 2020 page 3

at an o ita o ma e for i annin for i ar e e in efore o r eart r er ou will not e a le to rive or our to si wee s a ter surger ou will nee to arrange or someone to e availa le to el ou to an rom our a ointments e ollowing is a list o some im ortant ti s w en lanning or our isc arge rom t e os ital rrange or el at ome or ail activities suc as cleaning groceries laun r an gar ening or si to eig t wee s ursing an ome care services are routinel su lie ut are availa le i necessar ou s oul e a le to care or oursel t e time ou are rea to go ome ost atients are rea to e isc arge etween ive an seven a s a ter surger rrange or a amil mem er or rien to sta wit ou eac nig t or u to one wee a ter ou get ome rom t e os ital lan to e o wor or etween our an wee s e en ing on t e t e o wor ou o oo into an sic ness ene its t at ma e availa le to rovi e ou wit su ort uring our recover ar e from ou are not going to e a le to manage at ome t e time ou are rea to leave os ital re a ilitation can e arrange or ou isc arge lanning oor inator can e availa le to ou an our amil e ore our surger an uring our os ital sta Country and interstate patients If you are a country or interstate patient you will need to have accommodation close to the hospital available to you from the time of discharge ou will nee to sta in elai e until a s a ter surger until a ollowu visit wit our surgeon e ore eing a le to return ome is is to minimise t e c ances o com lications occurring a ter ou ave le t elai e an ma e some istance rom el ou will nee to a or our own accommo ation w ile sta ing in as accommo ation is not rovi e elai e For country South Australian patients ou ma e eligi le or a su si towar s our travel an accommo ation t roug t e atient ssistance rans ort c eme i ou are a ermanent resi ent o out ustralia an live more t an ilometres rom t e os ital lease as our local octor call our local o ice or c ec online at www countr ea t sa sa gov au ats or urt er in ormation For interstate patients age e uest t e in ormation or our state

at o nee to o on t e a m r er lease noti our surgeon s o ice ou ave an signs t at ma suggest an in ection suc as ever or ig tem erature coug col or lu s m toms urning or ain on urination or re ness aroun cuts or scratc es on our s in ou nee ele or one n ortunatel ue to a ou are unsure a out w ic me ications ou s oul cease or continue ou ave an ot er uestions elai e ar iot oracic on lin ers rivate r er to ou nee to e er surger c ange in our ersonal circumstances ental treatment an m ea in s or e o t one or an e e es n t e event o an emergenc or un oreseen circumstances our surger ma nee to e ost one or cancelle oul our surger e ost one ever e ort will e ma e to resc e ule our surger as soon as ossi le

at o nee to o o ita ou will e in orme w at time ou are e ecte at t e os ital n arrival ou will nee to re ort to t e missions o ice or to t e rece tion es w ere t e will c ec all our etails inclu ing ame urrent a ress ate o irt ontact etails rivate me ical insurance etails t nicit e icare etails mergenc contact etails en arri e at t e e will also rovi e ou wit irections to t e war w ere ou are to e a mitte ou woul li e a tour o t e os ital rior to surger lease as t e nursing sta on t e war once ou are a mitte e war sta are a to ta e ou an our amil on a tour so t at ou will now w ere t e o erating t eatre an intensive care unit are locate rior to our o eration

What happens in the theatre in t e t eatre and an additional line C C or Central eloatarea o en e eneral eno Catheter ill or e in entral erted into a a itional line enous e o to aree ome enerao thin ect once einatin eter o r will nec eorinserte che t into a vein in t in to e e t on e o enter the theatre our nec or c est enter t e t eatre The o eratin roo tea incl de e o erating room team inclu es o r r eon at lea t three n r e our surgeon at least t ree nurses oour r anae theti t a er ioni t anaest etist a er usionist w o o erate heart lmac n ine an a oho erates t e the eart lung achine and a r ical a i tant surgical assistant willbeecold col and an have avemany man bright rig t It twill lights machines and instruments lig ts mac ines an instruments ntra eno line all t tue es ntravenous linesare are small that ill ee in erted into ein oo t at will inserte into the t e veins armsto to su l l oou wit oour r ar ith me icationsand an rere lace lace l lui edication id sd uring rin surger not erline line will r er Another ill alalso o ee inserte into an arter in our in erted into an arter in o r wrist ri t to monitor our loo ressure an an ed to onitor o r lood re re r e ill lace dot onto o r che t hich to a heart ursesillwille connected lace ots onto our c est w ic will connecte onitor The eheart onitorto aill eart ho e eart monitor will s ow omonitor r heart eat our eart eat A ter the ir t i in erted o r ter t e irst is inserte our anae theti t a i e o o e anaest etist ma give ou some edication me icationtotohelel o oueel eelrela relaedeand dro an rows The anae theti t ill a o to reathe e anaest etist will as ou to intoreat a li ehtinto ei ahtlig atweig and i e o t mas an edication thro o r t roug o that our o will give ou me hication are asolee rin areraslee er t atd ou uring surger

at an e e t imme iate after r er ollowing surger ou will e trans erre to t e ntensive are nit or t e irst our to si ours a ter our surger ou will e aslee sometimes ou will e e t aslee longer i re uire ou can e ect to sta in t e or a ro imatel to ours a ter our surger ut occasionall t is is longer i ou re uire s ecial me ications or treatment our me ical team will eci e w en ou are a le to move to a war en ou irst awa en rom t e anaest etic o not e alarme i ou eel some iscom ort ou will uic l receive ain me ication to relieve it on wa ing ou will notice t at ou are connecte to a variet o monitors an e ui ment ese tu es ma seem aw war an uncom orta le ut are im ortant or our recover lease in a etaile list elow reat in t e ollowing surger ou will ave a reat ing tu e in our win i e to assist ou wit our reat ing w ile ou are aslee is will e remove as soon as ou are awa e enoug to reat e or oursel ter t e reat ing tu e is remove ou ma in t at or t e ne t ew a s our t roat coul e a little it sore an our voice ma soun oarse eart monitor ou will e attac e to a e si e eart monitor electro es t at continuousl monitor our eart rate an r t m ntra eno ine ntravenous lines are use to su l lui an me ication to ou e will e remove w en a ro riate e tt e ou ma notice t at ou ave one or more c est tu es lace ust elow our incision wra e in t e ressing t at covers t is area ese tu es el to rain t e e tra lui rom insi e our c est our c est tu es will remain in lace or a a or two a ter surger an will e remove w en t e elai e amount o lui raining t roug t em slows or sto s rinar at eter cat eter rains our urine rom our la er an is usuall remove once ou can wal wit out assistance to t e at room or on octor s or ers t icall on t e secon a a ter our surger n i ion ou will ave an incision on our c est an e en ing on t e t e o surger ou ma also ave an incision on our arm s or leg s ese ressing will remain in lace until at least our a s a ter our surger w en our nurse will remove t em n most cases a ressing will not e rea lie ometimes ou ma ave a s ecial vacuum ressing t at is use ul or certain atients is will sta on or a out a wee a in ire ter surger our eart ma nee tem orar electrical su ort to el it eat w ile it is ealing em orar acema er wires are inserte un er our s in uring surger an can e attac e to a small acema er o acema er wires will e remove w en t e are no longer nee e ar iot oracic atient n ormation oo let June age

at o nee to no a o t t e nten i e are nit o o m re ati e or i nifi ant ot er o tain information e can tele one t e in ormation at an time or Ashford Hospital ICU Flinders Private Hospital ICU r e e Hospital ICU e sta re er t at ust one erson rom t e amil ring or in ormation is erson can ass on relevant in ormation to ot er amil mem ers rien s nterstate an overseas relatives ma call t e unit irectl i itin o r our amil can visit at an time ecause mornings are o ten a us time visiting a ter am is re erre ut t is ma not e ossi le our amil ma ave to wait in t e waiting room ell our amil to use t e one t e oor o t e u on arrival sta are us wit atients it ma ta e a little w ile or t em to answer atience is a reciate lease limit visitor num ers to no more t an two eo le at a time Infection Control o rotect ot ou an our relatives rom t e ris o cross in ection our amil an rien s will nee to was t eir an s an t en use alco ol ru eac time t e enter an leave t e unit or a ter using t e at room toilet acilities lco ol gel is ensers are locate t e sin near t e entr n some circumstances our amil an rien s ma e as e to wear a gown an gloves w en visiting lease note t at in or er to maintain atient con i entialit it ma e necessar to restrict t e in ormation rovi e over t e one an to ot er ersons ot er t an t e rimar or secon ar contacts i enti ie t e atient our surgeon will usuall contact someone ou ave nominate at t e en o our surger our amil an rien s nee to wait a out one our a ter t at time e ore visiting ou in t e age

