Bypassoperation

An aneurysm in the head

By an inherent abnormality of a blood vessel an aneurysm develops. This concerns a bulge of the septum of the artery. Nearly always the aneurysm is situated on the division of two or three arteries. The aneurysm can be best compared with a tyre in which a hole is in the tyre so that on that spot the inner tube bulges. This bulge is the aneurysm. By the pressure in the artery the septum is getting thinner and the result can be a cerebral/brain haemorrhage. Sometimes the aneurysm is not bleeding but the bulge is getting bigger and bigger and it might put pressure on the surrounded brains and/or brain nerves. This can lead to neurological symptoms. It is also possible that there is an aneurysm without symptoms.

Presently you will be admitted to hospital into department D3 of Utrecht University Medical Centre (UMC Utrecht). Mainly patients with different disorders in the field of neurosurgery are admitted to this department.

This information is of importance to you as a patient who is being considered for a bypass/aneurysm operation.  Here you can find essential information that is needed before admission.

The official language here is Dutch. Generally the nurses, doctors and paramedics speak English. If you are not able to speak Dutch or English it is to the advantage of yourself and the medical staff that you bring someone who can speak one of these languages.

Department D3

The department is situated on the third floor and is sub-divided into D3 west and D3 east. The medium-care unit (7 beds) and a group of 8 beds for the benefit of the neurosurgery specialism is situated on the west side. The east side of the neurosurgery department has 32 beds. 

We have four-bedded and two-bedded rooms, and some single rooms. All patient rooms have their own toilet and bathroom facilities such as a shower and a washbasin.

Telephone number
Reception secretary: +31 88 75 568 48

(preferably on Friday between 10.30 - 12.00 a.m.)

Your mail address
Universitair Medisch Centrum Utrecht, locatie UMC Utrecht

Mrs/Mr __________________________________

Afdeling (department) D3, kamer (room) _______________

Huispostnummer (Home postal code) D03.134

Postbus (P.O. Box) 85500 3508 GA Utrecht the Netherlands

Your visiting address
UMC Utrecht

Heidelberglaan 100

Utrecht

Afdeling (department) D3

Nursing care

Because there is a chance that in your country the concept of nursing care has another meaning, we give an outline of nursing care in the Netherlands.

Nursing includes hygiene, mobilization, medical and technical treatment.

• Hygiene: physical welfare, washing, showering, brushing teeth etc.
• Mobilization: aid is given after the operation to get you out of your bed and rebuild your condition. If needed with the help of the physiotherapist.
• Medical/technical treatment: wound nursing, infusion, drains, the removal of stitches,  hand out of medicines etc.
  

Rules of the department

• In the department we have a general rule for patients and their visitors:
• Visiting hours from 15.00 - 20.00 p.m.
• Hour of rest between 13.00 - 14.00 p.m.
• The contact person can call the department, preferably between 10.00 - 12.00 a.m.
• At the medium care no flowers and plants are allowed.
• If you are intending to leave the department, you have to tell the nurse where you want to go to and when you think you will return. This is because of a planned examination or a visit by your treating surgeon.
• In the UMC Utrecht you are allowed to smoke only in designated areas.
• For family/companions there is no accommodation available in the department.
  
  

Culture of the department

•  In our department we have mixed nursing which means that there might be females as well as males in one room.
• During every shift one nurse has her/his responsibility for your care.
• The nurses are accustomed to being addressed by their first names.
• The doctor on duty is responsible for the daily medical treatment and for you he/she is the first indicated person to consult about your physical well-being, treatment and examinations. Frequently the doctor on duty is in contact with your attending/treating specialist.  
• The hospital provides food and beverages for patients only.
• The official language is Dutch, but English is within the bounds of  possibilities. In exceptional cases we can use the interpreter-telephone.
  

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Preparations for admission

• Before you come to the UMC Utrecht, you can prepare yourself for your admission:
• Write down your symptoms and questions if necessary, so as not to forget them.
• Bring with you the following items;
• medications (the ones you take at home) in the original packaging;
• insurance papers;
• any special diet that may have been prescribed for you;
• blood group card (if you possess one);
• a dressing gown, pyjamas, clothes and a pair of sturdy shoes with non-slip soles;
• toilet articles;
• recreational items, for example: books, magazines, crossword books or handicrafts;
• possible a dictionary.

You are advised to leave your valuables at home.

MRSA

MRSA-screening
Prior to your admission, MRSA-screening takes place. The aim of this screening is preventative namely; the early detection of the MRSA, which means a bacteria immune to a hospital. On the day agreed, you are kindly requested to check in at ten a.m. at the desk on department D3, not at the central reception. (In the weekend you are kindly requested to check in at nine a.m.).

The procedure of the screening is as follows:

As soon as you have arrived at our department you will be taken to an examination room. MRSA cultures will be taken three times, with an interval of a minimal of one hour. During this time you are not allowed to leave the examination room. After the cultures have been taken you can go back to your hotel or your accommodation.

The cultures* that are taken:

• The nose culture.
• The throat culture.
• The rectum culture.
• A culture of wounds (if needed)
• A culture of any possible skin infection.
• Urine analysis.
• Expectorate analysis (if possible).

