Endovascular Abdominal Aortic Aneurysm Repair Surgery

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1 Endovascular Abdominal Aortic Aneurysm Repair Surgery

2 You are scheduled for an admission to Cooper University Hospital for Endovascular Abdominal Aortic Aneurysm surgery (EVAR). Please read this handout, which discusses how you can prepare for your surgery as well as what you can expect during your stay in the hospital and when you go home. It describes how the members of your health care team -- physicians, nurse practitioners, nurses, social workers, physical therapists, case managers, and nutritionists will work with you during your hospitalization to ensure a smooth transition to home. Please share this information with your family members and/or friends who will be helping you throughout this surgical process. It is anticipated that you will be ready for discharge 1-2 days after surgery, although this will vary depending on your specific needs. The health care team will be helping you with any concerns you have about discharge. If you have any questions, please speak with your surgeon, nurse practitioner, or bedside nurse. Thank you for allowing us to participate in your care.

3 BEFORE SURGERY Surgeon s Evaluation You will be evaluated by your vascular surgeon and possibly a nurse practitioner in the office prior to your surgery. A full medical and surgical history will be obtained and you will have a physical examination. It is important that you supply a current list of your medications and that you complete the patient health survey that was sent to you prior to your appointment. Your CT scan or ultrasound will be evaluated and your surgery will be discussed. You may be ordered further testing at this time. In addition, you will: Have an understanding of your diagnosis and treatment options. Sign a consent form giving your permission for the surgery and blood transfusion after it has been explained to you. Discuss when to discontinue medications such as Plavix, Coumadin, and diabetic medications. *The Surgical Scheduler for Vascular Surgery will be in contact with you to give you the date for your surgery and discuss additional appointments that you may need (such as an evaluation with a cardiologist or pulmonologist). You may contact her directly at Pre-Admission Testing Within 30 days of your surgery, you will be scheduled for an appointment at Pre-Admission Testing. It is important that you keep this appointment. Please contact our surgical scheduler immediately if you were unable to keep this appointment. At this appointment you will: Have blood tests, a chest x-ray, and EKG. You do not need to fast for this testing. Have additional tests if they are indicated. Medications and Additional Preparation for Surgery You will be instructed by your surgeon or nurse practitioner on medications to hold prior to your surgery. Pack items you may want during your hospital stay. You may want to bring your own toiletries (toothbrush, hair brush), slippers, and a robe to the hospital. However, it is not necessary that you bring these items as they will be supplied to you. Your family can bring other items once you are assigned a room. Please do not bring any valuables such as expensive clothing or handbags, jewelry, cash, or credit cards to the hospital. Leave all rings (including your wedding rings) and good jewelry at home. The Day and Night Before Surgery: No smoking or drinking alcohol!!! Do not eat or drink anything after midnight the night before your surgery. Try to have a healthy dinner. Eating a low fat and low salt dinner may help to minimize your thirst. Shower the night before or morning of surgery. If you were given a pre-operative scrub at your pre-surgery office visit you should use it at this time.

4 One working day prior to your surgery, you will receive a telephone call from our Same Day Surgery Unit (SDS) between 4PM and 8PM. If you do not receive this telephone call, you may call During this pre-operative telephone call, you will be given information regarding where you are to report, and what time you are to report. The Morning of Surgery: EATING AND DRINKING: ALL eating and drinking should STOP at midnight, the night before the procedure. This restriction includes gum, mints, candy and smoking. You may brush your teeth in the morning, but do not swallow any water. PLEASE BE AWARE THAT FAILURE TO FOLLOW THESE INSTRUCTIONS COULD RESULT IN THE CANCELLATION OF YOUR PROCEDURE. If you were instructed to take some of your usual morning medications then you may take them with a few sips of plain water. If instructed, you should bring any x-rays or test results to the hospital with you. The Day of Surgery The Same Day Surgery Unit will instruct you as to where to report when they call you the day before your surgery. You will be admitted and final preparation for your surgery will take place. Before you go to the Operating Room, you will need to go to the bathroom and change into a hospital gown. You will need to remove all hair accessories and eye makeup. You may be given a sedative to help you relax. You will be awake when arriving at the Operating Room. You will be given medications through an intravenous line (IV) in your arm that will put you to sleep. The surgery will generally take approximately 2 hours. You will spend an additional period of time in the Post- Anesthesia Care Unit (PACU). Your visitors can wait in the surgical family waiting area and your surgeon will contact them after the surgery is complete to give them an update. The nurse caring for you will contact your family when it is appropriate for you to have visitors after your surgery.

