Patients who choose to come to Miller Family Heart & Vascular Institute for heart surgery can expect to be operated on by the best surgeons and cared for by the finest nurses and medical staff in the world.
This is a general description of the heart surgery program. More specific instructions are included in the information you will receive during your visit, hospital stay and before you go home. Please feel free to ask questions to our health care team at any time during your stay.
About 2,000 thoracic and cardiovascular patients are scheduled through our TCI program each year. This means patients come to Cleveland Clinic a few days before surgery as an outpatient to complete the pre-surgery evaluation and receive information to prepare for surgery. The TCI program allows patients to spend more time with their families instead of being admitted to the hospital several days before surgery.
The TCI Center is located at the Thoracic & Cardiovascular Surgery Outpatient Center in J4 - 1.
- »Evaluation Process
Patients come into the TCI Center for a one or two-day evaluation process that includes meeting with:
The TCI Surgical Nurse Clinician
The TCI surgical nurse clinician works with your surgeon. He or she will perform a limited exam, review your records and provide you with instructions for your surgery. Instructions include:
- You will watch a video outlining what to expect on the day of surgery. You also will receive information about how to prepare for surgery and what to expect during your hospital stay and recovery at home.
- You will receive a binder that explains the surgical process, what to expect during your hospital stay, and important steps for recovery. Your family will bring this binder to the hospital after your surgery, as you will refer to it often during your stay. Also plan to bring it to all of your outpatient doctor's appointments.
- You will receive a free guided imagery CD to listen to before, during and after your surgery. Guided imagery uses the power of imagination to induce peace, calm, strength and control. The calming music on guided imagery programs can be very helpful in quieting the mind. Many people find the program's soothing words create a greater sense of calm, well-being, safety and control. Plan to bring a CD player with you on the day of surgery to listen to the CDs.
- You will also learn about theStatus.com, a website where you can create a private, secure and confidential Web page to communicate how the patient is doing to family and friends.
- You will have time for questions and answers.
TCI patient with cardiothoracic anesthesiologist
The Cardiothoracic Anesthesiologist
You will meet one of our Cardiothoracic Anesthesiologists who is specially trained to administer anesthesia for cardiac surgery patients.
You will meet with a cardiologist who will perform a preoperative cardiac exam, answer your questions and review your medications.
The cardiologist will review your medical records and test results. He or she may order additional tests, if necessary. These tests may include a cardiac catheterization, echocardiogram, electrocardiogram, chest x-ray, blood-work or urinalysis.
Every attempt is made for you to meet your surgeon on the day of your preoperative visit. If this is not possible, we will schedule a more convenient time for you to meet the surgeon and discuss your surgery.
Where to check in
The night before surgery you will be told what time and where to report for surgery. Please limit the number of family members. You and your family will be asked to register with the receptionist at Desk J1 - 2, Miller Pavilion Surgical Center and Family Waiting area (in the Miller Family Pavilion, 1st Floor). "Red Coat" staff members are available if you need assistance with directions.
Surgery takes place on the fourth floor of the J building in state-of-the-art operating rooms that are specially designed for heart surgery. The operating room nurses and cardiothoracic anesthesia team work with your surgeon to ensure your safety and comfort during surgery.
Waiting During Surgery
While you are in surgery, your family waits in the Miller Pavilion Surgical Center and Family Waiting area. Your family will receive a communication device/pager so we can contact them when surgery updates are available. Please wait in the Surgical Center and Family Waiting area until you are called to attend the Family ICU Class. The CVICU Nurse Coordinator will provide your family with additional instructions about what to expect during the day.
Family ICU Class
The Family ICU Class is held on the day of surgery to provide your family with important information about what to expect the day of surgery. Your family will also receive information about visiting in the Cardiovascular Intensive Care Unit (CVICU). It is a good time to ask questions. Classes are twice daily, usually held at about 10 a.m. and 3 p.m., Mondays through Fridays in room Q1-204C located just off the Great Hall in the Glickman Building (down the hall from the waiting area). Classes are taught by the Cardiovascular ICU Nurse Coordinators. These CVICU Nurse Coordinators are also available to facilitate communication between families and members of the health care team.