* The word culture means that a cotton bud is brushed against skin (the perineum), mucous membranes (throat and nose) and any wounds.

Some bacteria are taken by the cotton buds from the skin and the mucous membranes without damaging them. Also urine will be taken. The cotton buds and the urine will be sent to the laboratory and will be inspected for any possible MRSA bacteria.

Only the cost of laboratory investigations will be charged for that day. After three days the results of the cultures are known. Irrespective of the results hospital admission will follow. In the case of a positive result, certain precautionary measures will be taken. Should this apply to you, then you will be informed further. You are kindly requested to call us after 10 am for the results of the MRSA-screening.

What is MRSA?
The staphylococcus aureus is a bacteria that nearly everybody carries with them in the nose or on the skin. For example this bacteria can cause a boil and also infected wounds. Normally this kind of infections heals itself, sometimes a treatment of antibiotics is necessary. In the Netherlands all staphylococcus aureus react well on the usual antibiotics. In a number of countries it appears that the staphylococcus aureus are insensitive to the antibiotics prescribed in the Netherlands. That means that inflammations cannot be treated with these antibiotics. This kind of staphylococcus we call: Meticillin-Resistent Staphylococcus-Aureus (MRSA). This form of MRSA is not different from the usual staphylococcus aureus, it does not cause an infection more often and the infections are not serious. Typical of this bacteria is that it does not react to the usual antibiotics. Treatment with another antibiotics is necessary. The specific antibiotic treatment must be given with great care to prevent the MRSA becoming oversensitive to this antibiotic. This is of major importance in the treatment and prevention of spreading MRSA.

Measures have been taken in the UMC Utrecht tot prevent the bacteria from spreading. Because of these strict measures, we can trace and treat the MRSA bacteria rapidly. MRSA is also present in hospitals in other countries. Therefore, there is a small chance that you have brought the bacteria from the hospital in your country to the Netherlands. Although the chance is very small, we wish to examine the possibility that you are a carrier of this bacteria.

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Operative disclosure of the aneurysm

The treatment of an aneurysm is operation. The most accepted technique is the ‘clipping‘ of the aneurysm. By way of trepanation the aneurysm is approached, in which a clip (the ‘aneurysm-clip’) is placed on the neck of the aneurysm.

Only the permanent disclosure of the bulging with the help of a clip guarantees that a bleeding will not occur again. Sometimes it is not possible to clip the aneurysm because of its shape. In these cases they can bypass the aneurysm.

Bypass-surgery in short

The bypass is a vessel which is placed around the aneurysm like a diversion. In general a vessel is taken out of a part of the lower leg needed for the bypass. The bypass is used as an extra vessel. The aim is that the blood will take this new extra road in order to lower the pressure in the vessel with the aneurysm. By the time the bypass has taken over the function it is possible to disconnect the aneurysm by closing off the vessel that leads to the aneurysm.  Two kinds of bypasses can be placed:

• The extra-intra cranial bypass (EC-IC bypass):

 This is a bypass which is partially laid outside the skull.

• The intra-intra cranial bypass (IC-IC bypass):

 This is a bypass which lays completely within the skull.

Prior to the decision, the doctor will discuss which bypass applies to you.

Care from admission to discharge

The day of admission

Before the operation the following examinations will be done:

• The Electro Cardio Gram or ECG.
• X Thorax.
• Blood samples.

On the day of admission the nurse has an introduction talk together with you and your partner/companion. In this talk the following subjects will be asked:

• You are asked about complaints/symptoms, your case history, your present medication, allergies and your pattern of defecation (having problems keeping one’s bowels open) and urinate (passing water).
• Explanation of the department rules and a tour around the department.
• Explanation on what is to be expected before and after the operation, for example before you go to the operation after midnight you must have been fasting. After the operation you will stay at least for one night in the intensive care unit.  

Examinations, if any are still needed, will be discussed with you by your doctor and arranged by him/her. You can think of an angiocardiogram, a CT scan or a MRI. If you like we can give you an explanation about the examinations.

Before the operation a number of people will want to see you.

• The anesthetist will discuss the anesthetic and if desired premedication and/or sleeping medication
• The doctor on duty or possibly the medical intern takes the anamnesis or physical examination.

The operating surgeon tells you all about the operation and possibly risks.

The evening before the operation

You will be purged by way of a drip enema by a nurse.

You will be allowed to drink until midnight, after this time you need to fast.

The evening before the operation you must take a shower and wash your hair. If help is needed it will be given. The hair (of the head) is shaved, partially, in the operating theatre.

The day of the operation

In the morning you can refresh yourself, in the meantime we make the bed and you must wear an operating gown. The premedication and your own medication is handed out by the nurse. Afterwards two nurses will take you to the anteroom of the operating theatre, and here you are received by a surgical nurse. After some time he/she will take you to the operating theatre.

When the operation is finished you are moved to the recovery room. You will stay there or in the Intensive Care (IC) for at least one night.

