Hospital Stay

Before your operation:

You will meet with your surgeon who will check that you understand your operation and check your consent form is complete. Your surgeon will need to draw an arrow on your skin to mark the correct side for the operation. Feel free to ask any questions.

You will meet with your anaesthetist who will discuss your health and your anaesthetic.

The nurses will complete paperwork with you including contact details for friends and family. They will fit tight stockings, a wristband and give you a gown to wear. The stockings reduce the risk of blood clots in the leg. Once you have been admitted you will be asked to change into your gown. You will need to wear a wristband all the time you are in hospital for your safety. This will be checked when you go to theatre and when you are given medication. If you have an allergy the wristband will be red. Your property will be safely stored until after your operation has taken place. We encourage a friend or relative to take your valuables and extra luggage until visiting time.

Staff will check your wristband, your name and date of birth, and safety questions. Please do not be surprised when they ask you what operation you are having, this is a safety check.

The anaesthetist will attach machines that measure your heart rate, blood pressure and oxygen levels. All patients are given extra oxygen to breathe through a mask. A cannula is put into the back of your hand so injections can be given into the vein. The anaesthetic is started with an injection, you won’t feel or remember anything after this. The next steps will vary depending on which operation you are having.

We do safety checks multiple times throughout surgery, these are part of the World Health Organisation (WHO) Surgical Safety Checklist. Surgeons around the world use the checklist and this has saved many lives.

When your operation has finished you will wake up in the recovery room. You can start to drink once you are more alert and the nurse tells you that you can. When you are comfortable and your nurse is happy with your recovery, you will then be taken back to the Ward. Sometimes you may need to be cared for in the Intensive Care Unit (ICU).

You will be monitored closely overnight, feel free to ignore us and keep sleeping unless we ask you questions. You may not want to drink very much at first, but fluid can be given through a drip to keep you hydrated if required. You can eat and drink once you feel you want to. You can have visitors for a short while in the evening after your operation.

Most operations cause some discomfort afterwards. The anaesthetist gives you pain killers whilst you are asleep. If you are in pain when you wake up tell your nurse, and they can give extra pain relief. The anaesthetist may visit to make sure your pain is controlled.

Pain following surgery is a worry for many people. Pain control is important for your recovery following surgery, we want you to be as stress and pain free as possible. The following methods can be used for your pain relief, depending on what suits you best. Morphine and codeine cause constipation; it is best to prevent this problem by drinking plenty, walking around, having a healthy diet, and taking laxatives.

Morphine

Patient Controlled Analgesia (PCA)

This is a popular method, it allows you to be in control of your pain relief. Your PCA system will be set up in the recovery room when you wake up after surgery. At Heartlands we use electronic pumps with a handset. A drip will be set up and connected to a pump containing morphine. Whenever you feel pain, you press a button to receive a small dose of morphine from the pump.

You should press the button whenever you feel pain, use it as much as you need. Don’t wait for your pain to build up, it is harder to control again if this happens. It is useful to give yourself a dose before physiotherapy and getting out of bed.

The machine has a special safety feature – the machine switches off for five minutes after giving a dose of morphine.  This prevents you getting an overdose, so you can press the button as much as you need.

You will normally have the PCA for 2 or 3 days after your operation. As the pain from your wound improves tablets should be able to control the pain.

Morphine infusion

For 24 hours after your operation this is a drip into a vein that continuously gives morphine from a pump. The dose is carefully calculated by your anaesthetist and the effect is monitored by your nurse.

Intrathecal morphine

This is a one off injection of morphine into the back, this is done in theatre. The injection is put into the fluid that surrounds the spinal cord. This stops the sensation of pain and may make you drowsy. The effect lasts for some hours and keeps you comfortable for the first night.

Are there any side effects?

Morphine can cause some side effects. Morphine causes constipation and you will need laxatives to help. Some people may feel sick – if you do, let your nurse know and they will give you anti sickness medication. Some people may have itching – antihistamine tablets and soothing cream can help. Some people feel a bit drowsy – this is quite normal, but if it is distressing please tell your nurse. If we think you are too drowsy we will reduce the dose of morphine, we can also give medication to block the effect of the morphine.

Paravertebral

A thin flexible tube is inserted into your back whilst you are asleep in theatre. It sits between the ribs next to the nerves on the side of the chest, rather than by the spinal cord. Local anaesthetic can be given continuously. This numbs the nerves on the side of your chest where your wounds are. The paravertebral stays in place for up to 3 days. You do not need a catheter in the bladder with this method. This method does not usually have any side effects.

Epidural

A thin, flexible tube is inserted into your back in theatre. This can be done either while you are still awake, or when you have already been put to sleep, depending on your anaesthetist. A local anaesthetic will be injected first to minimise any discomfort. The insertion takes about 20 minutes. The tip of the tube stays near the spinal cord (in the epidural space). Local anaesthetic and drug similar to morphine can be given through the tube continuously. This numbs the nerves on both sides of the chest, the stomach and legs. If you have an epidural you will also need a catheter in the bladder. The nurses will use cold spray to monitor how well the epidural is working. The monitoring is vital for safety reasons and to make sure the epidural is working. The epidural normally stays in for up to 3 days. After this time the nurses will remove the epidural and you can have another type of pain control.

Tablets & liquids

As your pain improves tablets will be able to give you good pain control. Before you go home we will check you are comfortable whilst taking tablets or liquids. You will normally have a combination of at least 2 medications that work together. These should be taken regularly and include:

• Paracetamol
• Ibuprofen
• Codeine or tramadol

If you need more pain relief you may have morphine instead of codeine/tramadol.

