Carotid Endarterectomy

WHAT YOU SHOULD KNOW

Risks

IF YOU'RE HEADING FOR THE HOSPITAL...

Before You Go

• Your physician may suggest you take a sleeping pill the night before the operation.
• Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you when to begin fasting.

When You Arrive

• Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
• Do not wear contact lenses to the hospital. You may wear glasses.

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
• Chest X-ray: The doctor will examine this picture of your lungs and heart to make sure you can withstand the stress of surgery.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• 12 Lead ECG: This is a more detailed type of heart monitor. Readings are usually taken for 5 to 10 minutes at a time. They can help to detect any problems in the heart.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
• Arterial Doppler: Your doctor will order this painless test to determine how much blood is flowing through the artery. During the test, medical personnel listen to the flow of blood with a small machine placed on the skin over the artery.
• CVP Line: A CVP line, also called a central line, is an IV tube inserted in a large blood vessel near your collarbone, in your neck, or in your groin. To make insertion easier, the head of your bed may be lowered to help the blood vessel fill up and expand. The skin at the insertion site will be numbed to reduce any pain. Once in place, the line can be used to give medicines and measure the activity of your heart.
• Swan-Ganz: This is another type of IV tube that may be inserted in a vein near your collarbone or in your neck. The tube is then guided through the inside of your heart and into your lungs. One part of this tube is hooked to a monitor that measures pressure within the heart and lungs. Another part may be used to give medicine.
• Cardiac Outputs: These tests check the heart's pumping capacity. First, an IV liquid is pushed into your Swan-Ganz line very quickly. Then sensors in the line measure how long it takes the heart to push the liquid out into your system.
• Arterial Line: This tube, also called an "art line" or an "A-line," is inserted into an artery, usually in the wrist or groin. The line is attached to liquid-filled tubing to keep it from clogging up. It can be used to measure your blood pressure or to draw blood for tests.
• Anesthesia: You'll need a pain-killer during the operation. For this type of surgery, the following options are available:
• Cervical Block: This is a local pain-killer that will numb your neck but leave you awake during surgery.
• General Anesthesia: This alternative puts you completely to sleep throughout the operation. The anesthetic is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.

During Surgery

After Surgery

• Oxygen: At times after the operation, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
• Blood Gases: This test measures the amount of oxygen, acids, and carbon dioxide in the blood---measurements that are especially important if you're having any trouble breathing. The blood sample for the test is taken from an artery in the wrist, elbow, or groin.
• Blood Transfusion: If you lose a lot of blood during the surgery, you may need a transfusion. Although you might be worried about catching AIDS or hepatitis from tainted blood, the risks posed by going without a transfusion are actually much greater. Your chance of receiving infected blood is about 1 in a million; severe blood loss, on the other hand, can easily trigger a heart attack.
• Neuro Signs: Nurses will regularly check your eyes, memory, hand grasp, and balance, and see how easily you can be awakened. These signs indicate how well your brain is recovering from the trauma of surgery.
• Day or Night Confusion: Patients recovering in the ICU often can't tell whether it's day or night, since the lights are on 24 hours a day. This problem will disappear once you are moved to a room on a regular floor.
• Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
• Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Incentive spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Activity: You will need to rest in bed for a while. But even when you're confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
• Pressure Stockings: These tight elastic stockings keep blood from collecting in the legs and causing clots.
• Pneumatic Boots: For extra insurance against blood clots, these plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens and loosens different parts of the boots, helping to push the blood back up to the heart.
• Nasogastric Tube: This type of tube, also called an NG tube, is threaded through your nose and throat and down into your stomach. It is attached to suction, which will keep your stomach empty. It may also help to get your bowels working. Food or medicine is sometimes given through the tube.
• Eating: When your doctor can hear bowel sounds (stomach growling) through a stethoscope, you'll be able to eat. You will probably get ice chips first and then liquids (water, broth, apple juice, or soda). If you do not have problems with the liquids, you'll then be allowed to eat soft foods such as ice cream, applesauce, or custard. If these foods agree with you, you can return to a regular diet.
• Bowel Movements: Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
• Foley Catheter: This is a tube that is sometimes inserted into the bladder to drain your urine. The catheter may make you feel as though you have to urinate. Relax and the catheter will drain the urine for you.
• Don't pull on the catheter because this could cause injury.
• Don't kink the catheter; this will stop the flow.
• Don't lift the bag of urine above the catheter. If you do, the urine will flow back into your bladder, possibly causing an infection.
• The catheter will be taken out when you can urinate on your own.
• Strict Intake/Output: Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O."
• Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
• Your output of urine may have to be measured. Ask your doctor whether it's OK to use the toilet.
• Medicines:
• Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
• Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
• Blood Thinners: These drugs keep clots from forming in the bloodstream and causing a stroke. They may first be given in your IV. Later, they may be given by mouth or as a shot. They make it easier to bleed or bruise. To prevent bleeding from your gums, be sure to use a soft-bristle toothbrush.
• Clot Busters: These drugs help break down clots that have already formed. They may be given in your IV, either alone or at the same time as other blood thinners. Like blood thinners, these drugs make it easy to bleed, so be especially careful to avoid injury while taking them.
• Blood Pressure Medicine: This medicine may be given to keep your blood pressure down. If it's very high, or if you are vomiting a lot, the medicine may first be given in your IV. Later it can be taken by mouth. Keeping your blood pressure under control will protect your heart, brain, kidneys, and other organs.
• Stool Softeners: These medications make bowel movements softer so you won't need to strain.

After You Leave

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• For pain or swelling, you may put ice in a plastic bag, cover it with a towel, and place it over the incision for 15 to 20 minutes out of every hour as long as necessary. Do not sleep on the ice pack. Treatment with ice is most effective when started right after the operation and used for 24 to 48 hours.
• The earlobe on the side of the surgery may feel numb after the operation. This problem is often temporary, but sometimes is permanent.
• When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water. Then put on a clean, new bandage. Change your bandage any time it gets wet or dirty.
• Eat healthy meals from all 5 food groups: fruits, vegetables, breads, dairy products, and meat. This will increase your energy level and promote faster healing.
• Unless instructed otherwise, drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day. Limit caffeinated beverages, such as coffee, tea, and soda.
• Do not lift anything heavy until your doctor gives the OK.

Call Your Doctor If...

• Your incision is swollen and red, or you see any pus. These are signs of infection.
• Your stitches or staples come apart, or there is a steady stream of blood or liquid coming from them.
• Your bandage becomes soaked with blood.
• You develop a fever.

Seek Care Immediately If...

• You suddenly have trouble breathing. You could have a blood clot in your lungs or an allergy to one of your medicines.
• Any of the following signs of stroke appear:
• • Inability to speak, move part of your body, or see
  • Blurred vision
  • Dizziness
  • Confusion
  • Unconsciousness
• You have any of the following signs of heart attack:
• • Chest pain that spreads to your arms, jaw, or back
  • Sweating
  • Nausea
  • Difficulty breathing