Cardiovascular ICU Nurse Coordinator teaching Family ICU Class
Remember to designate one individual as the family spokesperson to provide an efficient flow of consistent information and to ensure patient confidentiality.
Receiving Updates about the Patient's Surgery
Your family will receive an update on their pager notifying them that the major portion of the cardiac procedure has been started.
Please note the amount of time it takes to perform the surgery can vary greatly. Emergency situations and unexpected findings may result in long wait times. We also hope your family will understand that delays result from our commitment to providing each patient with the best care. Please be prepared for unexpected delays by bringing reading or writing materials, small games or cds and audioplayers to occupy yourself while waiting. We will do our best to make sure that you and your family are as comfortable as possible during your stay.
The waiting area is located near the Patient and Family Health and Education Center, located at Q1 - 2, off the Grand Hallway. Here you will find educational resources and public computers to research health information, access MyChart, thestatus.com, and other health related websites.
- »After Surgery
After surgery on the heart is complete, the surgeon will update the family. Please listen carefully and take notes as you talk to the surgeon. Have a list of questions ready to ask the surgeon.
CVICU Nurse helping patient use incentive spirometer
After speaking with the surgeon, it will be about 2 hours before you can check in to visit the patient. During this time, the patient will still be in the operating room for the closing process. Then the patient will be transferred to the Cardiovascular Intensive Care Unit (CVICU), where it may take about 1 additional hour for the admission and recovery process. Your surgeon will tell your family what CVICU you will be in.
Your family will report to either the J5 or J6 CVICU Family Waiting areas 2 hours after speaking with the surgeon. Your family will be asked to check in with the receptionist and let him or her know that this is your first visit.
A receptionist is present in the Lounge from 9 a.m. - 9:30 p.m. Monday-Friday, and 9 a.m. - 5 p.m. Saturday, 9 a.m. - 5:30 p.m. Sunday. If you visit during these hours and the receptionist is not in, please wait. If you have been waiting longer than 10 minutes, please use the beige wall phone to call the unit. The phone numbers for each unit are posted next to the phone.
Cardiovascular Intensive Care Unit (CVICU)
Immediately after your surgery, you will be cared for by a team of specially trained nurses in the Cardiovascular Intensive Care Unit (CVICU). Their goal is to help you recover as quickly and safely as possible. Along with your surgeon, members of the cardiothoracic anesthesia and surgical teams who took care of you in the operating room will continue to follow your progress in the CVICU.
You will receive more information about the CVICU and what to expect in your heart surgery binder.
- »Surgical Recovery
Patients recover on a post-cardiovascular surgery nursing floor (also called a telemetry unit or step-down unit). There are six, 24-bed Post-Operative Units located on the 5th and 6th floor. Each patient room is private single occupancy.
During this time, you will begin your recovery phase. You will be encouraged to do as much as you can for yourself to assist in regaining strength and independence.
The balance of pain control and increasing activity will help you recover at a faster pace. More information on pain control after heart surgery.
A cardiologist or hospitalist will join the health care team at this time and manage your care in conjunction with the surgeon. If you had thoracic surgery, your thoracic surgeon or hospitalist will join the health care team to manage your care.
Your health care team will follow your progress and help you recover as quickly as possible.
Please refer to your binder for recovery information during your hospital stay. You will receive a patient recovery plan that will show you what to expect each day.
- »Educational and Support Resources on the Nursing Unit
Patients and family members are provided many resources for support and education on the nursing unit:
Nurse reviewing Heart Center binder with patient
Family Resource Group
This program provides family members the opportunity to ask questions and receive information about the care of the patient after being discharged from the hospital. Common postoperative problems are also addressed. Experts discuss different topics including exercise, incision care, discharge planning, medications, and nutrition. Family Resource Group classes are held Monday through Friday, 9 a.m. - 10 a.m. in the J5 Family Education Room on the fifth floor.
Miller Family Heart & Vascular Institute Binder
You and your family members are given a binder before surgery. This binder has tabs that detail what to expect before surgery, during your hospital stay, hospital recovery, and recovery at home. You and your family will continue to review the information in the binder that was given to you before surgery. You will review discharge instructions, medication information, and a diagram of your surgery with your cardiologist and nurse before you go home. You will continue to use this binder at home to answer your questions and guide your recovery.
