Preparing for Surgery

• A hospital representative may call you to verify your insurance and personal information.
• You may need preadmission testing. The scheduler at your surgeon's office will guide you through this process.
• Print and complete the health history questionnaire (PDF) and have it available at the time of your phone interview or visit.
• If applicable, please bring your implantable electronic device cards; for example, pacemaker, AICD or spinal stimulator.
• For hip or knee replacement surgery, contact the program manager to schedule your preoperative class. Call 1.866.CALL.MLH (225.5654) for class dates and times or visit mainlinehealth.org/events.

• Your surgeon's office will determine whether you need to have lab work and an EKG, and will provide you with a lab/EKG request form.
• If you do not need to complete your preadmission assessment in person, one of our nurses will contact you by phone.
• If you need to come to the hospital for preadmission testing, your visit will include an assessment by a nurse, nurse practitioner and/or physician.
• You will have your lab work and EKG, if applicable, performed at this time.
• If you are unable to keep your preadmission testing appointment, please contact your surgeon's office to have them notify the preadmission testing department.
• The day before your surgery, we will call you between 2:00 pm and 7:00 pm to notify you of your arrival time.

Do:

• Bring your glasses with a case
• Bring your hearing aid with a case
• Bring a case for your dentures (you will be asked to remove them)
• Bring your CPAP or BiPAP machine if you will be admitted after your surgery
• Notify your surgeon if you develop a cold, cough, fever or other symptoms prior to the date of your surgery
• Wear loose-fitting and comfortable clothing as well as sturdy shoes
• Let us know if you need interpreter services
• Bring your favorite chewing gum

Do not:

• Wear jewelry, including wedding bands and body piercings
• Bring any valuables to the hospital
• Wear makeup, perfume or lotions
• Apply deodorant for breast surgeries
• Shave the surgical site 48 hours prior to surgery

Do:

• Take your medications as directed by your physician
• Take blood pressure, heart, seizure and thyroid medications with a sip of water unless directed otherwise
• Contact your ordering physician for further instructions if you are taking aspirin, blood thinners, anticoagulants or you are an insulin- dependent diabetic
• Bring your inhaler(s), if applicable

Do not:

• Stop any medications unless directed by your physician and/or surgeon
• Take your oral diabetic medications the day of surgery
• Take any diuretics ("water pills") the day of surgery
• Take aspirin, ibuprofen, anti-inflammatory, vitamin E, over-the-counter vitamins or any type of supplements, including herbals, seven to 14 days before surgery unless ordered by your physician

Good hygiene, such as frequent handwashing and daily skin cleansing, promotes good health. Daily skin cleansing helps remove germs that may cause infections. The following instructions should be followed to help reduce germs on your skin prior to your surgical procedure.

• Bactoshield®/Hibiclens® CHG 4% is an antiseptic soap. The active ingredient is chlorhexidine gluconate. Do not use this product if you are allergic to chlorhexidine gluconate.
• The NIGHT before and the MORNING of your procedure, shower or bathe with Bactoshield. This product should replace your regular soap used for cleansing most of your body surfaces. Bactoshield should not be used on your head or face; keep out of your eyes, ears and mouth.
• If you plan to wash your hair, do so with your regular shampoo. Then, rinse your hair and your body thoroughly to remove any shampoo residue.
• Wash your face with regular soap and water only.
• Wash your genital area with soap and water only.
• Thoroughly rinse your body with warm water from the neck down.
• Apply the minimum amount of Bactoshield to cover the skin. Use this product as you would any liquid soap. Leave on for two minutes. Bactoshield does not lather like regular soap.
• Wash your skin gently and rinse thoroughly with warm water. You do not need to scrub the skin to remove germs.
• Do not use regular soap after you have applied and rinsed the Bactoshield. Change into clean clothes after each shower.
• Do not apply any lotions, powders or perfumes to body areas that have been cleansed with Bactoshield.
• Do not use hair removal products or shave at or near the surgical site 48 hours before your procedure (72 hours for cardiac patients).
• If you are having perineal area surgery (vaginal, rectal or cystoscopy), please use Dial® soap.

