When your child comes into the hospital for surgery, we
want to ensure that you have all of the information and support
that you need.
We hope you will find most of the things you need to know in the
information below but if you have any other questions, please
contact your cardiac nurse specialist.
If you already know which section you want to look at, you can
use the bookmarks below:
Admission to the
ward
What will happen when we arrive?
We hope that we will already have seen you in pre-admission
clinic before the day of your child's admission. We will also
need to see you and your child before the operation. This
allows us to check that your child is well enough to undergo
surgery. You will also be asked to sign the formal operation
consent form at this time. This documents;
- that you have had the opportunity to discuss the operation with
a surgeon,
- that you understand why we believe it should be done,
- what exactly is going to be done,
- that there are risks with doing the operation (we will give
details of what these are)
- that you want us to proceed with the operation.
This is an extremely important consultation. If you have any
questions that remain or you have thought of since the time we met
you in outpatients, this is the time to discuss them so that we can
make sure that you are as ready as possible to proceed to
surgery. Whilst every effort will be made to ensure that the
surgeon you meet will be the surgeon performing the operation,
this is not always possible. However, the surgeon carrying out
your child's operation will always be experienced enough to do it
well.
Will there be more tests?
The anaesthetist, who will be looking after your child during
the operation, will also come to meet you and your child during
this time. This is an opportunity for you to ask questions
and to discuss the anaesthetic options available to your child and
about intensive care.
The nurse who admits you to the ward will go through your family
information and take your child's temperature, heart rate, blood
pressures and saturations. They will tell you when your child
needs to stop eating and drinking. If you have not attended
the pre-admission clinic, the nurse will also take your child's
height and weight and arrange for a blood test, Echo and
Electrocardiogram.
Can we visit the Intensive care Unit?
Your nurse will usually be able to arrange a visit to the
Paediatric Intensive Care Unit (PICU). This is a very big and
busy room where your child will stay for observation following
their surgery. Visiting PICU before your child is admitted
will help you familiarise yourselves with the environment.
We will try our very best to offer this to you, but it may
not be possible if the unit is closed to visitors which
is sometimes necessary.
The day of the operation
How do I help my child get ready for surgery?
On the day of your child's operation, please ensure that your
child has been bathed or showered and young people have removed any
jewellery or nail polish. Your child will need to stop
food or milk 6 hours prior to surgery and clear fluids from 2
hours. Your ward nurse and the anaesthetist will give
you specific times for your child. They may
also be given a "pre-med" to help them be calmer before surgery.
Can I go with my child to theatre?
When theatre calls your child will be taken down to theatre by a
nurse. It is usually possible for at least one parent to
accompany your child down to the anaesthetic room and this is
something that you can discuss the day before with the
anaesthetist. Your child may need a hospital trolley if a pre-med
has been given. A porter will push your child on the trolley.
You can usually stay with your child until they are asleep
How long will surgery take?
Before the operation we will give you an
estimated time of how long the procedure will take, but
sometimes parts of the operation can take longer that we
expect. This does not necessarily mean that anything has
gone wrong. As well as the actual time to do the procedure,
there is also anaesthetic time while your child goes to sleep and
is prepared for surgery with the necessary catheters etc that the
anaesthetist will have explained. Once your child has arrived in
PICU time is needed while the machines are set up and your child is
settled there.
However, we do understand that this can be a very
stressful time and if you are worried that all this is taking
longer than anticipated, you can speak to the cardiac nurse
specialist or cardiac surgery coordinator.
Where should I go during surgery?
Your child's nurse will then take you back up to Ward 32 to pack
up your child's belongings. Following your child's operation
they will be a patient on Paediatric Intensive Care Unit (PICU) and
so will no longer have a reserved bed on Ward 32. There is a
storage area for your child's suitcase on Ward 32 whilst they are
in PICU, so ask your nurse to show you where this is if required.
You may choose to stay in the hospital during the operation but
families have told us that it can be helpful to go out.
Whichever you choose, we will make sure we have a means of
contacting you so that we can let you know as soon as your child
comes out of surgery. You can then go to the PICU parents' room and
we will come to see you as soon as we are free.
Will you be able to update me during the operation?
We will not be able to do this while your child is in
surgery. This is because everyone in the operating team is
focussing on your child's operation and it is important that they
aren't interrupted. However, if there are any events that we need
to talk to you about whilst your child is in theatre, we will
contact you.
What to expect after
theatre
Where will my child go after surgery?
Your child will be taken to PICU directly from theatre once the
operation is complete. Here, your child will be looked after
by a specialist intensive care nurse. PICU will contact
you once your child had been settled into the unit post
operatively. Your child will be monitored by a nurse at the
end of their bed, and doctors also regularly review your
child. The nurse will try to answer any questions you may
have, and will refer to a doctor any questions he/she is unable to
answer. The nurse looking after your child will give you a
'Welcome to PICU' leaflet giving you lots of useful information
about what to expect whilst your child is in PICU. Its
important to realise that your child will look rather different
after surgery and will look rather pale. There will be breathing
tubes attached by tapes to some of the face, there will be
dressings and catheters in various places such as the side of the
neck, hands and wrists and in the groin area.
What equipment will my child need after surgery?
