Surgical & Procedural Care - Patient Handbook

Surgical &

Procedural Care

Patient Handbook

St. Luke’s Information

3 Important Phone Numbers

3 Visitors

3 Parking and Directions

3 Finding Your Way at St. Luke’s

How to Prepare

4 Before your Procedure

4 Preoperative Physical Checklist

Pre-Procedure

5 Food, Drink and Medications

5 Getting Ready

5 What to Bring to the Hospital

5 Coping with Anxiety

Procedure

6 At the Hospial Before Your Procedure

7 Anesthesia

7 In the Operating Room (OR)

Post-Procedure

8 After Your Surgery

Discharge

9 Pain Management

9 Nausea/Vomiting Management

10 Signs of Bleeding

10 Signs of Infection

10 Discharge Instructions

11 Leaving the Hospital

12 Notes

Table of Contents

Your procedure is at St. Luke’s Surgical & Procedural Care, 1015 E. 1st Street, Duluth, MN. This guide

will help you prepare for your procedure and know what to expect during your stay.

Appointment Date:

Surgeon’s Name and Phone Number:

A day or two before your surgery, a nurse will call you. They will give you an arrival time for your procedure

and any additional instructions you need to prepare for your procedure. If you have not been called by

7 pm one business day before your procedure, call 218.249.5244.

The information provided

is a general overview for all

surgical procedures. Your

surgeon may also give you

more detailed information

related to the specific

procedure you are having.

2 | St. Luke’s

St. Luke’s Information

IMPORTANT PHONE NUMBERS

St. Luke’s Hospital

Available 24/7

218.249.5555

Pre-Admissions Testing

Monday – Friday, 8 am – 4:30 pm

218.249.5644

St. Luke’s Surgical & Procedural Care

Monday – Friday, 5:30 am – 8 pm

218.249.5244

St. Luke’s Financial Specialists

218.249.5340

St. Luke’s Facility Assistants

Available 24/7

218.249.4940

Northland Pharmacy

Monday – Friday, 8 am – 6 pm

218.249.2460

VISITORS

Generally, you may have one adult visitor accompany

you the day of your procedure. This person should be

your support person.

• Check St. Luke’s website (slhduluth.com/visitors)

or call your surgeon’s office for the most up-

to-date visitor policy.

• Once you go into the operating room (OR),

your visitor may need to return to the

Surgical & Procedural Care waiting room.

• For refreshments, there is a coffee shop located

on the 2nd floor of Building A. Also, Blue Waves

Café is located on the 3rd floor of the hospital.

PARKING AND DIRECTIONS

• Park for free in the covered lot in front of

Building A (1015 E. 1st Street).

• Enter Building A. There will be an information

desk staff member or volunteer to help direct

you, and wheelchairs for patient use.

• Take elevators to 3rd floor, to the Surgical &

Procedural Care waiting room and check in at

the desk.

• For more information, visit slhduluth.com/surgery.

FINDING YOUR WAY AT ST. LUKE’S

To help make St. Luke’s as easy to navigate as

possible, all building and parking lot signs and

maps are color coded.

• Building A – GREEN

• Hospital – BLUE

• Medical Office Pavilion – RED

• Lakeview Building – PURPLE

• Northland Medical Center – GOLD

• SLH Clinic Building – ORANGE

There are campus maps located near all

entrance points, as well as courtesy phones and

digital directories. Once you are in a St. Luke’s

building there will be color-coded signage to direct

you to services in that building and to other

St. Luke’s buildings.

For a detailed map of St. Luke’s Campus,

visit slhduluth.com/map.

Need Help?

If you ever need assistance finding your way

at St. Luke’s or a wheelchair escort, call

St. Luke’s Facility Assistants at 218.249.4940.

Surgical & Procedural Care | 3

How to Prepare

BEFORE YOUR PROCEDURE

Here are several important things you will need to do

before your procedure.

• See your primary care provider. Schedule

a preoperative physical with your primary care

provider within 30 days of your procedure.

(If you do not have a primary care provider, reach

out to your surgeon’s office.) To help you and

your provider make sure you are ready for your

procedure, bring this booklet and talk through all of

the items in the Preoperative Physical Checklist

(next column) at your preoperative

physical appointment.

• Call your insurance provider. To see if a prior

authorization is required by your insurance policy,

call your insurance provider. If this is not completed

by the time of surgery, your procedure may be

delayed.

• Stop smoking. Since non-smokers have fewer

infections and faster healing, it is recommended

that you stop smoking 4 weeks prior to surgery.

• Stop drinking alcohol. All patients are required

to abstain from alcohol for 2 weeks prior to

surgery. This prevents complications such as

bleeding, infection, heart problems, and a longer

hospital stay.