Health Education Videos
Your room will have a large flat-screen color television. A complete directory of all available health education videos is available in your room. Ask your nurse for a TV guide if you need one. Health education videos are available on demand. You will receive information in your binder on how to request videos to view. Some videos will be suggested for your safety and patient education.
Heart Surgery Take Home Video
All patients receive a DVD to take home. This video reviews discharge instructions and lifestyle issues after heart surgery. You and your family may review this video at home and reinforce education received during your hospital stay.
The cardiac rehabilitation staff will discuss activity guidelines for you to follow after going home. The Home Activity Class, held daily at 3 p.m. Monday - Friday, in the J5 Cardiac Rehab Room, will present guidelines for activity progression and management of activity-related symptoms. Patients and family members should attend. The Preventive Cardiology and Rehabilitation Program is available for you to attend as an outpatient after you are discharged from the hospital.
The use of wireless computer devices IS permitted in public locations and patient areas in the Miller Pavilion. In addition, there are public computers located in the family waiting lounges and in the Patient & Family Health Education Center on the first floor. The Miller Family Heart & Vascular Institute website is a helpful resource for you and your family before and after your hospital stay.
- »To Help Ease Your Recovery
Healing Services Touch Therapies Program - The Touch Therapies Program includes light massage therapy, Reiki and Healing Touch™ to assist your recovery from medical or surgical interventions. The Touch Therapies Program is offered through a partnership between the Healing Services Team and the Sydell and Arnold Miller Family Heart & Vascular Institute.
Massage Therapy is used to support your medical condition and aid recovery from procedures. Massage can help reduce muscle tension, relieve stress and soothe pain. A light, 10-minute massage (with your physician’s approval) can assist your experience of well-being as you are healing. Fee-based massage therapy is offered to family members and visitors to help decrease stress so they can effectively support you.
Healing Touch™ and Reiki are relaxing, nurturing energy therapies where gentle touch assists in balancing your physical, mental, emotional and spiritual well-being to promote a deep sense of relaxation. These therapies work with your energy to support your natural ability to heal.
To receive any of these complimentary touch therapies, please call Healing Services at 216.445.9543.
Guided Imagery - Patients continue to use their guided imagery program obtained pre-surgery to help with relaxation and pain control. Family members may also find the programs relaxing. Programs are accessed by complimentary cds, online (for downloading into your mp3 player) or on our CC inpatient TV programs.
Patient with guided imagery CD
The Relaxation and Massage Suite - located on the 5th floor of the Miller Family Pavilion, is open 24 hours a day, 7 days a week. Patients and family members are welcome to go to this room to take a quite break from daily hospital routine. If you are not staying on the 5th floor, please let your health care team know if you'd like to visit the suite.
Art and Music Therapy - Cleveland Clinic's Arts and Medicine Institute offers art and music therapy to help patients in their healing and recovery. Call Cleveland Clinic's Arts and Medicine Institute at 216.444.8854 for more information.
- »Visiting Hours
Visiting hours on the nursing unit are unrestricted. However, it is important to take into consideration the patient's need for rest. Also, we ask that your guests be considerate of your roommate during their recovery phase by limiting to 2 to 3 visitors at a time.
- »Tips for Visitors
We appreciate your understanding and cooperation in helping us provide the best care for our patients. The following guidelines will help the patient and you during visitation:
- The initial visit in the CVICU may be a little intimidating. Being prepared for what you’ll see might help ease some anxiety.
- There is a limit of two visitors at one time in the CVICU.
- Limit your initial visit to 10-15 minutes to allow the patient to rest.
- After the first visit, you are welcome to return for the remainder of the visiting schedule. However, we encourage you to return home or to your lodging and rest after 9 p.m.
- Please respect requests to alter your visitation time or leave the room. As mentioned above, these requests are for the sole purpose of keeping the patient's care and safety our top priority.
- The family spokesperson should have contact information ready for the CVICU nurse.
- Please be respectful of all patients' need for rest, recovery and nursing care.
- To prevent infection and ensure patient safety, please wash your hands with soap and warm water, or apply the antibacterial foam located at the patient’s bedside to cleanse your hands before and after visiting the patient.
