Patients come into the TCI Center for a one or two-day evaluation process that includes meeting with:
The TCI Nurse
The TCI nurse 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 (notebook) 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 information on how to download guided imagery recordings to listen to before, during and after your surgery(If you do not have access to an mp3 player, we can provide you with a CD). 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 player with you on the day of surgery to listen to guided imagery.
- 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). Look for "Red Coat" staff members if you need assistance with directions - or ask any Cleveland Clinic employee - we are here to help. Your Direct Route is a website that you can access from your cell phone to help you with getting to the Cleveland Clinic - and around the campus.
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 teams 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 audio-players 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, and other health related websites.
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.
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.
Your health care team includes doctors, nurses and other healthcare professionals who specialize in your condition and treatment. The team will follow your progress and help you recover as quickly and safely 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 as you progress.
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
Cardiovascular Surgery Classes
There are three classes designed to help patients and families learn how to prepare to travel home, how to progress activity and recovery, and how to live a healthy lifestyle after heart surgery. These are great opportunities to answer questions and Days and times of classes are listed in your binder.
Miller Family Heart & Vascular Institute Binder
You and your family members are given a binder (notebook) 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. Cardiovascular Channel 33 is a TV channel with more than 70 videos about heart and blood vessel diseases, treatments prevention and disease management. For more information call 216.444.2657.
Heart Surgery Videos at Home
All patients receive directions on how to access heart surgery recovery videos on your home computer. These videos review discharge instructions and lifestyle issues after heart surgery. You and your family may review the videos at home; they review education received during your hospital stay.
We have also created a series of videos addressing common questions or concerns that people often ask once they return home. These can be accessed at clevelandclinic.org/hearthomerecovery.
The cardiac rehabilitation staff will discuss activity guidelines for you to follow after going home. The Home Activity Class will present guidelines for activity progression and management of activity-related symptoms. Patients and family members should attend. Look in your binder for days, times and locations. 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 online (for downloading into your mp3 player) or on our CC inpatient TV programs.
Rooftop Terrace - located on the top floor of the Miller Family Pavilion, offers beautiful views of the Cleveland skyline and a quite place to take a break.
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 216.448.8330 for more information.
Visiting hours on the nursing unit are unrestricted. However, it is important to take into consideration the patient's need for rest.
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.
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 5-6 days, depending on the type of procedure that was performed and your rate of recovery. 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.
On the day of discharge, please have your family member arrive well 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.
You will have an appointment in the Post-Op Clinic 3-5 days after you leave the hospital. If you live outside of the Cleveland area, please plan to spend a few nights in a local hotel so you can be seen in the clinic. The appointment is very important. We will make sure your recovery is going well and that your medications are correct. If you are traveling by plane, please plan to fly home about 14 days after your day of surgery.
Learn how to make travel arrangements to Cleveland Clinic after heart surgery.
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.
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 Activity 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 the Cleveland area:
For programs outside the Cleveland area:
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