• Receive a nurse phone call. A day or two

before your surgery, a nurse will call you. They will

give you an arrival time for your procedure and any

additional instructions you need to prepare for your

procedure. If you have not been called by 7 pm

one business day before your procedure,

call 218.249.5244.

PREOPERATIVE PHYSICAL CHECKLIST

Bring this checklist to your preoperative physical with

your primary care provider. Review the items on this

list to help avoid complications and delays in care.

Discuss if you are ready to have the procedure

by reviewing:

How well your blood sugar is controlled

If your Body Mass Index (BMI) is within a

safe range

Smoking cessation difficulties

Alcohol cessation difficulties

Whether insurance preauthorization is

needed and who to contact

Whether preoperative lab work is needed

Whether any diagnostic work is needed

(e.g., EKG)

Your health care directive (optional)

Discuss medication instructions if you take:

Blood thinners or anticoagulants

(e.g., Coumadin or Plavix)

Blood thinning medications (e.g., NSAIDs

or aspirin)

Diabetic medications or insulin

Scheduled pain medications

Blood pressure medication

Vitamins

Discuss your plan for recovering, specifically

regarding:

Ordering adaptive equipment

(e.g., crutches or a walker)

Arranging discharge to a long-term care or

rehabilitation facility

4 | St. Luke’s

Pre-Procedure

GETTING READY

• Arrange for a responsible adult to drive you home

after your procedure.

• If a wristband is placed at your lab appointment

(generally 2 to 3 days before your surgery), you

must leave it on.

• Before you arrive, please remove:

• All makeup and nail polish

• All body piercings and jewelry, including

wedding rings

• Bathe/shower the night before or morning of

surgery. Do not apply lotions, deodorants, oils

or powders.

• Do not shave the operative site.

• Notify your surgeon immediately if you develop

cold, flu or other symptoms of illness.

WHAT TO BRING TO THE HOSPITAL

• Wear loose, comfortable clothing

• DO bring:

• Your insurance card and picture ID

• An updated list of medications

• A container for your hearing aids, glasses,

contacts and/or dentures

• Your CPAP machine and mask, if you use one

• Emergency inhalers, if you are prescribed them

• DO NOT bring:

• Money or credit cards

• Medications

• Anything of value that you do not want lost

or damaged

COPING WITH ANXIETY

You may experience feelings of fear and anxiety

leading up to your procedure. Talk with your primary

care provider if you are unable to cope with anxiety.

The day of your procedure, inform surgical staff

immediately upon arrival. We will listen carefully and

do everything we can to make sure you are

comfortable. We will also notify your anesthesiologist

who will decide whether medication to help your

anxiety is appropriate.

To prevent complications or delays in your care, you

must follow these instructions.

FOOD, DRINK AND MEDICATIONS

• You may have clear liquids or water up to 6 hours

prior to your procedure.

• After midnight prior to your procedure, do not eat

any food or use tobacco products. This includes

hard candy, chewing gum, cigarettes and

chewing tobacco.

• For children less than 36 months old, breast

milk may be given up to 4 hours prior to

procedure or formula up to 6 hours prior to

procedure. However, follow the same guidelines

for solids and other liquids.

• Follow instructions from your primary care

provider regarding medications taken before

your surgery. You can continue to take

prescribed pain medication until the morning

of surgery. Acetaminophen (Tylenol) is ok to

take prior to surgery. Do not take NSAIDS

(Ibuprofen, Advil, Motrin, Aleve) without

discussing with your surgeon.

Surgical & Procedural Care | 5

Procedure

• Room Assignment: After you check in at the

front desk of Surgical & Procedural Care, the

staff will let your surgical team know you have

arrived. As soon as your room is available, you

will be brought back to your private preoperative

room. Your support person may accompany you,

if you wish.

• Vitals Check: Staff will weigh you and take

your vitals (temperature, heart rate, blood

pressure, etc.).

• Clothing Prep: You will be asked to remove

all clothing, including your undergarments, and

change into a hospital gown and socks.

• Medication Verification: Your nurse will verify

your medications along with the last date and

time taken. They will complete an assessment

and place an IV. An IV is a soft flexible tube

placed inside a vein, in which medications can be

administered through. There are several options

available to increase the comfort of your

IV placement.

• Additional Testing: Labs or diagnostic testing,

such as an EKG, may be completed.

• Meet and Greet: You will meet your

anesthesiologist and surgeon to discuss your care

and sign consent forms.

• Skin Prep: Depending on the type of procedure

you are having, you may require a skin prep. This

may require staff to clip hair and cleanse around

the operative site. Do not shave the operative site

before coming to the hospital.

• Specialized Clothing: You may be given

compressive stockings to wear and/or have

special sleeves applied to your lower legs that

provide intermittent pressure cycles. These will

help your blood circulation during and after

surgery, helping to prevent the formation of blood

clots.