at an e ar e t on e am tran ferre to a e surgical war aims to rovi e a sa e an caring environment w ere ou an our amil will e treate wit ignit an res ect ta un erstan t at coming into os ital can e a stress ul time an t ere ore will listen to our nee s act on our concerns an rovi e e cellent ealt care ocusse on our com ort an well eing ollowing our trans er rom t e ou will e reviewe our surgeon a car iac nurse as well as ot er sta involve in our care an ma e an ta e te e one a isiting ours are etween an m e a vise it ma e ina ro riate or c il ren or in ants to e roug t into t e war environment lease iscuss t e a ro riateness wit t e nursing sta rior to arrival e also olitel as t at an visitors w o are unwell wit lu li e s m toms or gastroenteritis lease re rain rom visiting en are mea time es ou can ma e outgoing an receive incoming calls on our mo ile or ou can ma e lan line one calls rom t e one ne t to our e one calls to t e os ital rom amil an rien s will e ut t roug to our room w en t e call en are i itin lease note t at visitors ma e as e to leave t e room so t at t e octor or nurse can rovi e ou wit treatment or care o r am rea ast etween am unc etween inner etween u er aroun am an m an m m an m m ewl a mitte atients ma receive a set meal lease let our nurse now i ou ave a s ecial ietar re uirement ou ma ave visitors out o t ese ours ut t is nee s to e arrange wit t e nursing sta motiona e ein ere ma e times ost o erativel t at ou ave eelings o a re ension an ear is is uite normal on t esitate to s ea to our nurse a out t is ou are eeling tire an o not want to receive visitors or nee to restrict t em lease s ea to our nurse elai e ar iot oracic atient n ormation oo let June age

ar mo ement after o r n t e ast car iac surger atients remaine in e or several a s a ter t eir o eration to romote rest an ealing owever researc as s own t at t ere is ene it in getting u out o e an moving aroun as soon as ossi le a ter our o eration ese a vantages inclu e im rove lung unction re uce ris o loo clots revention o neumonia ecrease lengt o sta an less loss o muscle tone ven wit t e tu es an rains still in our o an o ten w ile still in intensive care ou will e encourage to get out o e wit t e el o nursing sta an a siot era ist is ma e i icult at irst ut ou will ave lent o el an e sa e an su orte ever ste o t e wa r er arlier movement a ter surger ma start t e evening o our o eration inclu ing en ing an straig tening our legs almost as soon as ou are awa e angling our legs over t e e si e gentl sitting out o e in a c air or even a small wal i ou are a le n t e irst a a ter our surger i ossi le ou will trans er rom t e e to t e c air two to t ree times an gentl wal in t e room an allwa n a two onwar s t e siot era ist an nursing sta will continue to increase our mo ilit to el ou get ac to moving as muc as ossi le as soon as ou can a ter surger

o o ontro m ain after m o eration en in ur to t e od ill ave a lot o ain occurs as a ter m o eration in surger ain u i u ses are sent to t e rain e a ount o ain ou ave varies ro erson to erson o e eo e ee a ot o ain ot ers not ver uc are t e e ert on our ain n now ow uc ain ou are ee ing ain o owing surger is good or ou t is i ortant or ou to e co orta e enoug to ta e dee reat s and coug to e a e to do our e ercises or to get out o ed and wa ain revents ou ro doing t is co ications can occur ere are severa wa s to contro our ain or ost eo e strong ain i ers given out or in ection a e su icient or eo e aving a or surger ot er et ods are avai a e ease discuss t ese wit our anaest etist How will my pain be prevented or relieved PLEASE REMEMBER ain i ers cannot a wa s re ove our ain co ete o e disco ort a sti e resent ut we wi do our est to a e ou as co orta e as ossi e ow will t is i ortant ou te t e nurse now our nurse uc ow muc ain it urts ave ain is ou s ou d a so te our nurse i ou are ee ing sic so t at an nausea can e treated on t wait to e as ed or t in t at ou are eing a nuisance ou wi a so e as ed at regu ar interva s ow uc ain ou ave w en ou are resting and w en ou are oving or coug ing ou wi e as ed to rate our ain on a sca e o w ere is no ain and is un eara e ain ou a re er to descri e our ain as i d oderate or evere 0 NO HURT 2 4 6 8 10 HURTS A HURTS A HURTS EVEN LITTLE BIT LITTLE MORE MORE HURTS A WHOLE LOT HURTS WORST elai e ou wi ro a re uire strong ain edications or two to t ree da s a ter surger t is ti e our wounds ave egun to ea and our ain is uc ess owever ou a ow long will m ain last ave so e disco ort or so e ti e is can e contro ed si e ta ets suc as araceta o wit er a s t e occasiona stronger ana gesic ou ave ain ust te our nurse or a ter disc arge our ccasiona ou a e erience side e ects suc as di iness con usion or a ucinations ro t e stronger ain edications a ucinations are w en ou see ear s e taste or ee so et ing t at is not t ere et our doctor or nurse now i ou e erience an side e ects so we can c ange our edication to so et ing ore suita e or ou ar iot oracic atient n ormation oo let June age

Information about having a blood transfusion This information sheet explains why you might need a blood transfusion and what to expect Talk to your doctor about why you need or may need one and if there are other options in your case Why might I need a blood transfusion You may need a blood transfusion if You lose large amounts of blood in surgery childbirth or after a major accident Have anaemia lack of red blood cells that cannot be treated with iron or other vitamins alone Your body cannot make enough healthy new blood cells This may be due to a bone marrow problem or the effects of chemotherapy What are the different types of blood transfusions Blood donations are split into different parts and stored in special bags or bottles You can then be given just the part that your body needs The 3 main parts include Red blood cells which carry oxygen to tissues and organs Platelets which help stop bleeding Plasma which contains blood clotting factors to help stop bleeding and also other proteins and antibodies What are the risks of blood transfusion Australia has one of the safest blood supplies in the world but as with all medical procedures a blood transfusion is not free from risk The most common risks of transfusion include Minor reactions such as a mild temperature or skin rash Fluid overload causing breathing difficulties especially in older people and also other proteins and antibodies Risks of transfusion which are very low include Receiving blood that is not matched to you Severe reactions for example allergy or acute lung injury Transmission of infection for example bacteria or viruses Staff are trained to watch closely for reactions and to respond quickly How is a blood transfusion given Blood is dripped into a vein usually in your arm or hand using a soft plastic tube Each pack of blood a unit can take up to 4 hours but can be given more quickly if needed Clinical staff will do strict checks of your identity when a blood sample is taken and again just before your transfusion It is important you wear an ID band and state your full name and date of birth when asked This is to prevent you being given the wrong blood meant for someone else Speak up if there is any problem when staff check your identity Make sure that your details including spelling are 100 correct Department for Health Ageing Government of South Australia All rights reserved BloodSafe TP L3 806 v2 0 2016 page 14

ost people feel no different during their transfusion Some develop a slight fever chills or a rash These are usuall due to a mild reaction or allerg These can e treated with medication to reduce fever or giving the lood more slowl Staff will carefull monitor ou for an pro lems during the transfusion This means checking our pulse lood pressure and temperature at regular times f ou feel at all unwell during the transfusion it is important that ou let the nurse know straight awa Treatment is our choice ou have the right to refuse ut need to full understand the conse uences of this efore doing so f ou have an reason for not accepting a lood transfusion please let our doctor know now h do need a lood transfusion hat are the enefits and risks in m case Are there other options An thing ou don t understand are concerned a out or want e plained f ou are having planned surger s there an thing can do to reduce m need for lood transfusion Am starting out anaemic or low in iron and how can this e corrected s it possi le to collect and return m lood that is lost during this operation ou need to tell our doctor if ou Have an reason for not accepting a lood transfusion Have had a reaction or pro lem with a lood transfusion in the past now that ou have an special transfusion re uirements or needs Are on an lood thinning medication such as aspirin warfarin clopidogrel api a an da igatran rivaro a an which can increase the amount of leeding f ou are having surger ask our doctor whether these should stop efore the operation and when Please remem er for our safet onl our doctor can make this decision ecause the risks of stopping ma e greater than the enefits Are taking an other medications including her al and those availa le over the counter without prescription as some of these can also thin the lood f ou have an concerns no matter how small ou think the ma our doctor nurse or midwife e ou should talk with f ou have access to the nternet and want to find out more a out transfusion ou might find the following we site useful www mytransfusion com au Department for Health Ageing Government of South Australia All rights reserved BloodSafe TP L3 806 v2 0 2016 SA Health Safety and Quality Community Advisory Group SQCAG Adelaide Patient materials at www sahealth sa gov au bloodorgantissue ardiothoracic Patient nformation Booklet June 2020 page 15

