Question on CPAP use after heart by-pass op.

[Lambeau]

I have been on CPAP therapy for just two weeks as of tomorrow. A week from tomorrow I am scheduled for an angiogram at a well known heart hospital in Minneapolis. That angiogram with tell my cardiologist whether I need a stent put into a ventricular artery to clear a blockage, or if heart by-pass surgery will be required.

If I have a stent put in (which I hope is the case), I will be home the next day after just one overnight stay in the hospital for 'observation'.

But my concern is if the more radical open heart bypass surgery is required and the surgeons crack my chest open by sawing through the sternum. If that is the case, I would likely be in the hospital from 6 to 8 days, and then home recuperation for about 8 weeks.

I would envision that while mending in the hospital, I would have oxygen supplied with tubes up through my nasal passages. So I don't know how I could wear my mask, yet I was told to bring my Phillips Respironics System One with humidifier with me when I report to the cardiology desk when I check in on July 29th. My home is 45 miles away from the hospital where I will be at.

I am at a loss as to how I could manage using this after major heart surgery, and how the hospital nursing staff would have access to distilled water or even know how to hook me up to sleep, day or nighttime, if that was indeed going to happen.

I am also concerned with the security of where my machine is while I am in the O.R., then in the recovery room, and then in my hospital room for several days. It's not that I suspect an outright theft of my property (though that is possible), but the hubbub of activity in an absolutley HUGE hospital and the keeping track of where my machine is and who it belongs to and just gets lost in the chaos. I'm told not to bring valuables or jewelery or money or credit cards with me, so why are hospital administrators concerned with that, but not a very expensive BiPap machine and mask?

Also, IF I am taken off the machine while there, how does that impact my compliance hours for insurance purposes?

Has anyone on this forum had similar situations with any type of hospitalizations? Looking for some suggestions as to how to handle this as I go into a great unknown area with no experience in this area.

[Julie]

You MUST talk to the people involved - doctors (surgeon, anesthesiologist), head nurse or whoever they say is appropriate, and home care people if they'll be involved. Each facility has different ways to handling things and coordinating patient care, and what someone else here might have experienced may not be the same at all. Your team will make sure you're covered and explain things - don't let them not do that - and ask questions (you're not bothering them, you're paying their salary).

[StuUnderPressure]

A more thorough discussion with your Cardiologist seems to be in order.

Is it possible that only the angiogram and stents (if needed) is planned for this visit? Or, do they plan on doing the open-heart surgery (if needed) immediately after the angiogram?

Again, clear instructions from your Cardiologist is needed - because what they do may determine whether or not you can use your BiPap.

[BlackSpinner]

I would envision that while mending in the hospital, I would have oxygen supplied with tubes up through my nasal passages. So I don't know how I could wear my mask, yet I was told to bring my Phillips Respironics System One with humidifier with me when I report to the cardiology desk when I check in on July 29th. My home is 45 miles away from the hospital where I will be at.

Good. It sounds like they are knowledgeable about the effectiveness of cpap therapy. Many masks have O2 ports and they can also add O2 where the hose attaches either to the machine or mask. O2 does no good if you are not breathing so having the cpap machine is required.

[Lambeau]

I appreciate your reply, but quite frankly it does not appear to be very practical for me.

The cardiologist I saw at my local clinic was a 'visiting' doc from Abbott-Northwestern Hospital/Minneapolis Heart Institute. I cannot begin to describe how huge it is. I've gotten lost in the maze of miles of hallways there when I have visited patients there several years ago.

The cardiologist I saw from there who came to down where I live, is not the cardiologist who will perform my surgery. He is one from a group of 60 heart surgeons in his group, and one will be assigned to me when I get there. Same for the anesthesiologists; I have no idea of who to contact or how to do so. And as I stated before, I live 45 miles away from that hospital and will need to rely on others for transportation. My wife is not able to drive me there due to her fear of driving in a large city. She knows she'd be in a wreck just navigating an Interstate Highway's clover-leaf.

[Lambeau]

A more thorough discussion with your Cardiologist seems to be in order.

Is it possible that only the angiogram and stents (if needed) is planned for this visit? Or, do they plan on doing the open-heart surgery (if needed) immediately after the angiogram?

Again, clear instructions from your Cardiologist is needed - because what they do may determine whether or not you can use your BiPap.

The angiogram will determine if stent or a by-pass is the route they will take. If the angiogram shows a stent will suffice, it will be done at the same time frame as the angiogram is done. I would be awake, but sedated for that and would only be in the hospital for one night for observation and then sent home.

It is the by-pass possiblilty that concerns me as to CPAP. They will not know until they do the angiogram. If that is what is indicated (bypass), it would be done that very same day, or the next morning.

[Papit]

Hey, Lambeau. Yep, I was in a similar situation several days ago for a different kind of surgery. During the pre-op evaluation visit a week before surgery, they told me it was up to me as to whether I could use my xpap, or the hospital's xpap or no xpap. Like you, I wasn't sure whether I wanted to use xpap with everything else that would be going on (oxygen nasal prongs, etc.). They call all xpap, "CPAP". (Who knows if they have BiPAP or ASV machines and know how to set them to your prescription? )So I elected to take mine with me, have it there and decide day by day whether I wanted to use it. Also like you, loss of my xpap machine, tube and mask in the hospital did cross my mind. Here's what I found out at least in the hospital I used -- and I suspect procedures are fairly uniform across the country.