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At the moment your condition is stable, you are moved to the Medium Care, if there is room. The Medium Care is an in-between department amongst the IC and the department. In the Medium Care there are more facilities for monitoring. But after a couple of days you are sent back to the department.

After the operation you have two or more infusions, just for fluid and administering medicines. Furthermore you have an urine catheter, just for urine drainage. In the wound a drain is left behind in order to let the excess blood run along this way and not by way of the wound. Within 24 hours after the operation the drain is removed. Infusion and the catheter are removed as soon as it is safe to do so.

Points of interest

Observations

Regularly blood pressure, pulse, temperature and pupil controls will be done. At the same time your memory, orientation and mobility are tested. These observations are necessary to notice changes in time and if necessary take precautions. For this it is important that you or your partner are able to understand English or Dutch.

Medicines

At fixed times medicines are distributed by the nurses.

Position

When you have had an EC-IC bypass it is important that you do not lie on the operation site and if you wear spectacles it is advised to bend the side-piece outwards from the operation site to relieve pressure from the bypass.

Improving the mobility

When you are back on the department you are allowed to improve your mobility. The nurse (and the physiotherapist, if desired) accompanies you. During the time of improving the mobility you have to wear a tight elastic stocking on the operated leg, this is the leg in which they have taken out the vessel used for the operation. The stocking is a support for the blood circulation in the leg.

Care for wounds

Head wound

• The fourth day after the operation the wound is inspected and the wound bandage is renewed.
• The seventh day after the operation the stitches/staples are removed alternately after inspection of the wound.
• The next day the remaining stitches/staples are removed, again after inspection.

This is all be done by the nurses and if necessary the doctor is called in to assist.

Leg wound

• The stitches of the leg wound are removed after ten days either in turns or at once.

Defecation

You are asked daily if you have had a bowel movement. In the event that you have not had one for three days you will get an enema.

Possible complaints after the operation

• Pain: Especially the first couple of days you will have headache and pain in the jaws at the site of the operation. Generally the pain in your leg will not be so bad.
• Swelling around the eyes: Commonly it happens between the third and fifth day. The swelling disappears spontaneously.
• Whistling in the ear: This does not happen to everybody.

Tiredness: Not only the first couple of days you feel tired quickly, but also some weeks after the operation you must bear in mind that you will be tired after the slightest effort.

Period of discharge from hospital

Generally the discharge from hospital takes place between the tenth and fourteenth day after the operation. By mutual agreement the day of discharge from hospital is planned ahead, so that you have time to sort out your affairs. You will get advice from your doctor in attendance with respect to rules of life and way of life. Your own doctor or GP will receive the information by post, so that he is well informed about you.

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The hospital

General information 

To get to the hospital 

The hospital is easy to reach by public transport. From Central Station the busses 28 and 12 drive regularly to the Science Park/UMC Utrecht. The UMC Utrecht has also a parking garage if your visitors come by car. You can park the car here for a charge. The second and third floor are reserved for visitors and patients. Parking space is limited. 

Parking fee: first 30 minutes free, afterwards the fee is 0,50 euro and 1,10 euro, depending on time and day of parking.

Hire of telephone and television

Every bed is fitted with a telephone and a television. The firm Tele Hire can connect you. This happens by way of a special application form available in the department. After having received your application form a host(ess) will inform you of the hire possibilities.

You have to pay 90,00 euro deposit (in Dutch money). Upon your leave the call charge will be settled. Sometimes you need to pay extra and sometimes you will get back some money of the earlier paid deposit.

Hire fee:

Telephone: 1.40 euro a day, excluding call charge  

Television: 2,80 euro a day

Interpreter telephone

If you have communication problems with your doctor or nurse (to understand what is the matter) the Netherlands Interpreting & Translation Center render assistance. For many languages interpreters are available. You can speak with the interpreter via a special telephone at hand on the department. This service is free.

Mobile telephone

In the UMC Utrecht it is not permitted to telephone by mobile, because they may influence the working of the medical equipment. Patients and visitors are urgently requested to turn off their mobile telephone in the hospital.

Meals and beverage

During your stay in the hospital a cold meal is served in the morning and at midday, and in the evening dinner is served. Daily you receive a menu choice-form for the two cold meals and for dinner. These forms match with your diet. When compiling the menu, the kitchen takes the several religious convictions in consideration.

At the cold meals and in the course of the day, afternoon and evening several beverages are served, such as coffee, tea, milk, buttermilk, fruit juice and soft drinks.

You are kindly requested to limit bringing your own food.

Smoking policy

You are not allowed to smoke in the hospital or its immediate surroundings.

Catering and shops

During your stay in the hospital, visitors may use restaurant ‘De Brink’. You can buy snacks, bread and hot meals. At the Brink’s cash desk it is only possible to pay by card.

In addition, the UMC Utrecht has coffee shops, a petit-restaurant, a shop, a flower shop, a hairdresser and a post office. For opening hours and more information you can ask our hosts and hostesses at the main entrance for the information booklet ‘’Ontdek het UMC Utrecht’’.

Hours of opening

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Geopend maandag t/m vrijdag van 8.00 - 17.00 uur.