In both the intensive care unit and the intermediate care unit, patient’s vital signs are monitored by bedside equipment. This equipment records heart rate and rhythm, respiratory rate, oxygen in the blood, and blood pressure. The numbers are used to evaluate heart function and oxygenation of the tissues. The equipment will alarm frequently which may cause some concern for you and your child. However, the nurses are always available to answer your questions and ease any fears.
Peripheral Intravenous Lines (PIVs) –A soft catheter placed in a small vein through which intravenous fluid and medications can be given. Usually a PIV will be placed upon admission into the hospital. Numbing ointment is available, and can be applied to your child’s skin prior to placing the peripheral line. Your child will have a PIV in place throughout their hospitalization.
A soft catheter placed (usually during surgery) in a large vein or a chamber of the heart. It is used to monitor heart pressures and to administer IV fluids, medications and nutrition. The insertion site can be in the neck, chest, groin or umbilicus.
Multiple pumps will be used to infuse potent medications to support the heart until it can recover from the trauma of surgery. Continuous IV drips are given to manage pain after surgery and while the breathing tube is in place. Fluids providing glucose and electrolytes will be given through one of the IV lines until your child can be fed by mouth again.
A machine that can breathe for your child while they are sedated. Essentially, it
delivers oxygen and removes carbon dioxide from the lungs. The ventilator is connected to the endotracheal tube (ETT) and can alarm often for various reasons.
A tube placed into the stomach through the nose or mouth, so that stomach contents and bile can be continuously drained. Your child will have this tube in place until the endotracheal tube (ETT) is removed.
Small tubes placed around the heart or lung to prevent accumulation of blood and body fluids after surgery. These drains are connected to a collection device to measure the drained fluid. It is usually removed when the amount of fluid draining decreases significantly (often within a few days of surgery).
Sometimes after open heart surgery, the heart’s natural pacing mechanism that keeps the heart in a normal rhythm is altered from swelling or injury to the tissue that stimulates normal electrical activity. If the rhythm does not support adequate blood pressure and oxygen delivery to the tissues, an external temporary pulse generator (pacemaker) is needed to maintain adequate heart rate until the heart’s normal pacing function returns. This is usually a temporary problem, but occasionally, can be permanent. External pacing wires are small wires placed in the heart muscle through which electrical impulses can travel to the heart. These wires exit the chest wall and can be attached to a pulse generator.
A small box that generates an electrical impulse sent to the heart muscle to stimulate contraction.
A soft tube placed in the bladder to drain urine. Urine output is monitored closely since this is an important indicator of heart function. This catheter stays in place for as long as the patient remains sedated after surgery, and/or if frequent assessment of urinary output is needed.
While in intensive care, your child will be observed closely. Staff may take frequent blood tests, x-rays and echocardiograms to evaluate heart function. Bedside nurses will also monitor your child’s pain level, and different types of medications may be administered to help alleviate any discomfort.
After surgery, patients may have swelling from the bypass pump used during the operation. Most swelling usually occurs between the first 24-48 hours post-surgery. Your child’s body will eventually reabsorb the excess water from the swelling and will flush it out through urination. Once all the excess fluid is excreted, the body will return to its normal size.
There are two types of incisions that can be made in the operating room: Sternotomy or a thoracotomy. The incision used depends on the type of surgery needed.
A sternotomy is an incision made on the front of the chest over the sternum. The sternum is separated and opened allowing surgeons access to the heart. Immediately after the operation, sternal wires and skin sutures are used to close the sternum and incision. Sometimes it is necessary to leave the sternum open for a brief period (usually 1-3 days) to allow time for swelling to decrease. If the sternum is left open, a dressing is sewn to the edges of the skin to cover the heart. A clear dressing is placed over this to cover the chest wall, and will remain there until the chest is closed. If the sternum is closed, a sticky tape called Steri-Strips and/or skin glue called Collodion is applied over the incision to keep it clean while it heals. The skin glue wears off over a two-week period, at which time the skin should be completely healed.
A thoracotomy is an incision made on the patient’s side that usually begins just below the armpit and extends around to the back. After surgery, the incision is closed and covered with Steri-Strips and Collodion.
Once your child is hemodynamically stabilized, it is important that they become more active. In fact, getting out of bed and walking as soon as possible should be a priority. Activity helps keep the lungs clear of fluid and mucous, increases bowel activity, strengthens muscles, decreases stiffness and is good for emotional well-being.