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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Cardiology, Cardiovascular Surgery

Family Timeline to Surgery and Recovery-VAD (7905)

Family Timeline to Surgery and Recovery-VAD (7905) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Cardiology, Cardiovascular Surgery

7905



Family Timeline to Surgery and Recovery- Ventricular Assist
Device

Pre-Ventricular Assist Device Implantation

First visit: Heart Failure Team

ξ Complete history and physical exam
ξ Review medical records and test results
ξ Discuss treatment options
ξ Do other tests as needed
ξ Share review of findings with referring doctor
ξ Discuss case with cardiac surgeon

Second visit:

Meet with Cardiac Surgeon

ξ Complete history and physical exam
ξ Review medical records and test results
ξ Discuss treatment options
ξ Plan for surgery (if needed) and time frame to stop any over the counter blood thinners,
aspirin, alcohol, smoking
ξ Do other tests before surgery, if needed
ξ Share review of findings with heart failure team
ξ Review VAD evaluation consent

Meet with VAD coordinator
ξ Review the ventricular assist device system
ξ Review the care the device needs to function well
ξ Review education plan in the hospital
ξ Review normal postoperative phase- length of stay, lines, drains, tubes
ξ Review what you need to do post discharge- staying at a local hotel (if needed),
timeline of lab tests, timeline of clinic visits
ξ Talk about coordination with local hospital, doctors

2

Home instruction: Prepare for Admission
ξ Your loved one should stop drinking alcohol.
ξ Your loved one should stop taking medicines as prescribed by the doctor.
ξ Your loved one should leave all jewelry, rings, large sums of money, and credit cards at
home.
ξ Your loved one should take along pajamas, a robe, non-skid slippers, cell phone, and
other personal items.
Admission for Ventricular Assist Device Implantation

Admission Instruction: Day of Admission

ξ Your loved one will have blood drawn.
ξ Your loved one and you will be asked a series of questions to complete admission
paperwork.
ξ Your loved one and you will meet with a heart failure nurse practitioner.
o Update medical history and physical exam
o Review medicines and discuss plan for taking medicines
o Order required tests, such as an echocardiogram or right heart catheterization
ξ Your loved one and you will meet with a cardiac surgery nurse practitioner or physician’s
assistant.
o Discuss expected post-surgical course
o Complete the surgical evaluation
o Sign consent for surgery
ξ Your loved one and you will meet with a Ventricular Assist Device coordinator.
o Review Ventricular Assist Device materials
o Discuss post-surgical education plan
o Complete quality of life survey and house preparation checklist
ξ Your loved one and you will meet with an Anesthesiologist.
o Discuss the time patient will go down to operating room for surgery
ξ Your loved one and you will meet with surgeon before surgery for questions.
Admission Instruction: Night before Surgery

ξ Your loved one may eat a light meal low in fat content.
ξ Your loved one should stop eating solid food at 7 PM.
ξ Your loved one should stop drinking milk, and juice with or without pulp at 7 PM.
ξ Your loved one should stop drinking clear liquids at midnight.
ξ Your loved one should not eat or drink after midnight unless discussed with a staff nurse.
ξ Your loved one will shower with an antimicrobial soap.
o Scrub from the neck to the toes for 2 to 3 minutes
o Do not break the skin when scrubbing
o Do not apply lotions or powders to skin

3

Admission Instruction: Morning of Surgery

ξ Your loved one should brush his teeth and rinse, but should not swallow.
ξ Your loved one will shower with antimicrobial soap called Hibiclens® again.
o Follow instructions given the night before
ξ Your loved one will take morning medicines as directed by the surgeon.
Family instruction: Day of Surgery

ξ Two family members may go with the patient to the operating room
ξ Family will be guided to the family waiting area by operating room staff
ξ Family will need to give a phone number to the operating room staff
ξ Family will need to pick up a pager from the operating room staff
ξ Family will be updated on patient condition throughout the surgery
ξ Family will be directed to the to the post-operative unit after surgery
ξ Family will be updated by the surgeon after the surgery is completed on the post-op unit.
Post Ventricular Assist Device Implantation

Day of Surgery: Cardiothoracic Surgery Unit (B4/5)

ξ Family may visit after a recovery period (1-2 hours).
ξ Your loved one will have a breathing tube will be in place after surgery. The patient will
not be able to talk. It is removed as soon as the patient is awake enough to breathe on
their own. After the tube is removed, the patient may begin to talk.
ξ Your loved one will have several tubes and line will be placed during surgery. Please see
the section in the binder called “Common Tubes and Lines” for details.
ξ Your loved one and you will hear several noises, such as the beep of the monitor and the
bubbles from the chest tubes. The noises you hear are normal.
ξ Your loved one may have wrist restraints in place after surgery. The restraints protect the
patient from hurting themselves while waking up from anesthesia.
ξ The nurse will start turning your loved one the evening of surgery.
Day after Surgery: Post-op Day # 1-2