After surgery your child may have some of the following
equipment and items attached to them:
Ventilator
Your child may have a tube down their nose or mouth to support
their breathing (ventilation) after surgery. For this, they
will need sedation with medication. During their recovery the
ventilator will gradually be reduced until they are able to
breathe on their own without the machine. They will then be
'extubated' (the tube removed). We may give them
additional oxygen after this either using a face mask
or prongs inserted into the nostrils. In infants we
may use head box oxygen which allows us to give warmed, humidified
oxygen to the child that will allow them to cough and keep their
lungs clear more efficiently.
Nasogastric tube
This is a fine tube that is passed through the nostril into the
stomach. This allows us to give food and medication.
Intravenous access & 'Arterial line'
Your child will usually have a small plastic catheter placed in
their neck, often referred to as a "Central Line". This is a
very important item as it allows us to measure the pressure within
the heart and also to give medications securely into the
circulation. These include drugs that will help control the
blood pressure as well as medication. Another small plastic
catheter will be placed into a vein somewhere else, usually a hand
or foot, that will allow us to give fluids and other medications as
required.
There will be a small plastic catheter inserted into an artery,
most often at the wrist or at the top of the leg. Often referred to
as an "Arterial Line". This is used to monitor the blood pressure
and is also used to take out blood samples to check on the
functioning of the lungs and informs us how best to set up the
Ventilator (see below).
Monitoring
Your child will be connected by wires to a number of other
monitors that give us continuous information on a number of other
vital signs. These include oxygen saturation, heart rate and
rhythm, respiratory rate, temperature and blood pressure.
These are all shown on a large monitor that is above your
child's bed.
Pacing wires
Most children will have little wires coming through their skin.
Normally these wires are wound up and attached to the child's
chest but sometimes they may be attached to a pacing box.
They can be used to control the heart's rhythm and are
sometimes necessary after a heart operation if the conduction
system in the heart has been affected by the operation. If
the pacing wires are being used, this is usually temporary. A
day or so after the operation, if they are not being used, they can
be removed often under sedation, particularly for smaller children,
by gently pulling them out. This is not painful, but creates
a tickling sensation as they come out.
Chest drains
After cardiac surgery each child will have one or two chest
drains coming out of their chest. These are necessary to
remove any fluids that build up after the operation. The
drains will remain in place until the fluid has stopped being
produced. This may be a number of days after the operation.
When it is time for them to be removed, they are pulled out
after the child has been given some sedation. A black stitch
is used to close over the small incision that is left behind and
this stitch will be removed 5 days after the drains have been
removed, either in the hospital or by your district nurse.
Urinary catheter
Each child has a catheter placed to drain the bladder after a
heart operation. The amount of urine that is produced is a
very sensitive and useful indicator of how the heart is functioning
after the operation and how your child is recovering. It is
therefore very important to know accurately how much urine is being
produced.
Transfer to the ward
When will my child transfer to the ward?
Once the clinical team are happy that your child is stable after
the operation and no longer needs to be on the intensive care unit,
they will be transferred to the ward. This may be on the day
after the operation or a number of days later: it depends on your
child's progress. Initially they will go to the High
Dependency Unit (HDU). This is a very good sign that your
child is on the road to recovery and is ready to move from one to
one care, to the specialist care of the HDU nurses, who each look
after two patients. This care will usually be provided
on Ward 32 in the specialist HDU, but may also be provided on PICU
on some occasions. We realise this will be a time of
adjustment so please talk to the cardiac nurse specialist and the
nurses caring for your child if you have any questions or
worries.
What's the difference between the High Dependency Unit and the
rest of Ward 32?
Whilst on HDU, your child will be reviewed on the doctors rounds
twice a day, which start at 9am and 4.30pm. On the ward round
you will see doctors from Ward 32, doctors from PICU and nurses
from HDU. You can speak to the team as part of the ward round
but if at any time you are worried about your child, speak to the
nursing staff. They will talk to you about your questions
or concerns and agree a plan of action with
you. There is also a poster by the side of your
child's bed which will remind you how to raise any concerns so that
we can take the very best care of you and your child.
After a time, your child will be well enough to move
onto the main part of Ward 32. Here, the nurses are
all experienced in looking after patients following heart
surgery or with heart conditions and each nurse will look after
three patients. This is a further sign that your child is
recovering well. During this period we will start talking to
you about discharge. You will find out more
about looking after your child following cardiac surgery, and
particularly what medications they need and what they do.
Again, your child will be reviewed by one of the consultant
cardiologists on the ward round every day, usually in the early
part of the morning. This is an opportunity for you to meet
the doctors and ask any questions that you may have as we want you
to be as much a part of the care of your child as possible.
Also we do not want you to worry about things when we can
help reassure you. However, being able to contact your doctor
is not solely limited to these times and if you ask your nurse, a
time can be arranged for you to meet with anyone in the team.
For more information on Ward 32, click here
Who else is there to support us?
There is a wide team available to support you and your child
during your stay; you can talk to the cardiac nurse specialist and
or the clinical psychologist all of whom are regularly available on
the ward. The play specialist will be able to help your child
understand and cope with their time on the ward as well as
providing activities and entertainment.
