Pre-Operative and Pre-Procedural Protocols for Medications, etc:

1. •DO NOT eat or drink anything after midnight the night before your procedure or surgery.
   

2. •Take all essential medications with a sip of water on the morning of the surgery. The essential medications
   include: cardiac and blood pressure medications, cholesterol medications and aspirin.
   

3. •If you are on Plavix, call my office 1 week prior to surgery.
   

4. •If you are a diabetic on pills: DO NOT take any diabetic tablet on the morning of your surgery.
   

5. •If you are a diabetic on insulin: Take no regular insulin the morning of surgery. Discuss all other types of insulin with the Physicians Assistant in Pre-admission or with your own primary care physician.
   

6. •If you are on Coumadin discontinue it 5 days prior to surgery. You must be off Coumadin for a full 5 days.
   

7. •If you are on Coumadin due to a prosthetic heart valve or recent blood clot (DVT)* stop Coumadin as described above, but make sure arrangements have been made for low molecular weight heparin to be given to you (Lovenox or Fragmin) or admission to the hospital the day before the procedure. *DVT developed within the last 3 months.
   

8. •If you are on Coumadin for any other reason the Coumadin can be safely discontinued for 5 days with no significant risk.
   

9. •If you have any questions speak to the staff when in Pre-Admission Testing or to my office.

Hospital Course for Aneurysm Repair (Open):

1. •Admission is via Same Day Surgery. Please arrive 2 hours before the scheduled surgery.
   

2. •Do not eat or drink anything after midnight the night before your procedure or surgery. See pre-operative protocol for further instructions.
   

3. •It is recommended that your family leave instructions with the nurses in Same Day Admitting so that they can be contacted after the surgery or procedure. The options include waiting in the main hospital lobby and leaving a home, work or cell phone number.
   

4. •Patients stay in the Surgical Intensive Care Unit or Recovery Room for 1-2 days. They then go to the Step-Down Unit and later to the regular nursing floor as the progress.
   

5. •Most patients remain on a ventilator or respirator overnight.
   

6. •Once the ventilator is removed it is important that you cough, take deep breaths and use the incentive spirometer, a device that helps keep your lungs inflated, hourly. These procedures help to prevent pneumonia.
   

7. •Most patients have an epidural to prevent pain for the first few days after surgery.
   

8. •After that intramuscular shots or tablets are given. All patients have a tube in their nose that passes down to the stomach. It drains stomach contents and prevents vomiting. It is removed when your bowels start working again, usually in 2-4 days.
   

9. •Once your bowels are working again (indicated by passing gas or having a bowel movement) a diet is begun. This starts with liquids and progresses to solid food over 1-2 days.
   

10. •A “Foley” or urinary catheter is left in place for several days to monitor fluid balance.
    

11. •Once some of the monitoring lines have been removed you will be taken out of bed and put in a chair. This also helps breathing. When sitting in the chair it is important to keep your legs elevated to prevent swelling.
    

12. •The day after sitting in the chair walking is started slowly. This is done with the assistance of the Nurses, Physical Therapists and aides.
    

13. •Most patients have “sequential stocking” on their legs for the first several days. These help prevent blood clots from forming in the legs.
    

14. •Once you can eat regular food, move your bowels, walk a short distances and your incisions or wounds are healing satisfactorily, you are ready for discharge.
    

15. •Patients who have a family member at home during he day can go home, otherwise rehab is recommended. If you feel rehab will be necessary let the staff know as soon as you are given a liquid diet as it can take many days to arrange the rehab bed.
    

16. •On discharge take the incentive spirometer with you and continue to use it for 2-3 weeks.
    

17. •Changes in your pre-operative medications are common for a brief time after the surgery. 

Discharge Instructions for Aneurysm Repair (Open):

1. •Take medications and diet as instructed on hospital discharge sheet. Frequently this means resume pre-surgical medications and diet.
   

2. •Many patients are recommended to take supplements.
   

3. •Take pain medication as prescribed.
   

4. •Take simple laxatives as needed.
   

5. •Get regular exercise, such as, walking.
   

6. •Keep your legs elevated when sitting to prevent swelling.
   

7. •Do not lift anything greater than 10lbs in weight for 6 weeks after surgery.
   

8. •Make an appointment with your primary care physician within 2 weeks of discharge from the hospital.
   

9. •If you are discharged with staples in your incision make an appointment to see me 1 week after discharge, otherwise make an appointment 2 weeks after discharge.
   

10. •Call my office if you have a fever, vomiting, new onset drainage or bleeding from your incision, redness or the incision that extends more than 1/2 inch from the edge of the wound.
    

11. •You should wait at least 4 weeks before driving a car.
    

12. •Most patients are recommended to take 6 weeks off of work.
    

13. •Call my office with any questions.