Who will make decisions if I cannot o arei roma e i ion there le e a ter ere arer er ro em of tr heart o after a noto er a eart le to ra er e o deci r care ma ion nota oe at oe to ma e e i ion a o t o r are n the nli el e en that o cannot co nicate ith o r a il or n t e unli el event t at ou cannot ocommunicate r healthcarewit tea our hoamil o orld our o ealtant deci ion ow to woul e adeouorwant care team o ecisions a o t too reon maoin e orhealth ou acare out our arran ongoing ealt and careother living li in e ent arrangements an ot er ersonal er onal atter And ho o ld woul wantor to omatters ant ton awe otho e deciouion ma e t ose ecisions or ou o anCare e are ti e allows irecti ire e allo o AnnAd ance ou to to write own our wis es re erences riteinstructions do n o r ori he an our uture re erence ealt care and en in o litre ction living or o r t re health endmatters o arrangements and care personal lian e li orin arran e ent and atter and uorstitute aer onal oint one or more to ma e tit t ese A ecisionoint oneaorers ore te ecisions on our e al i ou are eci ion a er to a e the e una le to ma e t em or oursel if annot An Ad ance Care irecti e i e tho e ho a o tareo irective a clear gives t ose n care vance nder tandin o ar clear need and w o care a outo ou un ourenee i heerstan ho ing ld oo lo o rsaanilit to wis es s oul ou lose a ilit to co nicate the or oourr el communicate t em or oursel n vance are irective re laces An Ad ance e re lace e isting n Care uring irecti ower o e iuar tin ians nd i rin e oicaler ower o ardian an hi ntici edical o on ttorne atoro er irecti Attorne and Antici ator irection t will give ou eace o min t at t ose caring or ou will now w at ou want tw ill e are o una eaceleoto ma indethat en i ou our own ecisions tho e carinor communicate or o ill noour wis hat es an o values ant hen o are na le to a ee itocontains r o n deci or are t e ionvance irective orm an a ste co nicate o r i he and steal e gui e t at gives ou ever t ing ou nee to com lete our vance are The it contain the Ad ance Care irective orm inclu ing e am le irecti e or in ormation and a te or u testitute statements ide that ai eers owitnesses e er thin ecision an o need co lete r Ad Care inter to reters act s oeets an ance ot er resources an lin irecti e or incls din e a le tate ent in or ation or tit te eci ion a er itne e and inter reter act heet and other re o rce and lin deci ion on o r ehal i o are na le to a e the or o r el e it an orm can e ownloa e The it and or atcan e do nloaded online or ree online or ree atwww advancecaredirectives sa gov au www advancecaredirectives sa gov au ar coco o othe t eorormcan cane ordered e A hard or ere one calling ervice hone callin er ice A on d rin on uring usiness ine ho r ours Cardiac r er atient atient n or ation oo letoo cto er elai e ar iot oracic n ormation let June page1 age

Your hospital journey The ollo in de cri e a journey t ical ath a Your o r hospital o ita o rne thro h ho ital a ter heart r er o r e erience a di er ro thi d e to o r er onal circ tance The ollo in de cri e a t ical ath a thro h ho ital a ter heart r er ollowing ical d ate to wao tr roug ter eart surger oareeo erience aion di es er arot thi er onalos circital atance Ad i escri our eHealth erience i er i rom to o ourr ersonal ion t ois ue ill ee r eon ancircumstances anae theti t and a Staffma n ad h iothera i t o r r eon ill di c o r r er ith a of a mi ion o mission eTests and ff on a ill ha e ou will see our surgeon an anaest etist an siot era ist our surgeon will iscuss our surger Investigations a lood te t incl din lood t e wit ou A che t ra will ave Tes s ou eart rh th te t C es o s loo tests inclu ing loo t e ei ht ei ht lood re re l e and te erat re ill c est ra Assessments o are a dia etic e ill chec o r lood e recorded eart r t m test ar le el ressure ulse an tem erature will ssessme s eig t weig t loo Treatments and A n r e ill ha e o r od read or r er e recor e ou are a ia etic we will c ec o ourill loo Medications ta e o r nor al edication nle the doctor ha sugar level in or ed o other i e nurse will s ave our o rea or surger ou will ta e TreManagement me s Pain o r anae theti t ill di c the t e o ain relie o ill ha e e o s our normal me ications unless our octor as in orme ou ill need to ho er ith r ical on e the ni ht rior Hygiene oto erwise eme Activity and e e Safety Nutrition and Hydration fe Elimination ur o Your Individual r o Needs m o Education and our Planning u ee s u o to r er and the ornin o r er a ter o r ho er our anaest etist will iscuss t e t e o ain relie ou will lea e ave e do not e talc deodorant or er A h iothera i t ill e lain ho to er or dee reathin ou co will nee s ower witthesurgical s onges t e reathin nig t and hin etoerci e and e o the T rior to surger an t e morning o surger a ter our de ice ill e e lained s ower lease o not use talc eo orant or er ume othin to eat or drin ro idni ht on the ni ht e ore the siot era ist will e lain ow to er ormt ee reat ing o eration or a directed o r anae theti an coug ing e ercises an t e use o t e reat ing The n rwill e eillea laine o to ro ide a rine a le or te tin evice on ad i ion ot ing to eat or rin rom mi nig t on t e nig t e ore t e a toral er ice are a aila leouroranaest o r etist irit al reli io and o eration or as irecte e otional need Tran lator are al o a aila le lea e a oe rnurse n r ewill as ou to rovi e a urine sam le or testing on a mission The n r e ill e lain o r o eration and hat to e ect astoral services are availa le or our s iritual religious an d rin o r ho ital ta lea e a the n r e an e tion emotional nee s ranslators are also availa le lease as that a e orr in o our nurse A ei nurse char ewilllannin i a an aila wle at to toro e lainCoordinator our o eration e ide ect hel or ad re ital ardin in as at ho a teran di char e uring ouriceos sta ana lease t e enurse uestions t at ma e worr ing ou isc arge lanning oor inator is availa le to rovi e el or a vice regar ing managing at ome a ter isc arge elai e Cardiothoracic ar iot oracic atient June Adelaide atient nnormation or ation ooooletlet cto er age page Adelaide Cardiothoracic atient n or ation oo let cto er page

o aa of rr er er ee ore r er me edication a ee given i en totohelel oou rela Treatments and ore surger ication ma Treatments and Medications rela o sta tintae in ollowing ed ollot is in me thi ication edication o ou must Medications ill ter thi ouha wille oaveen o agen a ter t edication is me ication hen it i ti e or o r r er o ill e ta en to Theatre T e re en it is time or our surger ou will e ta en to t e the o eratin theatre ith o r n o erating t eatres wit our nurse r en anaest etist will insert an anae intravenous t en ou me line ication An theti t line ill an in ert an give intra eno and to thenel i eou rela all aslee eatre wa e u in t e o an edication to hel ter o trela andouallwill a lee ntensive are nit A ter theatre o ill a e in the nten i e Care nit Tes s ter our surger ou will ave es o s loo tests Tests and A ter o r r er o ill ha e c est ra Investigations lood te t eart r t m test A che t ra ssessme s ter surger ou will e trans erre to t e ntensive are eart rh th te t C nit ou can e ect to sta in or a ro imatel Assessments A ter r er o ill e tran erred to the ours ut occasionall t is is longer inten ou iree Care uire nit C o can e ect to ta in C or a ro i atel s ecial me ications or treatment our loo ressure ulse ho r erature t occaanionall i lon will er i eoc re tem wounthi rains ec eire re ecial uentl edication loode reto are reatl ing e ou will aveora treat reat ent ing tuo erattac te erat nd drain once ill e ou chec re eentl mac ine treisand will oe remove caned reat or o oursel will nott eeaattached le to tal towa ilereathin t e reatachine ing tu e ill ha e a ou reathin is in lace thi ill e re o ed once o can reathe or o r el o eme ill not e a le to tal ter surger intravenous A ter r er hile the reathin t e i in lace ain me ication will e given via a ri or ainline edication ill e i en ia a dri or Pain Management intra e oreeno surger line ou will ave a s ower wit a surgical s onge e e eter oresurger r er ou o willill ave ha eaawas ho in er eithina t er ntensive ical on e Hygiene are nit fe Activity and Safety u r o and Nutrition r o Hydration Elimination m o page age A ter r er o ill ha e a a h in ed in the nten i e ter our Care nit surger a nurse will move ou rom si e to si e regularl outo willidee re larl A ter r to errelieve a n r eressure ill oone our o sroin ide encourage ing e ra ercises to relie e reto commence re on o r our in ee o illreate enco ed to ou ma e as e to sit out o e or e ta en or a small co ence o r dee reathin e erci e o a e a ed wal i ou are a le to it o t o ed or e ta en or a all al i o are a le ter surger A ter r er oou ma a haave e aadriri toto give i e ooul lui id s o ou a mae iaveosi sater o water ice w t e reatt ing tu e een as ha or ice orhen theenreathin e ha een remove re o ed A ter r er ou o will illave ha aetua et cat e eter catheter ter surger in ourin o r la er an ladder and ou o willill ave ha ewoun o ndrains drain ese Thewill e eill e c ec e regularl our nurse chec ed re larl o rn r e

