|
It is common to fear the unknown, and the prospect of sending your child to have a procedure on their heart is a daunting one. It is our goal to provide some framework for what to expect when you see them after their procedure. As you may be aware, almost all children will go to the PCICU after their surgery.
They will be brought to the PCICU by the anesthesia team where the PCICU team will receive a report and begin caring for the patient. Typically the PCICU team will need around a hour before family members will be able to come to the bedside; although, this amount of time can vary depending on the complexity and the status of the patient.
When you arrive at your childʼs bedside for the first time, they will likely still be under the effects of anesthesia and appear as if they are asleep. One of the most striking changes that parents notice is that their child may look very puffy or swollen. This appearance is related to several factors. Heart surgery is a very stimulating operation and the bodies natural response is to release many substances which cause inflammation. This is a normal response by the body to promote healing, but it can result in swelling. Also contributing to this is the amount of intravenous fluids and blood products given, particularly, if the procedure involved the use of the heart-lung bypass machine. The swollen appearance tends to be more prominent in smaller children. How long this appearance remains varies, often depending on the childʼs clinical status.
Beyond the general appearance of your child, they will have numerous tubes and catheters which were placed in the OR. In order to breath for your child, the anesthesia team places an endotracheal tube into the trachea (the windpipe). Typically the tube is placed through the mouth; occasionally the tube will be placed through the nose. It will be attached to a ventilator (respirator).
Your child will almost always have an intravenous catheter placed (if they did not have one prior to going to the operating room). IVs can be placed in the arms, hands, feet, legs, or neck, depending on where the anesthesia team is able to locate acceptable veins.
In order to monitor your childʼs blood pressure, the anesthesia team places a catheter into an artery (arterial line). The arteries most commonly used are the radial artery (on the thumb side of the wrist where you can feel your own pulse), the femoral artery (an artery in the groin), the posterior tibial artery (an artery in the foot), and the axillary artery (an artery in the armpit). Occasionally if the anesthesia team is not able to place the arterial line, the surgeon will place it by actually making an incision and exposing the artery (a cutdown).
Most children will also have a central line placed by the anesthesia team or a transthoracic catheter placed by the surgeon. This catheter is placed in a "central vein" (one of the major veins in the body) or directly into a chamber of the heart in the case of the transthoracic catheter. The reason for this catheter is two-fold. It allows the pressure in the upper chambers of the heart to be measured, giving valuable information about what fluids or medications may be given. It also provides a quick and safe route to give the medications and fluids, (there are certain medications which can only be given through a central line). Central lines are commonly placed in either the internal jugular vein (a vein on the side of the neck) or the subclavian vein (a vein which is under the clavicle (collarbone). They can also be placed in the femoral vein (vein in the groin area).
The surgeon will place chest tubes in order to drain the chest area where the surgery took place. Typically children have between one and three chest tubes.
After most surgeries the surgeon will also have placed pacing wires onto the heart. These will be thin blue wires coming out of the skin in the lower chest area. These wires can be used to provide an electrical stimulus to the heart if the heartʼs own natural electrical system is not working after the operation.
Lastly, you will notice that your child will have a bladder catheter placed in order to drain urine during the operation.
We know that the idea of not knowing what to expect when you see your child after their heart surgery can be very scary. We hope that this brief description will be helpful.
Please feel free to ask your childʼs team members questions about these issues.
|