ξ The Cardiac team visits daily to assess progress, called rounding. The time of day may
vary. They first meet outside the room to discuss the patient’s progress. Then they go into
the room to update the patient and family and answer any questions.
ξ See the section in the binder called “Your Health Care Team” for a list of health care
workers involved in the patients care while in the hospital. Specialized teams, not listed
in this section of the binder may also visit the patient, based on the needs of the patient.
ξ The Ventricular Assist Device team will visit daily to assess patient recovery progress.
ξ Your loved one may have lines and tubes removed on his progress. It is reviewed daily.

4

ξ Your loved one may have a diet ordered. Initial diet is clear liquid (e.g., water and ice
chips) and advances as tolerated.
ξ Physical therapy will help your loved one sit, stand, and walk. The nurse can also help.
o The goal is to get out of bed and sit in the chair at least 3 times a day.
o The goal is to walk in the hallway 4 times a day.
ξ Education about the Ventricular Assist Device is provided to the patient and family.
Post-op Day 3 until discharge: The Hospital Stay

ξ The Cardiac team visits daily to assess progress, called rounding. The time of day may
vary. They first meet outside the room to discuss the patient’s progress. Then they go into
the room to update the patient and family and answer any questions.
ξ See the section in the binder called “Your Health Care Team” for a list of health care
workers involved in the patients care while in the hospital. Specialized teams, not listed
in this section of the binder may also visit the patient, based on the needs of the patient.
ξ The Ventricular Assist Device team will visit daily to assess patient recovery progress.
ξ Your loved one may have lines and tubes removed on his progress. It is reviewed daily.
ξ Your loved one may have a diet ordered. Initial diet is clear liquid (e.g., water and ice
chips) and advances as tolerated.
ξ Your loved one will be asked to cough and deep breathe daily using an incentive
spirometer (Breathing Device).
ξ Physical therapy will help the your loved one sit, stand, and walk. The nurse can also
help.
o The goal is to get out of bed and sit in the chair at least 3 times a day.
o The goal is to walk in the hallway 4 times a day.
ξ Education is provided to patient and family every day while in the hospital.
ξ Discharge date will depend on the patients recovery, knowledge of the Ventricular Assist
Device, support system(s) ability to do dressing change, blood pressure control, and
stable weight.
Day of Discharge: Last day at the Hospital

ξ A member of the heart failure team talks about discharge with the patient. Please see the
section in the binder called “Homeward Bound” for details.
ξ A pharmacist reviews medicines with you and your loved one.
ξ The nurse reviews discharge instructions with you and your loved.
ξ Ventricular Assist Device coordinator reviews what is expected of you and your loved
one post discharge. They answer any questions.
ξ Other members of the health care team may meet with the your loved one and you before
leaving the hospital.
ξ You can pick up medicines at your loved one’s local pharmacy of choice before arriving
home or our hospital’s outpatient pharmacy.
ξ Other follow-up care is arranged as needed.

5

Recovery after leaving the hospital

After Discharge: Care at Home

ξ Daily, your loved one must review the Ventricular Assist Device numbers and collect a
weight. Bring those to clinic for evaluation by the provider.
ξ Every patient is unique in how they recover and feel after Ventricular Assist Device
implantation. There are some common feelings each patient experiences after surgery.
ξ Please see the section in the binder called “Homeward Bound” for more details.
Follow-up Visit: 2-3 days from discharge

ξ Your loved one will have blood drawn in the lab before attending follow-up visit.
ξ Your loved one will meet a Ventricular Assist Device team member to discuss progress.
ξ Future follow-up visits will be scheduled.
Follow-up visit: 2-4 weeks from discharge

ξ Your loved one and you will meet a Ventricular Assist Device NP to discuss their
progress
ξ Cardiac Rehab begins at this time
Follow-up visit: 4-6 weeks from Ventricular Assist Device implant

ξ Your loved one may have tests to be completed prior to appointment as ordered by the
surgeon
ξ You and your loved one will meet with a Ventricular Assist Device team member.
ξ Your loved one’s surgeon will discuss ability to drive and approve driving privileges
ξ Your loved one’s surgeon will discuss changing daily dressing changes to every three day
dressing changes
ξ Your loved one’s surgeon will discuss changing the lifting restriction




Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor.
This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because
each person’s health needs are different, you should talk with your doctor or others on your health care team
when using this information. If you have an emergency, please call 911. Copyright © 5/2016 University of
Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7905