Day after surgery a 1after r er Health Staff e ff es Tests oand s Investigations o willill eereviewe re ie ed t the r eon and ou e C Tea eam oourr surgeon an aa hsiot iothera i t ill i it d rin the da era ist will visit uring t e a rin the da o ill ha e uring t e a ou will ave loo loodtests te t estt ra Acche ra eart r test eart rh tht mte t C loo ressure ulse tem erature an reat ing will e Tes s Assessments loode re re l ou e te re and reathin ill via a c ec regularl ma erat receive a itional o gen ssessme s mas or nasal e chec ed res ecs larl once t e reat ing tu e as een remove o a recei e additional o en ia a a or na al the reathin t e e hato a een remonitor o ed Tre me s ouecwillonce continue to e attac eart e o s will e etogiven via an toline an mout and orall o ications ill contin e attached a heart onitor Treatments and me ou are rea also line aveand in ections er edication ill e i ou enma ia an o un th orall Medications once our s in to give ou loo t inning me ication once o are read o a al o ha e in ection nder o r egular ain me ication will via an line an in to i e o lood thinnin e given edication orall i our reat ing tu e as een remove Pain Management e lar ain edication ill e i en ia an line and orall ha assist een reou oto ed nursei ano r reathin siot erat istewill sit out o e start t eere an give ou andHygiene fe o ou ill gentl e hel wal ed ing moving ith a ed aa houtho eme leg e ercises to o in e ontinue ee reat ing Activity and A n r e and h iothera i t ill a i t o to it o t o ed e ercises an using our ug a illow to coug Safety tart entle al in o in a o t the ed and teach o Hygiene le ou ewill a e was s ower ercie e eltoedowit in ed ur o r o Contin e an erci elui and in t eo reat r T ing ou will eedee given reathin a lig t iet s once co h tu e aasilloeentoremove Nutrition and o willill roe ai en a li ht diet ande l cat id eter once in theour reathin ou l still ave a tu la er m o Hydration tourechaest een rains re ma o ede remove to a ourElimination u ee s o maill ro a l erre till hatoet aet war e catheter ou e trans to a in o r u o Your Individual Needs so our an a nurse e tranor surgeon erred to the ver one is ere to el ou ladder o r che t drain a e re o ed toda uestions ard toda ou mig t ave o r n r e or r eon an e tion Education and A i ht ha e er one i here to hel o Planning Adelaide Cardiothoracic atient n or ation oo let cto er elai e ar iot oracic atient n ormation oo let June o page age

a a ter r er o r r eon and a h iothera i t ill i it d rin the da r e ill care or o thro ho t the da Health Staff a afterand rAnerte t ill e ordered o r r eon a re ired Tests Investigations e ff our surgeon an a siot era ist will visit uring t e a ursesre will care e a reathin lood re orl e outet roug eratoutret and ill Tes s enchec edwill re elarl tests or ere our surgeon as re uire es o s o ill e ei hed toda e ore rea a t Assessments ssessme loo in ressure an The reat o enulse thi tem a erature e cea ed lineing inwill o renec Treatments and s recei ec e Medications orc che t regularl ill re ain ou will e weig e to a Tre me s e o s or c est will remain Hygiene The n r e eme Activity and Safety e ore rea ast ain edication thro h o r a e to ed a directed receiving o gen t is ma e cease lineor in ain our relie nec o r doctor and ta let or in ection ieen Pain Management a a it o ith ha in a ho er ain me ication t roug our ma e sto e as irecte A n r e and h iothera i t ill a i t o to it o t o our octor an ta lets or in ections given or ain relie ed and entle al in o in a o t the ed Contin e e edeee nurse ma eassist wit aving reathin erci eouand in oa sr Tower Nutrition and Hydration fe Elimination ur o r o nurse a ha al diet an e a nor siot era ist a willtolerated assist ou to sit out o e an gentle wal ing moving a out t e e ontinue ee Thereat n ringe e ercises ill a ian ousing ha eour o ened o r o el The t ou e ma in o ave r aladder re o ed not re io l normal aiet ase tolerate o done o r che t drain a e re o ed toda nurse ave o ene our owels e dre willin aso ri o ou n clothe o r ndimid alo o ecan in our la er ma e remove ill eet not reviousl one eed and Atu i echar e lannin Coordinator ith o and maho eeremove a e d cation di our c c est anarains in at a ter di to char our u ee s u age o ou can ress in our own clot es isc arge lanning oor inator will meet wit iscuss managing at ome a ter isc arge ou an

a a after r er a eter rff erour surgeon an a siot era ist will visit uring t e ao r urses care ou t roug r eonwill and a hor iothera i t out ill t i eit da rin the da Health Staff e ill caree or or ere o thro our hosurgeon t the daas re uire ost Tes s n r tests will es o s An atients loo test te t ave ill ae ordered o r r eon a Tests and re ired o t atient ha e a lood te t Investigations ssessme s loo ressure ulse tem erature an reat ing will e re l ou e te re and ill Assessments c lood ec e reregularl will erat e weig e ailreathin e chec ed re larl o ill e ei hed dail Tre me s our eart monitor ma e remove to a e o r heart onitor a e re o ed toda The C C e Treatments and e o s entral enous at eter in our nec or c est ma Medications remove Central toeno Catheter r nec or cheeen t receive a e a once loo in testoresults ave ave acing wires t ete ma e remove to recei a our re ou o ed toda once lood t re lt ha e een ed surgeon ma e cireanges o hama e acin the to aour eme re ications o ed toda o r eme egular r eon ain a mea ication e chan will e toe orovi r eedication ee nurse lar ain edication ro ided will assist ou witill se owering Hygiene The n r e ill a i t o ith ho erin ou will commence wal ing s ort istances t ree to our o aill co ence al in hort di tance ti e a Activity and fe times a ou can sit out o e or meals ontinue ee it o t an o ed or our eal Contin e dee Safety da reat oingcan e ercises using reathin e erci e and in o r T Pain Management e e ur o ormal iet as esire Nutritionr and or al diet a de ired o Hydration m o e tu e in our la er will e remove i it asn t alrea Elimination The t e in o r ladder ill e re o ed i it ha n t alread een ene oourr o owels een Thee nnurse r e will ill aas ii oou haave e oo ened el our u Your Individual ee s Needs page 8 ress in our own clot es re in o r o n clothe

a a ter r er Health Staff a after o r r eon and a h iothera i t ill i it rr eer ill care or o thro ho t the da Tests and o ill ha e a che t ra and C toda siot era ist will visit urses will care e ff our surgeon an a Investigations An other t illoute tordered o r r eon a re ired or outet roug e a Tes s Assessments ave a lc e est an re andto reathin a loodourewill re te raerat ill es o e s chec n ot er tests will e or ere our surgeon as re uire ed re larl o ill e ei hed dail ssessme Treatments and os r loo reatand ing will e o ndressure ill e ulse chec tem ed erature o r anr eon e regularl weig edre ailin Medications o rcnecr e ill re o e ou an will re eainin Regular medication Tre me ourpain woun s will e cwill ec be e provided our surgeon an our Pain Management nurse will remove an remaining ressings e ons Hygiene The nurse will provide you with assistance with showering if emeneeded egular ain me ication will e rovi e iothera t ill ith a ho wite es erci e lan Activity and e oe r eh nurse will irovi e hel ou wito assistance owering i reathin e erci e and in o r T nee eedee Safety Contin e lar eriod encoel ra ou edwitAi a toomeale aro nd the ourre t siot era are ist will ercise lan fe ard ontinue ti eeed rin the da reat ing e ercises an using our Nutrition or egular al diet rest erio s are encourage im to wal aroun t e war t ree to our times a a Elimination The n r e ill a i o ha e o ened o r o el ormal iet ur o o ha e an concern a o t ana in at ho e lea e Your Individual di c e nurse ith the i char e ave lannin Coordinator Needs m o will as i ou o ene our owels e ade aorout helmanaging and e ati ome ent hire or our uarran e ou ent ave can an concerns lease o ret e arge lanning oor inator ee sheniscuss wit rnt ho e isc cananie ema or ele an e ui Coordinator ment ire orto Education and A arrangements o r n r e to or a ei char lannin ou return ome Planning i it w i en o need to ea to o eone a o t o r care at ho e italto The n r ea ill c o r di char u o a ter lea s in ourho nurse organise iscdi arge lanning oor einator arranto evisitent i ou ith nee o to s ea to someone a out our care a ter leaving os ital e nurse will iscuss our isc arge arrangements wit ou age

