171 Ashley Ave.
Charleston, SC 29425
843-792-1414
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PCICU Family Information: Post-operative Period
After leaving the operating room your child will be admitted to the PCICU. It will take approximately 1 hour to stabilize
your child before you can visit. Please be sure to review the visiting rules.
There are many lines, tubes and monitors attached after surgery.
The monitor displays your child's vital signs. These may include heart rate, respirations, blood pressure, pressures inside
the heart and oxygen saturations.
 Monitor
Electrodes taped on your child's chest monitor the heart rate and respiratory or breathing rate. This allows us to determine
if there are any irregular rhythms after surgery.
 Electrodes
An endotracheal tube (ETT) or breathing tube is placed in your child's mouth and into their windpipe (trachea) while they
are asleep. This allows us to breath for them while they are still asleep from anesthesia using a ventilator.
Endotracheal Tube (ETT)
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Ventilator
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A nasogastric tube (NG) is placed in their nose or mouth, down their food pipe (esophagus) and into their stomach. This tube keeps
their stomach empty to help prevent them from getting sick and vomiting.
 Nasogastric Tube (NG)
Intravenous lines (IV's) may be place in their neck, arms, umbilicus and/or groin (or femoral area at the top of the thigh).
Medications and fluids are given through these lines.
A special IV called an arterial line may be place in the umbilicus, wrist or groin. This line allows continuous measurement
of the blood pressure and allows us to draw blood frequently without having to stick the child with a needle.
 Arterial Line
Intracardiac or chest lines are special IV's placed through the chest wall and directly into the heart at the end of the surgery by the doctor. These lines measure
the pressure inside the heart and help us determine the medications we need after surgery.
 Chest Lines
Chest tubes are large tubes inserted around the heart and lungs at the end of surgery. These tubes allow excess blood and
fluid from the surgery to drain. They connect to a large box on the floor at the foot of the bed. The blue color shows
us the water level. This fluid bubbles indicating the suction is working properly. Any red or yellow fluid is from the child.
 Chest Tubes
The patient may require temporary pacing. This means we have to help the heart beat. The pacing wires are blue wires taped
to the outside of the chest dressing. These wires go through the skin and lay on the heart. The wires attach to an outside
pacemaker and allow us to control irregular heartbeats or increase the rate until the heart recovers from the stress of surgery.
Pacing Wires
The pulse oximeter is a red light taped to the finger, hand, toe, and/or head which monitors the oxygen level in the blood.
Different levels are normal for different children depending on the cardiac defect.
A foley catheter is a tube placed into the bladder, which drains all the urine into a bag at the side of the bed. It is
important for us to measure the exact amount of urine the child makes.
It may be necessary to restrain your child with soft wrist and/or ankle restraints to prevent them from accidentally
removing any tubes or lines. This is for their safety.
You will notice some swelling, especially around the face and eyes. This is a result of the heart-lung machine and fluid
given during surgery. The kidneys will handle this extra fluid and the swelling will gradually go away. We often use
medications to help the kidneys work better.
All of these tubes and lines are gradually removed, when no longer needed for the care of your child.
Feeding in the ICU
Many infants are not fed by mouth prior to surgery. We give all the sugar, vitamins and minerals needed through special IV
fluids. This does not mean you will not be able to breast feed or bottle feed at some point. Please tell us if you want your
child fed breast milk or baby formula. You can express your milk to freeze until your child can take milk by mouth or by
tube. There are breast pumps available in PCICU, on 7C, NICU, or in Ronald McDonald House. The nurse will provide the kit,
bottles and labels needed to pump. The milk can be stored for six (6) months in a deep freezer. While your child is here,
we can store a limited amount of frozen breast milk. Label each bottle with the baby's name and the date. The pumping room
is located next to the PCICU waiting room. Please ask the nurse or the Guest Relations Representative for the access key.
There is a lactation consultant available to answer any questions or assist with problems. The doctor can order a lactation
consultation for you when needed. The consultant will contact you during normal working hours.
Babies are born with a natural reflex to suck, swallow and breathe. This reflex lasts about two (2) weeks. If an infant
has not had the chance to drink during this time, they must learn to coordinate sucking, swallowing and breathing. Most of
these infants require a feeding tube to give them milk until they can learn to drink all they need by mouth. The feeding
tube goes through the nose and into the stomach and sometimes into the intestine.
Pain
The doctors and nurses will provide medications for pain and anxiety, as needed. It is important to us that your child be
as comfortable as possible. We cannot eliminate all discomfort. You can help your child by touching, talking or singing to
your child. Comfort measures such as music and changing position (as condition permits) may also be helpful.
Parent Contact
Sometimes it is important to keep the child very quiet and still. With some children, this is not possible if they see or
hear their parents. Your nurse will let you know if it is all right to talk with or touch your child immediately after surgery.
Clothing
It is necessary to see your child's incision and lines. They will not be able to wear clothes for a while after surgery.