To protect patients’ safety and privacy, the following are not permitted in the CVICU:
- Food and drinks
- Flowers, balloons and other small gifts
- Cameras/video recorders or picture taking
- Cellular phones (must be turned off)
Patients always come first at Cleveland Clinic. In the CVICU, there are times when visitation may need to be postponed or shortened so we can continue to keep the patients' needs and safety our number one concern. You will be asked to leave the patient's room and wait in the Family Lounge when patient procedures are being performed and at other times when the doctor or other health care team members feel that visitation is not in the patient's best interest.
Your family member may have an endotracheal tube (breathing tube) in his or her throat, which is connected to a respirator to assist breathing. While it is in place, the patient will not be able to talk or swallow. You are encouraged to ask questions that only require a yes or no response, so the patient can shake or nod in reply. The endotracheal tube will be removed when the patient is fully awake and breathing independently. Once the endotracheal tube is removed, the patient will be able to talk. Keep in mind that the patient may be groggy and may not be able to communicate with you.
The medical equipment used in the CVICU and surgical units has alarm settings to alert caregivers to possible changes in a patient’s condition. These alarms are very sensitive to the patient’s movements and coughing, and may not reflect any real problem.
Don't forget to take care of yourself! We know how difficult it is to have a loved one in the hospital, and how uncertain things may seem. During these times, family members tend to ignore their own needs, and may even be afraid to leave the hospital. But, it is important that you take care of yourself. Eating properly, getting rest and taking care of your personal needs are important. We encourage you to talk about your feelings with our health care team - we will do our best to help you.
The surgical team will determine when the patient will be transferred from the CVICU to a step-down nursing unit.
If you have any questions or need assistance, please call the CVICU Nurse Coordinator by dialing 63272 on any beige house phone.
Once the patient has been transferred from the CVICU to a step-down nursing unit, please keep the following tips in mind:
- Encourage the patient to walk as much as tolerated, use the incentive spirometer and any other recommended breathing aids, and request pain medication when needed.
- Additional information is found in the patient binder.
To help prevent the spread of the seasonal flu and H1N1, Cleveland Clinic is limiting hospital visitation to healthy adults 19 and older. Please do not bring visitors under the age of 19 to visit patients at any Cleveland Clinic hospital. Thank you!
More information on this policy is available at:
- »Discharge to Home
Your cardiologist and surgical team will determine when you can go home. Your expected discharge date will be posted in your room.
The average hospital stay after surgery is about 5 days, depending on the type of procedure that was performed and your rate of recovery. If you had minimally invasive surgery, your hospital stay is usually shorter - from 3 to 5 days. Your health care team will follow your progress and help you recover as quickly as possible.
Once a discharge date has been set, you can make travel arrangements. If you are traveling home by plane, we recommend that you make sure your ticket is refundable should your discharge date change. You may want to stay one night in our hotels after discharge, so plan your flight home accordingly. If you are purchasing round trip airfare ahead of time, plan to schedule your return trip home about 10 to 14 days after your date of surgery.
On the day of discharge, please have your family member arrive before 11 a.m. to participate in your discharge planning and home-going instructions. If this is not possible, you may go to the Discharge Lounge after you are discharged from the unit.
If you are planning a long trip home, you may want to stay overnight in a hotel and begin your trip home the following day.
When you travel home after surgery:
- You are not permitted to drive a car
- You can be a passenger in a car
- You may fly in an airplane.
Your health care team is available to answer your questions. Keep a paper and pencil nearby and write your questions down. Phone numbers are provided in your binder to assist you with further questions when you return home.
- »Cardiac Rehabilitation
For many people after surgery, a cardiac rehabilitation program provides an excellent opportunity to continue the recovery you began in the hospital:
Phase I - Cardiac Health Rehabilitation Program - Exercise specialists see the patient in the hospital to assess activity needs and begin activity progression. Home activity instructions are given to encourage progressive activity. Cardiac Rehabilitation Discharge classes are also available to help answer questions by the patient and family.
Phase II - Preventive Cardiology and Rehabilitation Program - Builds on what you learned during Phase I: continue a regular exercise program, learn about heart disease, and learn strategies to change your lifestyle to prevent further progression of your disease. It also provides support and guidance as you recover from your surgery. Phase II cardiac rehabilitation is covered by most insurance companies. To learn about programs in your local area:
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