Preparing Your Child For Heart Surgery
What Your Child May Look Like After Surgery
Several tubes and lines are needed to monitor and care for your child while in the hospital. Even when you know what to expect, it is overwhelming to see the amount of tubes and lines that will be on your child when they arrive in the intensive care unit after surgery. Below are some of the tubes and lines you might see on your child and their function. Most of these will be seen right after surgery, but some may be needed at other times during your child's hospitalization.
In the intensive care unit and the intermediate care unit, a patient's vital signs are monitored by equipment at the bedside. This equipment records heart rate and rhythm, respiratory rate, the amount of oxygen in the blood, blood pressure and other such pressure readings. All of these numbers are used to evaluate heart function and oxygenation of the tissues. This equipment contributes to the noise in the room and alarms frequently. Look to your bedside nurse for insight into when these alarms are concerning and when it is nothing significant.
Intravenous (IV) Lines
Peripheral Intravenous Line (PIV) - This is a soft catheter placed in a small vein through which intravenous fluid and medications can be given. One of these will be placed upon admission into the hospital. Numbing ointment is available and can be applied to your child's skin prior to sticking them for the peripheral line. This cream numbs the skin so that your child, hopefully, will not feel the poke. Your child will have a PIV in place throughout their hospitalization.
Central Lines - This is a soft catheter placed (usually during surgery) in a large vein or a chamber of the heart for monitoring of heart pressures or administration of IV fluids, medications and nutrition. The insertion site can be located in the child's neck, chest, groin or umbilicus. These are usually removed prior to transfer from the ICU.
Arterial Lines - This is a soft catheter placed (usually during surgery) in an artery to measure blood pressure and remove blood for lab samples. These can be located in the wrist, foot, groin, or umbilicus. This is removed prior to transfer from the ICU.
IV Infusion Pumps and Drip Medications
Multiple pumps will be at your child's bedside infusing potent medications that the heart needs for support until the heart muscle has had time to recover from the trauma of surgery. Patients are typically kept on continuous drips to manage pain immediately after surgery and while they have a breathing tube in place. Fluid providing glucose and electrolytes will be given through one of the IV lines while your child is not able to eat by mouth.
Breathing Tube (Endotracheal Tube or ET Tube)
A tube inserted through the mouth into the airway so that a machine can breathe for your child while sedated during and after surgery. Your child will be given medication prior to tube insertion so that it will not hurt and they won't remember it. The tube is removed when the child's heart is functioning well on its own and the child is strong enough to breath on its own. The amount of time the tube is needed varies significantly from patient to patient.
The machine by which we can breathe for your child while they are sedated. It allows for delivery of oxygen and removal of carbon dioxide. The ventilator is connected to the ETT and can alarm often for various reasons.
Nasogastric or Orogastric Tube (NG or OG tube)
A tube placed through the nose or mouth into the stomach 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.
Two types of incisions can be made in the operating room. The type of repair dictates which type of incision is performed. They are called a sternotomy or a thoracotomy.
A sternotomy is an incision made on the front of the chest over the sternum. The sternum is then separated and opened to allow the surgeons access to perform the operation. The sternum and this incision are usually closed after the repair is complete using sternal wires and skin sutures; however, sometimes it is necessary to leave the sternum open after surgery for a brief period (usually 1-3 days) to allow time for swelling to decrease in the area, at which time the sternum and the incision can be closed. For the open sternum, a dressing is sewn to the skin edges and covers the heart. A clear dressing is then placed over this that covers much of the chest wall. This dressing stays in place until the chest is closed. For the closed sternum, a sticky tape called steri-strips and/or a skin glue called collodion is applied over the incision to keep it clean while it heals. This skin glue wears off over about 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. This incision is always closed and covered with steri-strips and collodion.
Chest Tubes or JP Drains
Small tubes placed in the space around the heart or lung to prevent accumulation of blood and body fluids after surgery. These drains are connected to a collection device for measurement of fluid drained and are removed when the amount of fluid draining drops off significantly (usually within a few days of surgery).
External Pacing Wires
Sometimes after open heart surgery, the heart's natural pacing mechanism that keeps the heart in a normal rhythm is altered due to 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 during surgery through which electrical impulses can travel to the heart. These wires exit the chest wall and can be attached to a pulse generator.
Pacemaker or Pulse Generator
An external pacemaker is the small box that generates the electrical impulse that is sent to the heart muscle to stimulate contraction.
A soft tube placed in the bladder to drain urine into a collection bag. Urine output is monitored closely as this is an important indicator of heart function. This catheter stays in place for as long as the patient remains continuously sedated after surgery (narcotics can cause you to retain urine) and/or frequent assessment of urinary output is needed.
Please feel free to ask your bedside nurse again for clarification of what each tube and line is once in the intensive care unit after surgery. They will be happy to provide further explanations. Patients often have swelling all over their body after surgery due to being on the bypass pump used during surgery. The most swelling typically occurs within the first 24-48 hours. Once the swelling stops, your child's body will reabsorb all that extra fluid and "pee it out," returning to their normal size. Your child will be closely monitored while in the intensive care and frequent blood tests, x-rays and echocardiograms may be needed to evaluate heart function. The bedside nurses will also be continuously monitoring your child for pain or discomfort for which there are many different types of medications available to treat. It is important that once your child is hemodynamically stabilized, they become more active and eat well. Your child needs to start getting out of bed and walking usually before they feel like they are ready. Activity helps keep your lungs clear of fluid and mucous, increases bowel activity, strengthens muscles, decreases stiffness (once they get over the discomfort of getting out of bed that first time!) and is good for their emotional well-being.