You will meet with your anesthesiologist on the day of your surgery. This person will review your medical history and discuss types of anesthesia options that are appropriate for your surgery. This is to ensure your safety and comfort during the procedure. You will be asked to sign a consent form before going to the operating room.

For people with Power of Attorney, you will need to give consent for patients who are unable to do so. Please be available to give informed consent in person or by phone.

The anesthesiologist and your surgeon will determine the best type of anesthesia for you, taking your preferences into consideration whenever possible.

Types of anesthesia:

• Monitored anesthesia care (MAC) – MAC anesthesia provides sedation through an intravenous line (IV) to sedate (calm) you and possibly put you to sleep. It does not cause you to fully lose consciousness.
• General anesthesia – You will be completely unconscious throughout the procedure. A breathing tube may be placed in your mouth to assist with breathing during the procedure.
• Regional anesthesia – Regional anesthesia blocks pain in one specific part of the body. This can be used in conjunction with general anesthesia or MAC. This may be a spinal/epidural or a block that targets the chest or below the waist, or a nerve block that targets a specific limb or area of the body.

You WILL NOT be able to drive the first 24 hours after general anesthesia or sedation.

If your surgery does not require an overnight stay in the hospital, you will need someone to take you home; you won’t be able to drive or take public transportation, including Uber, Lyft or a cab, by yourself. If you have not made transportation arrangements, your surgery may be canceled.

If you have regional anesthesia only, with no sedation, you will be permitted to drive yourself home.

• No solids for eight hours prior to surgery.
• A light meal, meaning plain toast only, is permitted for up to six hours prior to surgery.
• Unlimited clear liquids, meaning water or plain black coffee without any milk or cream, are permitted up to two hours prior to arrival at the hospital.

When you arrive at your designated time, you may need to report to the admissions/registration department to verify your insurance and pay any co-pays that may apply to you. You will be asked to sign a treatment authorization consent form and a privacy form (HIPAA).

• Bring a copy of your insurance card, a photo ID and credit card/cash/check for your co-pays, if applicable.
• Bring names and phone numbers of your emergency contact(s) and any home care agency you wish to contact, if needed.
• If your procedure requires you to be admitted to the hospital after surgery, please leave your overnight bag in the car until you have been assigned a room, if possible.
• Advance directive: If you are staying overnight after your procedure, you may bring a copy of your advance directive. For more information about advance directives, visit mainlinehealth.org/acp.
• When you arrive at the preoperative procedure unit, the nursing staff will help you prepare for your surgery. You will be asked to change into a hospital gown and remove items that will interfere with your surgery.
• The nurse will take your vital signs and start an intravenous line (IV) to administer anesthesia and provide hydration.
• Your surgical site may need special preparation. This may involve clipping the hair in the area and/ or scrubbing the area with a special soap.
• During your procedure, your family and friends will wait in the waiting room until they have been notified your procedure is complete. If you would like a designated person to be contacted by the surgeon, please be sure to leave the name and phone number with the nursing staff when you arrive for your procedure.

• When your procedure is over, you will be transported to PACU, where you will recover.
• The PACU nurses, along with the anesthesia staff, will monitor you closely throughout the recovery process.
• The PACU nurses specialize in caring for patients who have just had surgery. They will evaluate your vital signs and comfort level often, and will keep your family up-to-date on your progress. Comfort measures include keeping you warm and keeping your pain to a minimum.
• When you have met the criteria for moving to the next stage, you will be transported to your hospital bed if staying overnight, or to stage two of your final recovery process before being discharged from the hospital. Family and friends will be able to join you at this time.