aa a ter after rr er er Health Staff e ff o r r eon and a h iothera i t ill i it our surgeon an a siot era ist will visit e t roug ill careoutort eo athro ho t the da or rou urses will care Tes ests Testss and Te t are are usuall all not re uire ired at at tthiis stage ta e es o s Investigations ssessme s loo Assessments lood ressure re re ulse l e te re and ill ee tem erat erature an reathin reat ing will cchec ec eed regularl re larl Tre me s and Treatments e o s Medications eme Pain Management Hygiene e e Activity and Safety fe ur o Nutrition ou arge o willill ee re re are ared or or diiscchar e egular ication will e e lar ain meedication ill ee rovi ro ided el care care ress re in n clothe el in oourr oown clot es Your physiotherapist will help you with your exercise plan You our siot era ist will el ou wit our e ercise lan may climb the stairs today with your physiotherapist if you ou ma clim t e stairs to a wit our siot era ist i need to climb stairsstairs at home ou nee to clim at ome ontinue ee reat ing breathing eContinue ercises deep an using our exercises and using your TRIFLO ormal iet or al diet e nurse ene oour m o The Elimination n r e will ill as a ii oou haave e oo ened r oowels el our Individual u Your lease re uire an thin t ing or or need nee an answers to lea e as a ii oou re ire an er to ee s uestions Needs e are here to hel we are ere to el e tion Education o r nurse n r e will ill con con irm ir our o r diiscchar e arran e ent arge arrangements t some u o and our Planning time ost oo erative ar iac urger At o uring e ti eour d rin r o t o erio erati te e eriod the Cardiac e r aerilitation rogram t roat ra is availa ourlearea e eha ilitation that ileainaila in owill r area iscusse wit ou ill e di c ed ith o

i char e i ar e Health Staff An a oint ent ill e ade or o to ee o r r eon in o ee will a tere ma o reo or eration ointsurgeon ent ill e ff an oa t tointment ou to An seea our in o etwo ade eeo oeration r cardiolo a o t will i also aal out wee or s aotertoour n ai t in ointment eee ma tie or ou to see our car iologist in a out si wee s e lea e a or the e a oint ent detail e ore time a ro ointment ore tate ou o lealease e ho asital or t oeseare the co etails ntr oreinter leave ital to ee ou are t e countr o aosneed o r rom r eon rior to or retinterstate rnin to ou o r ma nee to see our surgeon rior to returning to our ome ho e Tes s n tests t at ou nee a ter isc arge will e e laine to Tests and An te t that o need a ter di char e ill e e lained to es o s ou our surgeon Investigations o o r r eon ou will continue to ave our loo ressure ulse ssessme s Assessments o ill contin e to ha e o r lood re re l e tem erature an reat ing c ec e regularl until isc arge te erat re and reathin chec ed re larl ntil di char e armacist to o ou aa ooutt the t e me ications Tre me sand A har Treatments aci t or or nurse n r e will ill s ea ea to edication ou will e ta ing ome wit ou on isc arge e o s o Medications ill e ta in ho e ith o on di char e our woun s an ressings will e c ec e rior to isc arge o r o nd and dre in ill e chec ed rior to di char e eme ontinue to ta e regular ain me icine a ter ou go ome as e resurgeon lar ain s edicine a ter o ouoma ho eave Pain Management Contin rescri ee to ta our an uestions re cri e tion o a aa out ain ed control o r r eon A an e e Hygiene Activity and fe Safety ur o r o Nutrition and m o Hydration ha e a o t ain control el care ress in normal a clot es el care dre in nor al da clothe ontinue to wal an e ercise a ter ou go ome as Contin e to al and e erci e a ter o o ho e a iscusse wit our siot era ist ontinue our ee direat c ing ed e ith o r h iotheraour it ercises an using Contin e o r dee reathin e erci e and emem er t at ou cannot rive or our to si in weeos r an Tou must a ter not liot ano thoinge eavier t an ive ilograms or e wee e s er that o cannot dri e or ee and o not li t aniet ei ht hea ier than or at lea t ee ormal or al diet ontinue wal ing an consti ation rin ing lent o water to revent Elimination Contin e al in and drin in lent o ater to our u e nurse willtie ation lain ow to care or our woun s an re ent con ee s revent in ection Your Individual The n r e ill e lain ho to care or o r o nd and u Needs o ou isc arge wit me ications an a ollow u re will ent ine ection a o ointment ee edter m arge rom ital w at ill e di char ith isc edication and aosollo Education and now on age an see me ical el i ou ave an Planning a oint ent ee A ter o r di char e ro ho ital rohat lems o oston isca earge and ee edical hel i o ha e an page age ro le o t di char e t

What can I do by the time I am discharged at an o t e illtime e a le toam i the ti e o are di char ed o al cli hort di tance t e time ou are isc arge ou will e a le to a li ht o tair wal s ort istances ho er itho t er i ion and clim a lig t o stairs re are li ht eal s ower wit out su ervision an a o lig ere a le to do the e thin rein are t meals assuming ou were a le to o t ese t rior to di char e o ill recei e a h rior iothera ro ra ou awillcrireceive t or an to isc arge a ne siot edication arogram di char aescri lant or an era new me ication a isc arge re ardin reha ilitation or ho elan care i regar ing re a ilitation or ome care i nece ar and di char e in tr ction necessar an isc arge instructions o are not di char ed on a a ter ou are not isc arge on a oa rter rour er surger o ill ou e enco ra ed will e dail to carr onail ith o r eon erci encourage to carr wite our ro ra contin e tocontinue eat a health e ercise rogram to eatdiet a iett an as andealt tr to re a tr chtoaresto asi muc le to ave eossi a le o toehaase oou eone a aila le someone availa le to el to hel o at ho e or a eeoua atter ome a wee a ter ou are isc arge oorare di char ed o li e alone ou live alone ave s ecial nee s or ha oe notecial oranion do not ea aveneed a com orhaamil comemanion a il closel e er er tooratten to toouattend or a cloew el ato s oa teror aouereturn da ome a ter olease t e e sta lea ane noti as to the see ttae and retnoti rn ho arge inator a isc to ee the lanning i char eoorlannin Coordinator eel ree to as uestions regar ing our care or lanne isc arge ar e rior to co in to the ho ital ings rior to coming to os ital eel ree to a e tion re ardin o recare or lanned char e ollowing is imdi ortant The ollo in iwi enortant in or ation in ormation recovering rom oreart atient reco erin ro heart surger r er ecover rom eart surger can eco ta er ero heart can t ree mont r ser or longer ta isten e three onth oor lon to our an er o iever ten to o rin od do t ing mo and eration e erou thin oderation areineeling ver tire or sore slow o are eelinowner tired or ore loire do n is normal a ter eart ness surger i o notal ea sur rise i Tiredne nor ter heart rouer eel dostrong not eoner ria edan i o wea t e ne t eel tron one da and tired and atient eae the ne t recover varies rom erson e erson atientto reco er arie ro er on to er on