First thing I did was put my return address label and my phone number on my machine for ID purposes and on the carrying case. First thing they did was take it from me and test it for general function and electrical safety . Then they put their own hospital ID label on my machine with their phone and date etc. to verify that it passed their tests and is available for my use during my stay. They don't check for settings, etc. That's your and your doc's responsibility and their label says so. Your machine then finds its way, along with your clothing and any other belongings you brought to the hospital, to the hospital room where you are going to stay after your brief period in the post-surgery recovery room. That is your nurse's responsibility. It seems to me that since the hospital takes initial documented responsibility for testing your machine, an audit trail is then established from the testing room to your nurse to your room and every nurse and doctor who subsequently provides medical services to you. Once recognizing that, I had no further concerns about the security of my machine.

I didn't feel like using xpap the first night although a nurse asked me whether I wanted to, so I could have. Oxygen can be routed into and through most xpap masks. I used my xpap the second and third nights. In my case no oxygen was needed beyond the first night, but the use of oxygen is a non-issue. If anything, I think you'd get more oxygen by having it go through your nicely sealed xpap mask than through the unsealed loose-fitting nose prongs they typically use to dispense oxygen to patients both while they sleep and during the day.

Good luck with your surgery, Lambeau. I'm convinced without a doubt that the risks associated with surgery these days are far, far lower than they were a generation ago. You'll no doubt emerge healthier than you've been in a long, long time. Sleep well and let us know how it all goes.

[oak]

Lambeau, all I can say is i have have both a triple bypass and a stent on a different occasion at Abbott. Do not worry about your cpap machine, they will take very good care of you. I know its scary now, but your machine will be taken care of. It wouldnt hurt to put a sticker with your name and address and phone on the bottom if that makes you feel better.

[Lambeau]

Thanks----that is the kind of information I was looking for. I will put my own ID tag on my CPAP carry bag with my phone number, name, and address, etc.

I know hospitals are supposed to have a protocol for getting your property to the room one is eventually taken to. My fears about loss of property are well founded, due to my experiences the last time I was in a different (and smaller) hospital for surgery a year ago for TURP surgery. My personal effects were sent to a room I was to wind up in, but then for one reason or another, I was reassigned to another room when I was in the recovery room.

When I got there, my belongings were not there! I did not discover that until two days later when I was being discharged. My street clothes and shoes were nowhere to be found in my room. It took staff an hour to track down where they were, as the 'chain of custody' somehow was broken and my stuff never got to my room that I was in.

[oak]

Good luck with your surgery! You will be in good hands! I cannot say enough good things about Abbott/Mpls Heart. Let us know how you do. Regards, Oak.

[Pugsy]

Compliance won't be an issue. If for some reason you are unable to use the machine the hours that is needed...
If need be your doctor can write an explanation of why machine wasn't used (if that should happen and need to be done) and depending on which insurance...a new reporting period can be established.
There's also some wiggle room in the compliance requirements anyway. Even with Medicare there is some room for less than optimal usage.
Exceptions to the rules are available.

If you have a family member or friend waiting in the final room (should the surgery happen) just warn them to look for your machine from the onset in case you aren't alert to look for it. That way if it doesn't find its way along with your movements...someone can start looking immediately.

[Lambeau]

I turn 73 on the day prior to my pending hospital adventure. I'm on Medicare with a Medicare Advantage Plan that picks up a lot of costs traditional Medicare does not cover. In all cases, a Medicare Advantage Plan MUST provide at least what traditional Medicare covers; never less coverage. But my Medicare Advantage Plan still requires the hours for compliance to Medicare rules.

So that is a relief that I will not need to worry about compliance issues in my first month of therapy on a new BiPAP machine.

[HoseCrusher]

An ID tag on your bag will make sure your bag makes it into your room... eventually.

You may also want to consider putting stickers on your machine, humidifier, hose, and mask with your contact information.

Now for the extreme...

You can make up some name tag sized stickers that say "I Use CPAP" and stick one on your forehead and another on your chest. Or, you can take a sharpie and write it on your chest. Whoever looks at you will see this and if it hasn't been added to your chart it may prompt them to add it.

When you check in make sure that they write down that you use CPAP. When the nurse comes to "visit" ask if that is on your chart. When the doctor comes to "visit" ask if it is on the chart and ask how they plan to implement its use in recovery. When the anesthesiologist comes to "visit" pass the information on and ask if it will make any difference on how they perform their "art."

When all that fails... it shouldn't but things happen, rest assured that they will be monitoring pulse/ox levels and if your apnea causes desaturations they will pick it up and may then look at the chart and recognize that you require CPAP.

Keep in mind that the body is a lot tougher than you think and even after surgery you can probably endure a night or two of being off CPAP and survive. By then you should be aware enough to ask where your machine is.

My hope is that everything will go smoothly and prove your concerns as unfounded, but it is better to be prepared with a plan of action than to just let things happen. Good luck and I hope you end up with a great improvement in your health.

[oak]

If you have bypass surgery, believe me, your last concern will be whether you or the hospital makes sure you use your cpap machine, at least for 2-3 days. By then, if you want to use it, they will make sure you have it available if you ask. Your nurses (and you) will be more concerned about you getting enough O2 and other things if needed for the first couple of days. (you will be sleeping almost all the time anyway).

If you have a stent, its no big deal and you will be there one night, tops. You can get your cpap out yourself and hook yourself up.

If your insurance plan has a problem with your compliance, as pugsy said, it is easily taken care of by the explanation that you were in the hospital having bypass surgery. Their wont be any problems. Trust me.

[squid13]

I had a total knee replacement on my right knee Feb. 11th and stayed in the hospital 3 days. I took my machine with me but elected not to use it. There is so much in and out of your room that the hospital is the last place to go for sleep and rest. I just elevated my bed and slept that way and had no problems, but what worked for me may not work for anyone else. I'm having a total knee on my left knee on Sept.9th so I'll decide what to do then, I may do the same as I did last time. As soon as I got home I was back on my machine.