• Once you have met the criteria for discharge, which include stable vital signs, being able to tolerate light refreshments and management of pain, you will start to prepare for your discharge from the hospital.
• At this time, the nursing staff will review the discharge instructions that have been prepared for you by your physician.
• If you had general anesthesia or sedation, you will NOT be permitted to drive for 24 hours after surgery.
• If you had general anesthesia, we strongly recommend that you have someone stay with you the first 24 hours following your surgery. You may continue to be sleepy and your judgment and reflexes may take time to return to normal. If you are taking opioids for pain, you won't be able to operate a car or dangerous machinery.
• Once you are discharged, any questions or concerns should be directed to your surgeon.

For some surgical or special procedures, you may be required to answer questions that will help us plan for your care. Depending upon factors such as your age, background and medical history, a preadmission evaluation may be performed by a registered nurse.

Preparing for the preadmission test

If preadmission testing is required, we ask that you prepare for your visit by making the following information available:

• All medications that you are taking with the original pharmacy containers
• A list of any allergies you have to medication, food, soaps, latex, etc.
• Any recent health problems
• Any chronic medical conditions
• Your use of tobacco, alcohol and drugs
• Any prior surgical and anesthesia procedures
• All letters, test results, consent forms, physical examination reports and any other information from your physician, medical consultant or surgeon
• Any special religious, cultural or personal needs as well as any vision, hearing or reading deficiencies

Ask your doctor:

• Are there any prescriptions, over-the-counter medications or herbal remedies that I should NOT take before my surgery?
• Can I eat or drink before my surgery?
• Should I trim my nails and remove nail polish or artificial nails?

If you have any other questions, write them down and address them with your doctor.

Ask someone you trust to:

• Take you to and from the surgery facility
• Be with you at the hospital or surgery facility
• Assist with your care and help provide support

Before you leave home:

• Shower and wash your hair. Do not wear makeup, perfume, powder or body lotion.
• Remove jewelry and piercings and leave them at home. Do not bring valuables or money to the surgery facility.
• Wear comfortable clothing.

• When appropriate, the operable site on your body will be marked by your physician. Not all surgeries are marked. Make sure they mark only the correct part and nowhere else. This helps to avoid mistakes. Collaborate with your surgeon concerning the correct marking of the surgical site.
• Marking usually happens when you are awake. Sometimes you cannot be awake for the marking. Whenever appropriate and possible, a family member or companion is encouraged to be involved in the site marking.
• Your neck, upper back or lower back will be marked if you are having spine surgery. The surgeon will confirm the exact place on your spine by X-ray.

The staff in the operating room or surgical team (surgeon, anesthesiologist, RN, surgical technician) will conduct a “time-out” to confirm the correct surgery, correct body part and correct side.

The staff in the operating room work as a team to provide the safest possible patient care. They are your advocates while you are having surgery.

The staff will review your Informed Consent form. Read it carefully. It lists:

• Your name
• Your agreement to have the surgery
• The kind of surgery you will have
• The risks of your surgery
• That you talked to your doctor about the surgery and asked questions

Make sure that everything on this form is correct. Make sure all of your questions have been answered. If you do not understand something on the form, speak up.

For your safety the staff may ask you the same question many times, for example:

• Who are you?
• What kind of surgery are you having?
• Which part of your body is being operated on?

They will also double-check the records from your doctor’s office.

• Tell your nurse or doctor about any pain or discomfort you are experiencing. Your nurse will ask you to rate your pain on a scale of 1 to 10 so that it can be treated appropriately. It is important to us to help relieve your pain (or help you reach a state of comfort).
• Ask questions about medicines that are given to you, especially new ones. What are they? What are they used for? Are there any side effects? Tell your caregivers about any allergies you have. If you have more questions about a medicine, talk to your doctor or nurse before taking it.
• Find out about any intravenous (IV) fluids that you are given. These are liquids that drip from a plastic bag into your vein. If you experience any discomfort at the IV site, notify your nurse.
• Ask your doctor when you can resume activities like work, exercise and travel.
• Discharge instructions will be discussed with you prior to leaving the hospital.