Going home oin ome Medications Following surgery your medications and e i ation the times you take them may be Following surgery your medications different they them were before and the from timeswhat you take may be surgery different from what they were before yourpharmacist surgery will provide you with a Your detailed medicationwill listprovide which will Your pharmacist you with a detailed list whic will outline anymedication new medications outline any that new are medications medications to be continued medications that are to be continued those that are to be stopped and details those that are to be stopped and of any herbal or vitamin supplements details of any herbal or vitamin You will have an opportunity to ask supplements any questions about your medications You will have an opportunity to ask any aboutthe your medications Bequestions sure to know names of your medications and understand Be sure to know the namestheir of your purpose dose effects and for medications and understan thei thow long you will needeffects to takeand them purpose dose for how Please take the medications as prescribed as there may be serious ovel oral anticoagulants consequences to increasing doses or s are a class o loo t inning me ication missing doses of the blood thinning an inclu e a igatran rivaro a an medication an a i a an ese me ications are Make other in healthcare alsosure e ective re ucing clots professionals Cardiologist owever t Dentist e are not currentl etc a rove or use in atients wit know that you are taking blood thinning mec anical eart valves medication Your healthcare team will determineta ing me type ications t at which of blood thinning medication t ris o is right for you lee ing The effect of warfarin can be Blood thinning medications e i ation for reareentin Blood thinning medications given to oopatientsotafter heart valve surgery some When taking medication that thinss your blood it is important to watch for bleeding this may include frequent bruising bowel movements that are bloody or black urine that is pink or blood tinged vomit that is brown or anticoagulant red severe headaches nose bleeds and severe abdominal pain questions valve orFollowing if they areheart in atrial fibrillation or if ou irregular heart beat n page page224 or an une laine ng or Some patients will be discharged on a blood thinning medication called warfarin There are some important nge things to note about warfarin long you will need to take them Our pharmacist will also work with you to Our pharmacist will also work with you assist in a smooth transition from to assist in a smooth transition from hospital to home Before you leave the hospital to home Before you leave the hospital you will be given a supply of hospital you will be given a supply hosp medication and may receive an medication medi andyou you may receive invoice invoice Your Yourcommunity communitypharmacist pharmacist can further you with any questions can furtherassist assist you with any me ications or t is ur ose t You advised to wear medical re are uires re uent loo atests an alert care ul monitoring to get t e bracelet that indicates that you ose are rig t or ou taking blood thinning medication atc measured through a blood test called team will ealt care etermine anour INR International Normalised w ic t e o or Ratio The INR will indicate how long it takes for the blood to clot If your blood is ou ave a a mec anic too thin you may bleed excessively if valve im lante it ma e ossi le or it ou is not to thin ave enough our ownclots macmay ineform to which can cause serious monitor our war arin s our complications surgeon a out t is e ore isc arge You will initially need regular blood monitoring at least twice a week if you are discharged on warfarin You can do this at a lab close to your home or local GP The frequency of blood monitoring will gradually reduce over time as your warfarin dose stabilises Your GP will adjust your warfarin dose based on the INR results If you have had a mechanical heart valve implanted it may be possible for you to have your own machine to monitor your INR in combination with your GP Ask your medical team about

Travelling Travelling Home ra e in If you have to travel a long distance to e in ome getra home stop for a short walk and ou your ave to travel longhours istance stretch legs everya 1 2 Try to to get ome sto or a s ort wal an have enough room in the car to be able stretc our legs ever one to two to sit and rest comfortably It is ours important that you request pain r to ave enoug room in t e car to medication before you leave the e a le to sit an rest com orta l t is hospital so you are comfortable for the im ortant t at ou re uest ain ride me home ication e ore ou leave t e os ital so ou are com orta le or t e Driving ri e ome ri Youin can resume driving approximately fourriving to six weeks after ou can resume surgery a ro imatel our to si wee s a ter surger your doctor if you have any Consult onsult our octor i ou ave an questions or concerns uestions or concerns Wear a seat belt as it will not harm earincision a seat Itelt it willrequirement not arm your is as a legal our incision t is a legal re uirement that you wear a seat belt even after t at ou wear a seat elt even a ter cardiac car iacsurgery surger A small smallpillow illowmay ma be used under seatseat belt to e use un your er our eltprevent to rubbing You may revent on ru your ing incision on our incision ou matocsitoose toback sit inwhere t e ac choose in the there w ere t ere is no air ag is no air bag PLEASE NOTE If you ou holdola a commercial ve icle licence ouwill will commercial vehicle licence you not e a le to recommence riving not be able to recommence driving commerciall or t ree mont s an commercially for 3 months and will will nee clearance rom our need clearance from your car iologist rior to recommencing cardiologist prior to recommencing riving driving ir ra e is recommen e t at ou o not l Airt Travel wit in ten a s o our surger ut it It recommended that octor you doenot is is est to consult our ore fly days of your mawithin ing an10air travel lanssurgery a ter but iteart is best to consult your doctor surger before making any air travel plans after heart surgery You may need a medical clearance to fly if this is within two to four weeks of your surgery Your surgeon can You may need a medical clearance provide this to l i t is is wit in two to our wee s o our surger our Showering and incision care surgeon can rovi e t is You will shower prior to your discharge from the hospital and o erin an in i ion are resume your normal hygiene habits ou will s ower rior to our once you are home Your incisions isc arge rom t e os ital an may itch or sore tight or numb resume ourfeel normal giene a its for a few weeks Some bruising around once ou are ome our incisions the is also normal ma incisions itc or eel a little sore tig t or numwarm or a not ewhot weewater s ome Use ruising aroun t e incisions is also You may wash your incisions normal gently with soap water let the se warm not and ot water water flowwas over your incisionsgentl but ou ma our incisions do scrub witnot soa anthem water let t e water lowyour overincisions our incisions ut use o not Pat dry do not scru t em powders or lotions on your at our incisions r o not use incisions ow ers or lotions on our incisions Showers are probably better than owers are ro a l etter t an baths in the first few weeks at s in t e irst ew wee s Doonot notswim swimfor orat at least least 6siweeks wee s after a tersurgery surger and an then t en only onl ifi your our wounds have healed woun s ave eale Fo o a ointment Follow up appointments on isc arge nsure ou ave ollow u a ointments wit follow up Ensure you have our ar iacwith urgeon two wee s appointments a ter our surger Your Cardiac Surgeon two weeks our ar iologist si to eig t wee s after your surgery a ter isc arge Your Cardiologist six to eight t is also a vise t at ou ma e an aftertodischarge a weeks ointment see our wit in t e wee advised a ter isc Itirst is also thatarge you make an appointment to see your GP within the first week after discharge Cardiac Surgery Patient Information Booklet October 2017 elai e ou will e given Upon discharge you will be given instructions regar ing our ollow u instructions regarding your follow up a ointments appointments ar iot oracic atient n ormation oo let June page page25

What can I expect after surgery What s at normal an eafteresurgery t after Try to get in a couple of naps during Diet What s normal after surgery minutes helptoyou sleep at nig t it isTo est notget na to ast night m it isinbest not nap past 3 30pm t e atoternoon in athee afternoon sure ou ave a e uate ain Make you have adequate controlsure e ore ou go to e atpain nig t control before you go to bed at gain sical activit ma el night ma e ou tire at nig t w ic ma You may not have much appetite It iet can take several weeks for your ou ma not ave muc a etite t appetite to return to normal Physical can ta e several wee s or our activity may help improve your sical a etite to return to normal appetite activit ma el im rove our a etite Many patients notice that their sense of an taste atients is diminished almost notice or t at t eir sense o taste Itiswill iminis e or almost absent return a sent t will return You may find it easier to eat five or ma meals in it easier to eat ive orof sixousmall per day instead si small meals a instea trying to eat threeerlarger meals o tr ing to eat t ree larger meals Some patients complain of nausea atients com for laina o nausea atome the smell of food week or at ttwo e smell o oo or a wee or two after surgery a ter surger Choose bland foods that do not have a ooseodour lan Try ooeating s t atcold o not strong foodsave as a strong o our r eating col oo s they tend to have a milder odour than as t e ten to ave a mil er o our hot foods t an ot oo s e in Swelling t is normal to ave generalise It is normal to have generalised swelling a ter surger is ma swelling after Thiss may ersist or oursurgery to si wee persist for four to six weeks ou ave an incision in our leg If you have an incision in your leg e ect swelling o t at leg expect swelling of that leg levate our eet w enever ou are Elevate your feet whenever you at rest are at rest voi crossing our legs as t is Avoid crossing as this inter eres wit your loo legs low interferes with blood flow voi soc s wit a tig t an Avoid socks with a tight band ee in Sleeping ou ma in it i icult to all aslee or ou ma in t at ou wa e u at You may find it difficult to fall asleep am or am an cannot all oracyoutomay find that you wake up at slee is will im rove 2 00am or 3 00am and cannot fall r totoget in a This cou will le oimprove na s uring back sleep t e a ut tr to limit t em to minutes o el ou get to slee at page page 26 rtheer day but try to limit them to 45 el wit slee activity may help Again physical make ner youetired e at night which may help with sleep ou ma eel generall tire an ave little energ some atients in Energy levels t e are reat less w en t e e ert may feel generally tired and have You t emselves little patients they is energy is usuallsome normal an find s oul are whenas theyouexert im breathless rove over time recover themselves rom surger This is usuallyto normal t is common ave aanda should w en ou improve over time as eel well an o a lot an to tyou en in recover surgery ou are from e auste t e ne t a It isou common to have a day eel our atigue or when you feel well and do is a lot to thenisfind reat lessness not and im roving getting or isthe more an ou you are worse exhausted nextt day ecte lease see or our octor Ife you feel your fatigue breathlessness is not improving is lease note t at energ levels can getting worse is more than e own a littleoror u to si toyou nine mont s anplease t at see t is your is notdoctor unusual expected Please note that energy levels can be on ti ation down a little for up to six to nine e ain me ication narcotics or months and that this is not unusual iron su lements ou are rescri e can cause consti ation Constipation ou ma use a la ative o our The painormedication c oice as our narcotics armacist or or iron supplements you are prescribed recommen ations can oucause s oulconstipation not go longer t an two You of your a smay wit use outaalaxative owel movement choice pharmacist ingori ask re your to our iet suc as for resrecommendations ruits an vegeta les ig i re reashould s an not cereals ma than el two You go longer days a bowel movement rin without a e uate amounts o lui s Adding fibre your such as fresh ercise willto also imdiet rove owel unction fruits and vegetables high fibre breads and cereals may help

