Strong Heart and Vascular Center

Division of Cardiac Surgery

Patient Education

Discharge Instructions

Your incision sites are easy to care for:

The Arglaes antimicrobial dressing (clear dressing) is intended to stay on for 7 days. You will receive an instruction sheet on its care and removal.
Wash incisions daily. Brief showers (no tub baths until incision fully healed) using an antibacterial soap. Do not rub the incision with a washcloth until the scabs are gone and skin is healed.
No dressings are needed unless there is drainage.
Do not apply ointments, oils, creams, salves, lotions, or powder to your incisions.
Itching, tightness and/or numbness along the incision are normal.
Lump at top of chest incisions goes down in about 3-4 months.

Be aware of signs of infection that may include:

Temperature of 101.5° or greater
Chills
Increase in opening of the incision
Increased redness, swelling, or warmth around the incision.
Increased drainage (clear, pinkish, yellowish drainage is normal unless it greatly increases)
Pus or foul odor
If you notice any of these signs of infection, call your doctor.

Prevention of Valve Infection

Bacterial endocarditis is an infection of the inner heart lining. It may cause destruction or scarring of the heart valves. People who have had a repair or replacement of any of their heart valves should be protected from this kind of infection.

Bacterial endocarditis may be caused by ANY DENTAL WORK, SKIN INFECTIONS, AND ANY MAJOR OR MINOR SURGERY. Usually it can be prevented if antibiotic medication is given before and possibly after such procedures. Be absolutely sure that your doctor and your dentist know that you have had valve surgery so that you can be given the appropriate antibiotic if you should require dental work or surgery.

Anticoagulation
Some people who have had the heart valves replaced or have an irregular heart beat may need to be given a medication, Coumadin (generic name, warfarin). Coumadin lengthens the time it normally takes for blood to clot and prevents small clots from forming on new valves.

While you are in the hospital, you will have a blood test (INR) every day to help determine how much medication you need. After you are home, you should have a blood test (INR) once a week to make sure you are taking the correct dosage of medication. When your family doctor feels that you are taking the correct dosage of medication, the blood test may be done less often, usually about once a month on a permanent basis.

For the first three weeks at home, following your heart surgery, you will need to observe certain guidelines and follow specific discharge instructions in order to speed you recovery and help you return to a normal pace of life.

Valve Surgery - Coumadin

IF you are taking Coumadin (Warfarin):

1. Take the medication at the same time each day.

2. If you forget a tablet one day, DO NOT take two tablets the next day.

3. DO NOT TAKE ASPIRIN OR ANY MEDICATION CONTAINING ASPIRIN (BUFFERIN, EXCEDRIN, ALKA-SELTZER, COLD REMEDIES) WHILE
YOU ARE TAKING COUMADIN EXCEPT AS ORDERED BY YOUR NP OR MD.

4. You may take Tylenol for mild discomforts and headaches.

5. If you need dental work or surgery done, be sure to let your doctor know you are taking Coumadin.

6. Carry an identification card that states the name and dosage of your medication.
An ID card is on the back of your Coumadin book.

7. While you are on Coumadin, small cuts may bleed longer.

8. Notify your doctor if you notice any of the following:

▪ increased bruising
▪ blood in your urine (red or pink in color)
▪ blood in your stools (black or tarry looking)
▪ coughing up blood
▪ excessive nose bleeds

9. Wear a Medic Alert tag to let people know you are taking Coumadin.
The Medic Alert tag may be obtained at your local pharmacy or by writing to:

Medic Alert Foundation
P.O. Box 1009
Turlock, California 95380

OR the website: http//www.coumadin.com