• Specialized Protection: A foam dressing may

be placed to prevent skin injuries on areas that

your nurse has identified as high risk for skin

breakdown during your procedure.

• Keeping You Informed: Sometimes there are

unforeseen or emergent circumstances that may

require a delay in your procedure start time. We

will communicate updates or possible delays to

the best of our abilities.

AT THE HOSPITAL BEFORE

YOUR PROCEDURE

6 | St. Luke’s

Procedure

ANESTHESIA

Your anesthesiologist provider will meet with you, and

together you will decide which type of anesthesia

is best for you. You may be asked to provide a

urine sample for pregnancy testing prior to receiving

anesthesia. You may not drive for 24 hours after

receiving any type of anesthesia, sedation or

narcotic medication.

There are several forms of anesthesia. Below is

an overview of each one.

General Anesthesia

This form of anesthesia is inhaled through a

mask and/or given through your IV. Once you

are completely asleep from the anesthesia, the

anesthesia provider will gently place a breathing tube

into your airway. Your anesthesia team, which may

consist of an anesthesiologist and a certified nurse

anesthetist, will monitor you very closely. They will

be watching your vital signs and comfort level. With

general anesthesia, you will not move, feel pain, or

have any memory of the procedure.

Sedation

This form of anesthesia is provided through your IV

and allows you to be comfortable while still breathing

on your own. Your levels of sedation and awareness

will depend on the type of procedure you are having.

Your anesthesia team will monitor you closely by

watching your vital signs and comfort level.

Spinal and Epidural Anesthesia

These forms of anesthesia numb parts of your body

to block pain. They are given through injection(s)

in or around the spine. Additional medication is

provided through your IV to relax and sedate you.

This additional medication often induces sleep and

most patients have no memory of the procedure.

Depending on several factors, your anesthesiologist

will determine if you are a candidate for spinal or

epidural anesthesia.

Peripheral Nerve Blocks

Medication can be injected near the nerves of the

surgery site to help alleviate post-operative pain.

Your anesthesiologist will discuss whether a nerve

block is a good option for you.

IN THE OPERATING ROOM (OR)

Before you leave your preoperative room there will be

a safety check. This will include verifying your name,

date of birth, and type of procedure. This will be

repeated when you arrive in the OR.

• You will be taken to the OR on the bed from your

preoperative room. Once you reach the OR, you

will be transferred to another bed.

• Your anesthesia team will place monitoring

equipment. This will include a blood pressure

cuff on your arm, a pulse oximeter on your finger,

and electrode stickers on your chest to monitor

your heart.

• For your safety and comfort, you will be

continuously monitored by your anesthesia team.

• The OR is a sterile environment. Everyone in the

room will wear protective coverings to reduce risk

of contamination. You may receive an antibiotic

through your IV to help prevent infection.

• The OR room temperature is cool. Keeping the

temperature low may be helpful in reducing

bacteria in the environment, as well as keeping

your surgical team cool. You will be given warm

blankets for your comfort.

Surgical & Procedural Care | 7

Post-Procedure

AFTER YOUR SURGERY

• Recovery Unit: Depending on the kind

of anesthesia you received, you may go to

the recovery unit as you wake up after

your procedure.

• Postoperative Update: You may not remember

speaking to your surgeon while you are in the

recovery unit. Usually, your surgeon will update

your support person while you are still waking up.

• Postoperative Care Location: After the

recovery unit, you will return to Surgical &

Procedural Care (unless you are admitted to the

hospital to stay overnight). A nurse will monitor

your vital signs, assess your comfort, nausea and

wakefulness.

• Ensuring Your Comfort: Your nurse will make

you as comfortable as possible by dimming the

lights, providing warm blankets, and making sure

you are positioned comfortably. They will also

offer you fluids and a light snack.

• Postoperative Instructions: The nurse will

review your postoperative medications and

instructions with you and your support person

before discharge. You may still feel sleepy when

you leave, so it is advised that you spend the

remainder of the day resting at home, with your

support person.

• Recovery Support – Movement: Your nurse

will encourage movement following your

procedure. Movement is proven to help prevent

complications such as pneumonia, blood clots,

constipation, skin breakdown and inability to

urinate. Continue to move as directed during your

recovery at home.

• Recovery Support – Breathing Exercises:

Your nurse will encourage you to cough and take

deep breaths after your procedure. This helps

to prevent pneumonia. You are encouraged to

continue coughing and deep breathing often

during your recovery at home.

• IV Removal: Before you leave the hospital,

your IV will be removed. Firm pressure should

be applied to the IV area for several minutes to

minimize bleeding and bruising.

8 | St. Luke’s

Discharge

PAIN MANAGEMENT

Pain control is very important for your recovery. After

your procedure, you will be asked to rate your pain

on a scale from zero to 10, zero being no pain and

10 being the worst pain possible. It is important to

communicate to your care team what level of pain is

tolerable.