Drink adequate amounts of fluids Exercise will also improve oo bowel function ou ma e erience moo swings an Mood eel e resse is is common an will ass You may experience mood swings ou ma ave goo a s an a and feel depressed This is common a s o not e iscourage and will pass ommunicate our eelings o enl You have good daysers and bad witmayour amil mem days Do not be discouraged ese eelings ma occur or u to Communicate yoursfeelings si to eig t wee ut t e will get etter witht your e last longer iscuss t is openly family members wit our sician These feelings may occur for up to six to eight weeks but they will get better If they last longer discuss this with your physician Special instructions for patients after valve surgery e ia in tr tion for It is important for patients who have atient after a e r er had valve surgery to protect their new t is imfrom ortant or atients w obyave valves bacterial infection a valve surgerbefore to rotect t eir taking antibiotics dental work new valves rom acterial in ection and before other medical ta ing anti iotics e ore ental interventions wor an e or oreoperations ot er me ical interventions or be o erations Antibiotics must prescribed by articularl in t e irst t ree mont your doctor or dentist before and s a ter t e new valve is im lante after these procedures to decrease iscuss t is wit our entist or theoctor risk of an infection that may affect your heart valve igns o in ection can inclu e Signs of infection can include fatigue atigue general eeling o unwell general feeling of unwell fever ever c ills an sweating rrange chills sweating Arrange to seeand our octor rig t awa toi see ou your Doctor right away if you evelo an o t ese s m toms develop any of these symptoms

What if I experience depression at if e erien e e re ion Depression e re ion Experiencing a change in your emotions and depression eriencingafter a c cardiac ange insurgery our is much more common than youamight emotions an e ression ter car iac surger is muc more common t an think ou mig t t in Just talking about it with others can do wonders help Weitare ust taltoing a out witnot otsure ers why can o there prevalence after wonis ers to el foredepression are not sure w t ere is or and e ression surgery butrevalence it is very real usuallya ter surger ut it is ver real an usuall resolves after six to 12 months You may resolves a ter si to mont s need a little additional help getting ou ma nee a little a itional el getting through this difficult time t roug t is i icult time If you answer yes to any of these questions it may be worth contacting your local doctor for assessment and possible treatment ou answer es to an o t ese uestions it ma e wort contacting our local octor or assessment an ossi le treatment D H H H H During the past month Y Have you often been bothered by Beyond feeling down depressed or hopeless 1300 22 4636 Have you often been bothered by having little interest or pleasure in doing things Have you often felt unable to stop worrying or felt you were worrying too much Have you often felt nervous anxious or unable to relax You can also visit Beyond Blue www beyondblue org au for guidance and further information page 28 Blue _____________________________

The following page can be pulled out and placed on your fridge or wall so that you have a guide to your recovery readily available to you

ADELAIDE C ARDIOTHORACIC wit rests a ing e swee ing s o ing e esume se ual activit i a le to wal minutes wit out s m toms anging lig t laun r tairs as a le e u les tairs slowl al ing times ail ills slowl minutes stri ing out start al ing minutes times a a can start stri ing out start ills slowl i ting onl gs i ting onl gs onger utings movies ca es restaurants e u les al ing minutes times a a com orta le ace on lat groun tairs slowl wit rests e u les im le coo ing lig t gar ening watering lig t wee ing avoi us ing ulling an twisting or or wee s as er octor erience o on t e on igging mowing lawn vacuuming as usual riving longer tri s mins or o erate sical wor s ea to car iologist al ing mins twice ail i ting u to gs until ee t en gra uall increase to normal levels an ra uall increase to mo erate activities riving s ort tri s mins or ig t sical wor most eo le wit less strenuous wor can return riving s ort tri s mins or ec wit octor non stress ul es wor e lore arttime al ing mins times ail acuuming wit rest move urniture an or a a ti itie al ing minutes times a a stroll on lat groun i ting onl gs no groceries c il ren etc entle e ercise i e on t lean on arms ou e me m ig t tas s onl ater gar en usting is es avoi us ing ulling an twisting or or wee s as er octor i NOTE THIS IS A GUIDE ONLY en an re eturn to normal s orting activities a ter wee s ontinue a ar iac e a ilitation rogram our ar iac e a team will gui e ou al ing mins twice ail i ting u to gs is ing oat out oor owls ole gol lat course ou les tennis rovi ing reast one is com orta le an not clic ing e erral as een sent to a ar iac e a ilitation rogram e will contact ou at ome i ting onl gs ol utting onl in oor owls is ing w ar eas swimming i woun eale uring or a ter activities

The following page can be pulled out and placed on your fridge or wall so that you have guidance readily available to you

After your discharge from hospital what now fter m i ar e from o ita at no o totooyour r olocal a EMERGENCY or or a call an an AMBULANCE Go f o a e If you have est ain t at eels li e angina or a eart attac Che t ain that eel li e an ina or a heart attac ortness o reat not relieve rest hortne o reath not relie ed re t u ene severe ea ac e dden ere headache u ene severe a inal ominal dden ere a do ain ain rig red t re tool stools lee ing ri ht or orleedin ro romo rouro owels el rigred t re lood loo Co oug hin ing u ri ht ainting ell s ells aintin eart rate aster t an eats er minute wit s ortness o eart rate a ter than eat er in te ith hortne o reat or a new irregular eart rate reath or a ne irre lar heart rate u en num ness or wea ness in arms or legs dden n ne or ea ne in ar or le on i Con er aider incallin or i oritini itino ro or aocalo tor octor o have a e If fyou levate tem erature more t an two times wit in ours le ated te erat re ore than C t o ti e ithin ho r treme atigue tre e ati e ain in cal t at ecomes worse w en li ting toes towar s our ea ain in cal that eco e or e hen li tin toe to ard o r head cute gout lare u Ac te o t lare ersistent lee ing or oo e rom our c est or leg woun o r che t or le o nd er i tent leedin or ooze ro ar ain w en ta ing a ee reat ain hen ta in a dee reath har in ras in ra h rinarTract tractninection ection rnin urning uent rination urination urgenc rinar rere ent r enc oror loo urine lood rine eig t gain o more t an one g wit in ours ei ht ain o ore than ithin ho r orsening an le swelling or leg ain or enin an le ellin or le ain orsening s ortness o reat or enin hortne o reath ew onset o nausea vomiting or iarr oea e on et o na ea o itin or diarrhoea ou ave an o ha e an page a e uestions lease call us at e tion lea e call at or or

What are my rights and responsibilities You have the right to Considerate and respectful care regardless of your beliefs and ethnic cultural and religious practices Know the name of the doctor who has primary responsibility for coordinating your care and the identity and functions of others who are involved in providing care Seek a second opinion and to refuse the presence of any health care workers who are not directly involved in the provision of your care Receive information from your doctor in nontechnical language regarding your illness its likely course the expected treatment the plans for discharge from the hospital and for follow up care Receive from your doctor a description of any proposed treatment the risks the various acceptable alternative methods of treatment including the risks and advantages of each and the consequences of receiving no treatment before giving consent to treatment Also unless the law prohibits you may refuse a recommended treatment test or procedure and you may leave the hospital against the advice of your doctor at your own risk after completion of hospital discharge forms Participate in decisions affecting your healthcare Be informed of the estimated costs charged by the hospital Refuse participation in any medical study or treatment considered experimental in nature You will not be involved in such a study without your understanding and permission Refuse participation in student teaching activities Confidentiality and privacy Details concerning your medical care including examination consultations and treatment are confidential No information or records pertaining to your care will be released without your permission or the permission of your representative unless such a release is required or authorised by law or necessary to enable another health care worker to assist with your care Know before your discharge from the hospital about the continuing health care you may require including the time and location for appointments and the name of the doctor who will be providing the follow up care You also have the right to assistance with discharge planning by qualified hospital staff to ensure appropriate post hospital placement Adelaide Cardiothoracic Patient Information Booklet June 2020 page 37