5 Your Hospital Stay After you have recovered from anesthesia, you will be moved to a room in a critical care patient area. The following is an overview of what you can expect during your hospital stay. Assessment Your nurse will closely monitor your condition. Initially after surgery, your blood pressure, pulse, and temperature will be taken frequently. Your incisions and lower extremity pulses will also be checked frequently. Do not be alarmed, it is normal to have your nurse checking on you often. Your nurse will assess you incision sites and help you change position to make you comfortable. As your recovery progresses, these observations will be less frequent. Diet You will NOT be able to eat immediately following your surgery. Your first meal will most likely be breakfast on the day after your surgery. You will be given sips of water with your pills and ice chips when your healthcare team feels that it is safe. Until you can eat, fluids will be given intravenously (IV). Activity You will be getting out of bed to a chair and walking with the assistance of your nurse or physical therapist as soon as you are medically and surgically stable. This may be as early as the day after your surgery. You should expect to get out of bed to a chair and walk at least three times a day. The nursing staff will help you turn from side to side and show you how to use the Incentive Spirometer and do coughing and deep breathing. Walking is important. When permitted, try to walk short distances at least three times a day. Ask for help from the nursing staff as necessary. Coughing and Deep Breathing Your nurse will show you how to do some simple deep breathing and coughing exercises. In addition, you will be shown how to use the Incentive Spirometer. You should use it 10 times every hour while you are awake in order to prevent lung problems after surgery. You should breathe in slowly and deeply to achieve the most benefit. Lower Extremity Clot Prevention Compression sleeves will be placed on your calves to help your circulation while you are in bed. You may also be instructed on simple leg exercises to perform while in bed. Pain Medications You need to let your nurse know your level of pain/discomfort after surgery so you can receive the pain medication that has been ordered. To help the staff assess your pain level you will be asked to rate your pain on a scale of 0-10 with 0 being no pain and 10 being the worst pain that you could imagine. Taking pain medication before the pain is excessive provides better relief. Care of Your Incision At first your groin incisions will be covered by a dressing, which your surgical team will remove. If the incision is draining, it may need a dressing; your nurse will change it as ordered. Look at your incision before you go home so that you can report any changes to your surgeon. Your nurse will discuss any special instructions regarding caring for your incision. You may take a shower the day after you are discharged and you can clean your incision with mild soap and

6 water. Rinse the soap off well and pat the incision dry with a clean towel. Bladder/Bowel Functions A Foley catheter is inserted during surgery to drain urine from the bladder. The catheter will generally be removed when you are medically stable. You will need to be able to urinate without the catheter in place before being discharged. You may also have gas pains for several days before your bowel function returns to normal. Walking and increasing your activity is the most effective method of relieving gas pain. You may experience some constipation after surgery. Increasing fluids and fiber in your diet can minimize the constipation. You will be prescribed a stool softener. Discharge Information Discharge is expected the day after surgery, but may be delayed if there are any concerns. If you have questions or concerns about your discharge plans, speak with your doctor, nurse practitioner, bedside nurse, case manager, or social worker. Any drains and tubes (such as the Foley catheter to drain your bladder or intravenous tube to give you fluids), which were inserted during surgery, will be removed as soon as indicated. Specific instructions about discharge will be given to you before you return home. If needed, a visiting nurse may be recommended and will be arranged before you leave the hospital. Rehabilitation may be recommended for you after your surgery. This could potentially be at an inpatient facility or with a physical therapist at your home. Your needs will be continuously assessed during your hospitalization. Discharge times vary, but may be as early as 10 a.m.

7 Important Phone Numbers Cooper University Hospital: Vascular Surgeons/Nurse Practitioners/Secretaries: Surgery Scheduling: Pre Admission Testing (PAT's): Same Day Surgery: If you have any questions, please call the office at Cooper University Hospital Department of Surgery, 3 Cooper Plaza, Suite 411, Camden, NJ CooperHealth.org C AEL 2/2012

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