Coronary Artery Bypass Graft

WHAT YOU SHOULD KNOW:

• Coronary artery bypass graft surgery is also called open heart surgery, or CABG. A CABG is done to open up blocked arteries in your heart. An artery is a blood vessel (tube) that carries blood with oxygen through your body. Parts of your heart may not get enough blood if an artery is blocked. When one or more of these arteries is blocked, you may have a heart attack. You may have mild to severe chest pain and a hard time doing daily activities such as climbing stairs or walking.
  
  
• CABG surgery can improve blood flow to the heart by bypassing (sending blood around) the blocked part of an artery. During surgery, a blood vessel from another part of your body is used to bypass the blocked artery. This bypass may restore blood flow to your heart muscle. The healthy blood vessel may be taken from your leg or chest and is called a graft. After CABG surgery, you will need to make some lifestyle changes. These changes include eating healthy and low fat foods, exercising, and quitting smoking. It may take six weeks, or more, for you to return to your usual activities. Having a CABG may relieve your chest pain and prevent heart problems such as a heart attack.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Your incisions may get infected. Certain diseases, such as diabetes, put you at higher risk for life-threatening problems, such as infection. You may bleed too much and need a blood transfusion. You may have very fast heartbeats that are not regular in rhythm. Your heart may not get enough oxygen and have trouble pumping blood through your body after surgery. You may feel sad most or all of the time after a CABG. There is a chance that your signs and symptoms may come back. If they come back, you may need another CABG.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. You may have fluid buildup around your heart. This fluid puts pressure on the heart, causing it to not work properly. You may also have fluid buildup around your lungs. This may make it hard for you to breathe after surgery. These problems may be life-threatening.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Intravenous: Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• Preparing for surgery: You will be taken on a stretcher to the room where your surgery will be done. You are then moved to a table or bed where you will lie on your back.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Medicines:
  
  
  • Blood thinners: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, and after your surgery. Blood thinners make it easier for you to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to help keep your gums from bleeding.
    
    
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria. Antibiotics may be given before, during, and after your surgery.
    
    
  • Heart medicine: Caregivers may give you heart medicine to prevent a heartbeat that is not a regular rhythm. This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Heart medicines may be given before, during, and after your surgery.
  
  
• Special lines and tubes: Special IV lines are usually inserted after you are asleep. Small tubes may be put into an artery or vein before, during, or after surgery. These will help caregivers watch how you are doing during or after surgery.
  
  
  • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
    
    
  • Central line: A central line is also called a CVP line. It is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.
  
  
• Tests:
  
  
  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
    
    
  • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.

During your surgery:

• Caregivers clean your chest area and cover you with sterile sheets to keep the surgery area clean. An incision (cut) is made in your chest. The rib cage is cut or spread apart so your caregiver can reach your heart. Your heart is slowed or stopped so that he can work on your heart. If your heart is stopped, your caregiver will connect your heart to a bypass machine. This machine pumps blood to your body and keeps blood out of your heart during surgery. He may not use a bypass machine. Instead, they may safely slow your heartbeat and attach the graft while your heart is beating.
  
  
• A separate incision is made to remove the graft. The graft is a piece of healthy blood vessel taken from somewhere else in your body, such as your leg. The graft vessel is then sewn to your artery above and below the block. If other arteries are blocked, your caregiver will attach a graft to those arteries also. This allows blood to flow around the blocked area to your heart muscle. After surgery, the blood is again allowed to flow through your heart. The incision where the graft came from will be closed with stitches and covered with bandages. The chest incision will be closed using a strong wire, staples, or stitches (thread) and covered with bandages.

After your surgery:

You will be taken to a room where you can rest until you are awake. You will have several wires or tubes in place, which may make it hard for you to move. These tubes help caregivers watch you closely for any problems. A breathing tube may be left in your mouth and throat after surgery. The tube may be hooked up to a machine called a ventilator, which will breathe for you. The breathing tube will be taken out as soon as you can breathe on your own. A bandage will cover your incisions to keep the area clean and dry to prevent infection. Do not try to get out of bed until your caregiver says it is okay.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Blood tests: Caregivers will monitor your blood sugar closely after surgery. This may help lower your chance of getting an infection.
  
  
• Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs. Removing fluid lets your lungs fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let the caregiver know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube. The chest tube is usually removed 24 to 48 hours after surgery. Your caregiver will monitor the fluid collecting from your chest tube and decide when to remove it.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing should be started right after surgery, as soon as you are awake. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake, even if you wake up during the night. You may be asked to use an incentive spirometer. This helps you take deeper breaths. Ask your caregiver how to use the incentive spirometer. You may have pain when you take deep breaths and cough because of your surgery. Ask your caregiver how to hold the pillow against your chest to help decrease the pain when deep breathing and coughing.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, your caregiver may put you on a special diet. You may be told to eat foods that are low in fat or cholesterol. You may also be told to limit the amount of salt you eat.
  
  
• Foley catheter: A Foley catheter is inserted during surgery. It is a long, bendable tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. A balloon on the end of the catheter is filled with liquid. The balloon holds the catheter in place inside your bladder. The catheter helps caregivers measure how much you are urinating. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter. This may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink, because this will block the flow of urine. Your catheter may be removed shortly after your surgery.
  
  
• Medicines: Your caregiver may give you one or more of the following medicines:
  
  
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Tell caregivers right away if you start feeling discomfort, pressure, burning, or tightness in your chest. Tell caregivers right away if you start sweating, have trouble breathing, or feel discomfort in your arm, back, neck, or jaw. Any of these may be a sign that your heart is not getting enough oxygen, and may need medicine to help.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Potassium: Potassium is a mineral that your body needs. If you do not have enough potassium in your body, it can affect the rhythm of your heart. This medicine may be given to increase the amount of potassium in your body.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
    
    
  • Insulin: If you have diabetes, insulin may be given to decrease the amount of sugar in your blood. It helps your body move the sugar to your cells, where it is needed for energy. If your blood sugar is high, caregivers may give you IV insulin after surgery. Controlling the amount of sugar in your blood may help prevent infection.
  
  
• Nasogastric tube: A nasogastric (NG) tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need an NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.
  
  
• Oxygen: You may need to get oxygen through a plastic mask or nasal cannula. A nasal cannula is a pair of short, thin tubes that are placed inside your nose. Tell your caregiver if the mask or prongs bother you, or if your nose gets dry. Ask your caregiver before taking off your oxygen mask, or removing your nasal cannula.
  
  
• Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or elastic wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps keep clots from forming.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: Vital signs include taking your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Vital signs will be checked often after surgery so caregivers can see how you are doing.
  
  
• Weight: You may be weighed each day. Caregivers compare your weight from day to day to record how much body fluid you have. You can become dehydrated if you lose too much. You can have shortness of breath or swelling in your legs if you retain too much.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.