• Slow release morphine tablets – to be taken regularly
• Liquid morphine – to be taken as required
• Suppositories

These are tablets that are put in your back passage (rectum). The tablet dissolves and the drug passes into the body. Anti-inflammatory medication may be very effective in a suppository.

If you are struggling with constipation a glycerine suppository may be recommended to help open your bowels.

Chest drains

These are there to take air and fluid away from where the surgery was done. These are checked regularly and will be removed when the amount of fluid and air have reduced and your chest X ray is satisfactory (usually 1 – 4 days). If your drain becomes disconnected let your nurse know straight away.

Electronic chest drains

Many of our patients have electronic drains. They run on batteries which are recharged by putting it back on the docking station when you are by your bed. When it is fully charged the battery may last a couple of hours. The display shows the medical team whether there is any air leaking from the lung and how much. You can carry the drain and walk around.

If the drain makes a strange sound don’t panic – let your nurse know. Do not try to alter the drain settings or silence an alarm. Usually the drain needs something simple adjusting. Keep the drain upright, this keeps the filters clear.

Water seal chest drains

These drains look like a small, clear bucket with a lid and handle. Air will bubble in the drain if it is leaking out of the lung, the medical team check this by asking you to cough. Fluid in the drain bottle may look yellow, pink or light red. This is normal. You can carry the drain and walk around unless it needs to be attached to a suction tube from the wall. The drain must be kept upright and below chest level. Raising it too high could let fluid go back into the chest. Tipping the drain could lose the air seal and allow air into the chest. If the drain is accidentally knocked over put it back upright and let your nurse know what has happened.

Flutter bag chest drains

Sometimes air or fluid may come out of the drain for longer than average. A flutter bag has a one way valve which allows air and fluid out of the chest but not back in. A shoulder strap can be used and the drain can be hidden under clothes. You can go home with a flutter bag. If you go home with a flutter bag we will see you once per week. At these visits we will check that you are well and whether it is time for the drain to be removed.

You will be seen by the doctors every day. They will check your progress and if there are any concerns. If you have any questions feel free to ask. They will assess any chest drains and check your pain is controlled. You will have a blood test and a chest X ray the day after your operation. A second ward round happens in the evening.

As well as painkillers, we can give you anti-sickness and laxative tablets. We can give these to help with nausea and constipation. You will have oxygen at first, this is reduced and stopped when your oxygen levels are normal without it. Nebulisers help clear mucous from the lungs. These are a mist made of salty water or medication, given by a mask.

If you take medications at home these can normally be taken in hospital too. Medication for blood pressure will be stopped for the first few days after surgery. Your blood pressure is lower after surgery, medication can be restarted once your blood pressure comes up again. Aspirin or medications that thin the blood are restarted once the risk of bleeding is low.

We want you to be up and about as quickly as possible after surgery, depending on your operation. Walking helps your lungs recover. The day after your operation you will sit in a chair and go for a short walk. You may need help from the nurses or physiotherapists to do this at first.

You should sit in the chair rather than in bed and walk on a regular basis, with help as required. Your walking should improve daily.  It is important to be active after your surgery, it helps expand your lungs and prevent chest infections (pneumonia), constipation and blood clots.

It is normal to have some shortness of breath during walking in the first few weeks after surgery. This will improve with time as you exercise and walk more. Before you go home the physiotherapists will make sure you are fit to go home.

You need to breathe deeply after your surgery to clear mucus from your chest. If you need extra help with clearing mucus a physiotherapist will guide you. They may give you a device to help with deep breathing exercises. Using a rolled up towel to support your wound can help with coughing, we can show you how to do this.

Hand hygiene is very important to prevent all kinds of infections. All patients and visitors should clean their hands when they come to the ward. All staff should clean their hands before touching a patient. Feel free to ask us if we have cleaned our hands or remind us to clean our hands!

In addition you should:

• Have a balanced diet
• Avoid smoking
• Have a shower or bath with soap either the day before or on the day of your operation
• Do not use a razor to remove hair near where your operation will be (the chest, the back or the neck depending on your procedure). Razors can cause invisible grazes on the skin which increase the risk of infection.
• If you have diabetes,  keep blood sugar levels within the target range

We do extra things to reduce the risk of infection. These include using sterile equipment, giving one off doses of antibiotics and keeping you warm during surgery.

Your wound will have a dressing at first, the skin can be cleaned with sterile saline for 48 hours after the operation. You can shower 48 hours after surgery.

We test everyone for MRSA before surgery.

What is MRSA?

MRSA (Meticillin Resistant Staphylococcus Aureus) is a type of bacteria which is resistant to some antibiotics; making any infections harder to treat.

Why have I been screened for MRSA?

Healthy people can carry MRSA in their nose or on their skin with no symptoms, however if the MRSA gets into a wound then the person may get an infection that requires treatment.

We screen all patients for MRSA. Screening will help us identify those patients who carry MRSA and treat them quickly. This can help reduce the risk of becoming infected and risk of spread to other patients.

What will happen if I carry MRSA?

You will be given an antiseptic body wash and a nasal cream along with instructions for use. If you are in hospital and MRSA is found, you may be moved to a side room. If an infection is present, you may need antibiotics.

Can I have Visitors?

Yes, visitors need to wear an apron and must not sit on your bed. They must also wash their hands thoroughly before and after visiting.

If friends or relatives have a health problem, they should check with their doctor and with one of the nursing staff before they visit.

What will happen when am I ready to leave hospital?

Having MRSA does not necessarily mean you will need to stay in hospital longer, if you have an infection you will need to remain until the medical staff feel you are ready for discharge.

You will need to finish the course of treatment when you are discharged home and will be informed if you need to be re-screened.

General cleanliness and hand hygiene is paramount when at home.  If you get admitted into hospital again, you will need to inform the staff you have had MRSA before.