Due to the effects of general anaesthetic on your lungs, there is an increased risk of developing respiratory complications with major surgery. You will be provided with an incentive spirometer which trains your lungs before surgery and re-opens the base of your lungs after surgery. You should aim to undertake incentive spirometer training 4 times per day before surgery.
ICOUGH is a respiratory bundle designed to reduce your risk of developing post operative venous thromboembolism events and pulmonary complications. The bundle includes early mobilisation, lung exercises, oral hygiene and education.
Alongside your regular medications, the doctors will prescribe the ICOUGH bundle during your hospital stay. This consists of:
- Incentive spirometry, coughing and deep breathing – to be practised hourly after your surgery.
- Chlorhexidine digluconate mouthwash – to be used 10-15 minutes after eating
- Sodium fluoride toothpaste – to be used twice daily.
- Getting out of bed, sitting in chair and mobilising – to prompt you to remain out of bed for at least 6 hours per day.
- ICOUGH explained – staff will explain why you are being asked to complete the above.
Incentive Spirometry
Having a general anaesthetic can cause the tiny air sacs in your lungs to collapse.
An incentive spirometer assists you to take a deep breath and reopen these air sacs after surgery.
It is important to practice using the incentive spirometer at home before your surgery as this will help your technique and improve your lung function.
You should aim to use your incentive spirometer at least 4 times a day before surgery and every hour after surgery
Coughing
It is important that you are able to cough effectively to clear any mucus that can build up after surgery.
Good pain control is important so that you are able to take a deep breath and cough properly.
Holding a towel or pillow over your operation site can help.
Oral Healthcare
The risk of a chest infection is increased by bacteria living in your mouth which can travel into your chest and cause an infection.
You should brush your teeth or dentures twice a day with a fluoride toothpaste for at least 2 minutes. You should also floss your teeth every day and use an antibacterial mouthwash twice a day. It is best to use the mouthwash 10-15 minutes after brushing your teeth.
If you have existing dental problems now is the time to visit the dentist or dental hygienist.
After your surgery you will be prompted to brush your teeth in the bathroom, and if unable, a member of staff can provide you with a bowl and water at your bedside.
Getting out of bed
Getting out of bed and mobilising is important for your recovery.
Activity will help prevent chest infections, help your circulation, help bowel function, improve your appetite, increase strength and decrease stress.
Some patients who require additional post operative monitoring may spend a short time on intensive care.
It is normal to have some ‘attachments’ after your operation but these will not hinder your ability to get up out of bed.
Whether you are on intensive care or the surgical ward if you are well enough, we aim to help you get out of bed from 6 hours after your surgery.
From the day after your surgery we encourage you to sit out of bed at least 6 hours a day and walk at least 60 metres 4 times a day, if you would normally be able to do so.
This might feel daunting, but the ward team are there to support you.
The times that you are in bed it is important to sit up rather than lying flat.
Sitting up in bed gives your lungs more room to expand which will help your breathing.
The head of the bed should be elevated to at least 30 – 45 degrees.
Understanding
You and your family need to take an active role in preparing for surgery and your recovery.