Depending on your procedure, pain may be expected

and you may not be pain-free when you leave.

However, there are several options available to help

lessen pain. Some pain management techniques

frequently used are pain medication and non-

medication pain relief. It is helpful to have a plan to

use a combination of these during your recovery.

Pain Medication

It is encouraged that you keep a log of when you

take pain medications to prevent accidental overdose.

Narcotics. Narcotics may be prescribed

following your procedure. These are used for

moderate to severe pain. It is important to take

these medications as prescribed. Oftentimes they

are prescribed “as needed,” and should only

be taken if you’re in pain. These should be taken

only when pain cannot be managed by

over-the-counter medications and non-medicated

pain relief methods.

Risks of narcotics can include constipation,

nausea, sleepiness and decreased tolerance

to pain. To prevent constipation, drink plenty

of liquids, move frequently, and take over-the-

counter stool softeners. Discuss with your

surgeon or pharmacist which stool softener they

recommend for you.

Over-the-Counter (OTC)/Non-narcotics

Many narcotic medications already contain Tylenol

(acetaminophen). You should not exceed 4,000

milligrams (mg) of acetaminophen in a 24-hour

period. Nonsteroidal anti-inflammatories such as

Ibuprofen, Motrin, Advil, Aleve and Naproxen may

be taken as directed.

For children, follow packaging instructions for the

maximum amount of medication your child can

have in a single day. Call your child’s provider if

you are unsure of the instructions. Consult your

provider before giving aspirin to your child.

Non-Medication Pain Relief

Ice. Double-bagged ice cubes or commercially

made ice packs can be used. Be sure to place

a towel between the ice and skin to prevent

frostbite or damage to the skin. Use ice as

directed by your surgeon.

Elevation. Elevate the affected area above the

level of the heart as able. This decreases swelling,

which helps alleviate pain.

Alternative pain management techniques.

Alternative techniques include guided imagery,

meditation, music, acupuncture, massage,

essential oils, or other techniques suggested by

your surgeon.

NAUSEA/VOMITING MANAGEMENT

Nausea is not uncommon following anesthesia,

especially following abdominal and gynecological

surgeries. If you’ve experienced post-operative

nausea or vomiting in the past, please let your

anesthesia team know before surgery.

If you become nauseous, here are some things that

can help:

• Chew on ice chips and drink clear liquids, slowly

progressing to bland foods as you’re able.

• Take pain medications with food.

• Aromatherapy, such as peppermint oil,

may help.

• Ask your care providers if medication to treat

nausea is appropriate for you.

Surgical & Procedural Care | 9

Discharge

DISCHARGE INSTRUCTIONS

A nurse will review discharge instructions regarding your post-operative care with you. Make sure your questions

and concerns are addressed by either your nurse or surgeon.

SIGNS OF BLEEDING

Bleeding may happen inside of the body or outside of the body. Depending on the type of procedure you

had, some bleeding could be normal and expected. Ask your surgeon what normal bleeding is for the type of

procedure you had. If you are unsure as to whether your bleeding is normal, call your surgeon’s office. If you are

experiencing heavy bleeding call 911.

SIGNS OF INFECTION

Most surgical infections appear at the incision site within 30 days after surgery. Surgical wound infections may

have pus draining from them, and can be red, painful, or hot to touch. You may have a fever and feel sick. Call

your surgeon immediately if you are experiencing any signs of infection.

10 | St. Luke’s

Leaving the Hospital

LEAVING THE HOSPITAL

Many procedures do not require a hospital stay. If

your procedure does require a stay, it will be our goal

to help you transition to the next phase of your care

as quickly as possible. When you are discharged, it

allows a bed to be available for someone else who

needs the high level of care that our inpatient setting

provides.

• Inform your care providers of your preferred

pharmacy. Northland Pharmacy, located on

St. Luke’s campus, is available to fill your

prescriptions Monday through Friday, 8 am

to 6 pm. They accept most insurance plans.

• If you are planning to go to a skilled nursing

or rehab facility after your procedure, tell your

surgeon and nurse.

• If you are planning to go home after your

procedure, you will need to have a responsible

adult available to drive you home. You should not

drive for 24 hours following your procedure or

while you are taking narcotic medications.

• A nurse may call you following your procedure to

see how you are doing. If you have any concerns

or questions, contact your surgeon’s office.

LEARN MORE

If you’d like to learn more about your procedure or

health condition, visit slhduluth.com/HealthLibrary

Surgical & Procedural Care | 11

Notes

12 | St. Luke’s

Notes

Surgical & Procedural Care | 13

Notes

915 E. 1st Street

Duluth, MN 55805

218.249.5555

06/22