You have the right to Not be restrained except as authorised by your doctor or in an emergency when necessary to protect you or others from injury Retain and use your personal clothing and possessions as space permits unless to do so would infringe on the rights of other patients or unless medically contra indicated Expect safety where practices and environment are concerned Privacy for visits during established patient visiting hours Make a comment or complaint about the treatment or the quality of the health services or care without fear that you will be discriminated against Have your dietary and other special needs considered You have the responsibility to Respect the privacy and confidentiality of other patients It is illegal to disclose any information about another patient s presence in the hospital or their treatment This includes verbal and digital communication as well as the use of photographs videos etc and information published online and or via any social media platform Violations will be taken seriously and may lead to the discharge of the offending patient and their exclusion from ACHA Health hospitals in the future Civil and or criminal proceedings may also result Provide accurate and complete information about present complaints past illnesses hospitalisations medications and other matters relating to your health Report unexpected changes in your condition to the responsible practitioner Report if you do not comprehend a contemplated course of action or what is expected of you Follow the treatment plan recommended by the practitioner primarily responsible for your care This may include following instructions of nurses and allied health personnel as they carry out the coordinated plan of care and implement the responsible practitioner s orders Keep appointments and when unable to do so for any reason to notify the responsible practitioner or the health care facility Behave in a lawful manner and contribute to a safe and comfortable environment For further information please visit Ashford Hospital and Flinders Private Hospital Rights and Responsibilities http acha org au application files 3014 9396 6030 ACHA036_Patient_Rights pdf ________________________________________________________________________ Calvary Adelaide Hospital Rights and Responsibilities https www calvarycare org au about you rights and responsibilities ____________________________________________________________ page 38

Contact information onta t Adelaide Cardiothoracic ADELAIDE ite e el e el linder ri ate o ital A h ord eciali t Centre CARDIOTHORACIC linder ri e Anzac i h a ed ord ar A A h ord A o ha e an e tion or re ire an rther in or ation lea e do not he itate to contact at Adelaide Cardiothoracic hone at or et een a and onda to rida ail contact adelaidecardiothoracic co uite n ac e ical uites e niteac ig wa adelaidecardiothoracic s or one co a evel a lin ers rivate lin ers rive os ital e or ar one mail contact ecar iot oracic com au References Links anda elai Acknowledgements e site www a elai ecar iot oracic com au A tralian Co i ion on a et and alit ealth Care eferen e in in an A o t the A tralian Charter o ustralian ommission on a et ealthcare i ht A ide or atient an ualit in ealt are con er carer and a ilie out t e ustralian arter o www safetyandquality gov a ealt care ig ts gui e or Ad anced Care irecti e o th A tralia ad ancecaredirecti e a o a no e ement vance are out ustralia irectives eart o ndation www a vancecare irectives sa gov au heart o ndation or a atients consumer s carers an amilies www sa et an ualit gov au _______________ _______________________ _________________________ _________________ ________________________ elai e ar iot oracic atient n ormation oo let June age

Adelaide Community Healthcare Alliance Incorporated ACHA Patient Information Sheet AUSTRALIAN and NEW ZEALAND SOCIETY of CARDIAC AND THORACIC SURGEONS ANZSCTS CARDIAC SURGERY DATABASE and AUSTRALIAN AND NEW ZEALAND COLLABORATIVE PERFUSION REGISTRY ANZCPR Introduction You are about to undergo or have recently undergone heart surgery Generally heart surgery is successful in improving the quality and length of the patient s life with a small risk of death or major complications However in certain people the surgery is less successful This may be due to some people having characteristics that increase their risk of complications or it may be due to the type of operation done and the circumstances in which it is performed Quality Assurance is a vital component of your hospital stay That is to ensure that the results of all surgeons and surgical units remain at a consistently high standard In order to improve the success of heart surgery we need to know what factors increase a patient s risk of complications and which surgical procedures have the most successful outcome To achieve this the Australian and New Zealand Society of Cardiac and Thoracic Surgeons ANZSCTS Cardiac Surgery Database and the Australian and New Zealand Collaborative Perfusion Registry ANZCPR have been set up to monitor the results of cardiac operations These registries aim to record information on every adult having a heart operation The success of these registries depends on the amount of data we collect We are asking you to participate in these Cardiac Surgery registries by allowing us to document information relevant to your operation These projects will be conducted in accordance with the NHRMC National Statement on Ethical Conduct in Human Research 2007 updated May 2015 What Information Do We Need The information we require includes your name date of birth Medicare Number hospital identification number the name of the hospital the reason you are having cardiac surgery and other information directly related to your operation The hospital will also undertake follow up of you at 30 days to collect any relevant health or medical information since your procedure The long term results of heart surgery are equally important to us since it allows us to evaluate the real effectiveness of the various procedures For that reason the registries will retain your information for at least 15 years We also plan to link patient information to hospital administrative and government databases to enable the assessment of longer term outcomes such as mortality No identifiable information obtained from this would ever be published We Will Keep Your Information Confidential Your personal information is confidential and cannot be used outside the registries Procedures are in place to protect your information and keep it confidential Registry data is only accessible by authorised staff of the Cardiac Surgery Database and ANZCPR projects A collective data analysis will be made available through the reporting system of ANZSCTS and ANZCPR and through publications in medical journals You cannot be identified in any reports produced by these registries How We Collected the Information The hospital staff will complete the forms required and the information will be entered onto a database computer Risk and Benefits To You Your information is protected and legally we are not allowed to identify you The registries will produce general reports and medical publications on the outcomes of surgery which we anticipate will improve the quality of cardiac surgery in the future Having your data entered into the registries will not alter the care and treatment you receive You Can Choose Not to Be in these Registries We understand that not everyone is comfortable about having details related to their cardiac condition documented in a registry If you feel this way and do not want this information included please contact the ANZCPR project co ordinator on 08 8204 5382 who in turn will contact the ANZSCTS Project Co ordinator on 1800 285 382 Once you have opted off these registries all your personal identifiers will be removed however your cardiac surgery procedure information will remain A decision on whether or not you wish to be involved in the registries does not affect your treatment in any way If you have any questions concerns or require further information about either Cardiac Surgery Registry please do not hesitate to contact the ANZCPR Project Co ordinator on 08 8204 5382 or the ANZSCTS Cardiac Surgery Database Project Co ordinator on 1800 285 382 These studies has been reviewed by the Southern Adelaide Clinical Human Research Ethics Committee SAC HREC Should you wish to discuss the project with someone not directly involved in particular in relation to matters concerning policies your rights as a participant or should you wish to make a confidential complaint you may contact the Executive Officer of the SAC HREC on 08 8204 6453 page 40 ANZSCTS Cardiac Surgery and ANZCPR Databases Patient Information Sheet Version 1 0 dated 08Feb2016

For more information ADELAIDE CARDIOTHORACIC HEART A D L uite n ac e ical uites n ac ig wa s or ele one R EO evel lin ers rivate lin ers rive e or ele one os ital ar mail contact a elai ecar iot oracic com au ____________________________________ e site ________________________________ www a elai ecar iot oracic com au Terms of use is material as een evelo e or general in ormation an e ucational ur oses onl t oes not constitute me ical a vice lease consult our ealt care rovi er i ou ave or sus ect ou ave a ealt ro lem e ealt in ormation rovi e as een evelo e elai e ar iot oracic an is ase on t e availa le scienti ic evi ence at t e time o writing e in ormation is o taine an evelo e rom a variet o sources inclu ing ut not limite to colla orations wit t ir arties an in ormation rovi e t ir arties un er licence t is not an en orsement o an organisation ro uct or service ile care as een ta en to re aring t e content o t is material elai e ar iot oracic its em lo ees an relate arties cannot acce t an lia ilit inclu ing or an loss or amage resulting rom t e reliance on t e content or or its accurac currenc an com leteness n use o elai e ar iot oracic s materials or in ormation e entire contents o t is material are su ect to co is ocument as een reviewe an en orse consumers in a revise September www ausgoal gov au creative commons All ri ht re er ed Adelaide Cardiothoracic oo let ritten and co iled e i ed September Adelaide Cardiothoracic and ron n rie anot er erson or organisation is at t e user s own ris rig t rotection