Your child will not be cold. The nurse will watch your child's temperature. The child may wear an outfit that
opens completely, top to bottom when they are better.
Length of ICU Stay
The length of the ICU stay will vary on your child's heart defect and surgery. Transfer of your child to the step-down
cardiology floor (7C) occurs when they:
- can breathe on their own without difficulty
- have stable vital signs
- do not need certain cardiac IV medications
While in the ICU, please take breaks for exercise and fresh air. It is important to get rest! When your child is ready to
leave the ICU, you will be able to stay with them and help care for them. Upon transfer to the floor, you may be a little
nervous. Your nurse will be available to answer questions and help you.
Transferring to the Floor
All the rooms on 7C are private and have telemetry to watch your child's heart rhythm. Parents are both allowed and expected
to stay with their child. There is one cot per room. Cots must be put away by 8 a.m. to allow staff access to the child.
Children are not allowed to stay overnight in the room. Siblings may visit if they are not sick.
It is the expectation that parents stay with the child to learn:
- how to care for your child when you go home
- what medications your child will be on and how to give them
- when to contact the doctor
Once on 7C a primary nurse is assigned to care for your child. They coordinate the care of your child. They provide your
discharge teaching including information about your child's medications, feeding issues and other needs you may have. It
is important you are comfortable before discharge.
Telemetry to monitor your child's heart rate and rhythm is continuous. It works on the seventh and eighth floors of the
Children's Hospital only. Your doctor must approve any trips off the unit.
Feeding your Child
Feeding provides nutrition for your baby's growth. If your baby has a congenital heart defect, they may not gain weight as
easily as other babies. When feeding, keep your baby close and snug. Babies need formula or breast milk until they are one
year old.
If you are bottle-feeding, it is best to hold your baby. Find a comfortable position for you and your baby. Burp the baby
after each ounce of formula and after feeding. Most babies like warm formula. Place the bottle in a cup of warm water.
Do not put the bottle in the microwave. Never leave the baby alone with the bottle and never prop a bottle in the baby's mouth.
Always place the baby on its side after feeding.
If you wish to breast feed your infant, this is a great time to focus on how to nurse your infant. Your nurse will help with
any questions and provide additional information as needed.
Most children with heart problems will need to eat about every three hours. Your doctors and nurses will work with the
dietician to set goals ensuring your infant takes an appropriate amount of formula or breast milk. There are lactation
consultants and support groups for breast feeding in the area. There are also local companies that rent breast pumps.
If you would like more information, please let your nurse know.
Some infants still need help learning to take a bottle or breast. Occupational therapy will continue to work with you and
your child until they are eating well. Your infant must be eating well before you can go home.
Circumcision
If you are interested in having your infant circumcised, please let your nurse know. It can be arranged before you leave
the hospital. Some children must wait until a certain age. Your doctor will discuss this with you.
Discharged to Home
A car seat is required before leaving with your child. By law, all infants and children less than eight (8) years and/or
less than eighty (80) pounds are required to have an appropriate restraint in a moving vehicle.
Discharge time is 11 a.m. If you have a problem with a ride, please tell the nursing staff immediately.
If your child is on medications at discharge, the nursing staff needs to contact your pharmacy to assure all medications
are available. Your nurse will provide written information on all medications before you leave. Your nurse will make sure
you understand the right amount of medication to give and the right times to give it.
The doctor will order an echocardiogram and x-ray before your child leaves. You will receive written discharge instructions
describing the care of incisions, activity, complications, etc. Before leaving for home, make sure you understand your
discharge instructions and all your questions are answered. If you have any questions once you get home, please feel free
to call (843) 792-2300 and ask for the pediatric cardiology intern on call.
The Atrium and Child Life Program
While in the hospital, your child will need something to distract them and to help them cope with being sick. The Atrium and the
Child Life Program are here to help your sick child and their brothers and sisters. The Atrium is located in room 741 on
the seventh floor of the Children's Hospital. It is designed to meet the play and activity needs of children, teens and
their families during hospitalization. We recognize that a hospital stay can be stressful and upsetting. The need to play
is normal, familiar and comforting. Play and activities can assist children and families to cope positively with
the hospital experience. The Atrium is as a "safe place" where medical treatments and procedures do not take place.
The Atrium is under the direction of the Child Life Department. The staff are trained professionals that provide
therapeutic play, emotional support and developmental assistance to patients of all ages.
Ronald McDonald House (RMH) of Charleston
The RMH provides a room for healthy family members of patients under eighteen (18) years of age who are in an intensive care unit.
The family must live more than twenty-five (25) miles from the hospital. There is a fee of $15 a night, which decreases to
$10 a night after one (1) week. Each family is required to perform a daily chore such as emptying the garbage or cleaning
the kitchen. If you are interested in staying at RMH, please ask your nurse to add your name to the waiting list as soon
as possible. Upon transfer of your child to the floor, you must give up your room. There is a long waiting list of
families needing a room. The phone number for placement on the waiting list is (843) 723-7957. Please be sure to review the RMH rules.
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