Respiratory complications are one of the main problems that can occur following major surgery. They arise for many reasons but particularly after surgery due to the effects of anaesthesia, postoperative discomfort and with reduced mobility post-surgery.
Physiotherapy after major surgery is important in reducing your risk of developing some complication e.g chest infections and deep vein blood clots.
This leaflet is to explain the physiotherapy you may receive after your operation and to get you to practice exercises that will prevent and treat common complications
Some advice before your operation
What to bring into hospital
Please bring into hospital well fitted footwear to walk in after your operation, slippers that cover the whole of your feet (i.e not flip flops or slippers that can come off your feet easily). If slippers are not suitable you may find ‘slipper socks’, which have grips at the sole, helpful. When appropriate bring in some comfortable clothing that you can get dressed into.
Active Cycle of Breathing Exercises (ACBT)
These are breathing exercises that help expand your lungs and clear any secretions (phlegm) from your lungs. They are important in reducing your risk of chest infections and also used to treat lung complications. We recommend you practice ACBT prior to your operations to get familiar with the technique
Breathing control - (also known as diaphragmatic breathing) This is normal gentle breathing. Rest your hands on your tummy with your arms relaxed, breath in through your nose if possible rather than your mouth, your abdomen should rise gently. Your upper chest and shoulders should be relaxed
Deep breathing
Keeping your hands over your abdomen as in step 1. Take deep breaths. Your hands should rise more than with ‘breathing control’ and try and hold at the end of the breath for 3 seconds. Do 3 deep breaths this way
Return to ‘breathing control’ to rest (step 1) - Repeat ‘deep breathing’ (step 2)
Huffing - Take a small breath in, open your mouth wide and force the breath out hard and fast
(it’s like misting up a mirror to polish it)
You can go back and repeat the whole cycle if you need to (if you can feel and hear phlegm)
Supported coughing / huffing
Coughing and huffing can be uncomfortable if you have an abdominal incision. It helps if you can support your wound as you huff/cough, either with your hands on either side of your wound giving firm pressure towards your wound, OR by placing a clean, folded towel over your wound and giving gentle pressure as you cough.
It is very important to be able to deep breath and cough. If you are unable to do this please tell your nurse and doctor on the ward.
We advise ACBT and supported cough as often as needed but as a general guide every hour immediately after you wake up from your operation. They can be reduced as you return to normal mobility and if your chest remains clear of secretions.
Bed exercises
For the first few days after the operation and for those patients who aren’t able to get out of bed initially it is important to perform regular exercises in the bed to aid circulation.
1. Move the feet up and down at the ankles x 10
2. Bend and straighten the knees x 10
3. Tighten the muscles at the top of the thigh by pushing the knees down into the bed
Try to do these exercises every hour.
Physiotherapy after your operation
Walking
Getting out of bed and walking first day post-surgery is very important. Your physio will help you walk and will continue to until you are back to normal. You may be connected to drip, drains and have a catheter, we will help you walk with these in place.
We recommend at least 4 walks a day if you are medically stable. The physio team aim to do 2 walks a day and in the evening the nursing staff aim to do a further 2. We encourage you to ask for your walks and you may find it helpful to time your walks when you are going to get back into bed. There may be times due to staffing levels and emergencies when unfortunately we are unable to walk with you twice a day. We appreciate your understanding in this matter
Sitting out
Sitting out in a chair is important for your lungs and you will be expected to this as much as possible from the first day after your surgery. It is recommended to sit out for 8 hours but this does not mean in one session, many people break this up into manageable chunks with a rest in the bed between sitting out. Please inform staff if you need a rest on the bed.
Chest physio
A physiotherapist will listen to your lungs using a stethoscope and will check how you are managing the breathing exercises. There are occasions when you may need more complex physiotherapy for your lungs or mobility, this will be explained by your physiotherapist if required
When physio stops
You will stop being seen by the physiotherapy team when your walking and lungs are back to normal.
When you are discharged home
If you have any concerns with managing at home after your operation please discuss this with your physiotherapist and nurse while you are on the ward.
After you are discharged home we advise you to gradually increase you activity. It is important to do gentle exercise daily to increase your strength and stamina. Start with going for a short walk for example and increase your distance each day. If you participate in sport or exercise you should introduce this into your life style gradually. Please avoid excessive lifting, bending and stretching during the first 6-8 weeks of your operation. Specific advise about more strenuous forms of exercise should be guided by you consultant or specialist nurse.
If at home you are concerned with your progress contact your GP who can advise on the most appropriate service for you.
Other members of the team
As well as seeing a physiotherapist you may see a technical instructor or a physiotherapy assistant. They work with the physiotherapist to assess and treat you as part of your physiotherapy. You may also be seen by student physiotherapist under the guidance and supervision of a qualified physiotherapist, this will be explained to you when appropriate.
How to recognise the physio team
There are many different uniforms that health care workers wear in the Trust. The Physio’s are recognisable as wearing a white tunic or polo shirt with a navy blue trim and navy blue trousers, the technical instructors and physio assistants wear a light blue tunic or polo shirt with navy trousers.
If you require any further advice regarding physiotherapy before or after your operation please contact us on: 01228 814741
Confidentiality
‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.
For further information on confidentiality contact the Information Governance Team:
Information.Governance@ncic.nhs.uk | 01228 603961
Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
If you would like to raise a complaint regarding your care, please contact the Complaints Department:
complaints@ncic.nhs.uk | 01228 936302