Intensive Care (I.T.U. or P.I.C.U.)
All patients will be taken to the Intensive Care unit after heart surgery; for babies and children it will be a Paediatric unit whilst older patients will be on an adult unit – in a Children's Hospital it may well be a specific Cardiac Intensive Care Unit. Some will stay there only a few hours, others will be there longer.
Usually families are offered a 'tour' of the Intensive Care Unit prior to the operation. Although this can be a traumatic experience, it is very helpful to find out what the various machines do and what all the wires and lines will be doing for the patient. Seeing the Intensive Care Unit first helps reduce the shock and emotions when you later visit for the first time after surgery. If you understand a little of how things work you will be greatly reassured.
What to expect
Once in Intensive Care, the patient will be cared for by a team of very skilled doctors and nurses. There will be someone present monitoring the patient almost constantly.
Most patients will be connected to a ventilator machine when they first get to I.T.U. This will mean that they will have a tube coming from their mouth, which will be attached to the ventilator; it may well be taped to their head to prevent it from moving. The ventilator is used to help them breathe.
Another tube will go through a nostril and into the stomach, this is to drain the stomach and prevent sickness. There will also be a tube coming out from each side of the chest; these drains are used to remove any fluid from the heart or chest cavity. Yet another tube will be used to drain urine from their bladder until their kidneys are fully functional again.
Thin tubes referred to as 'lines' are inserted into veins and an artery, and these are used to administer drugs, give fluids if needed, to take blood samples if required and to keep a constant check on the patient's blood pressure. These will often be located in the groin and also the side of the neck, but the exact location will depend on how easily they can find the veins they need.
Depending on the type of surgery they have had had done, they will either have a scar down the centre of the chest or under their left or right arm. Immediately after surgery the scar will be covered with a dressing, which will be removed after a few days.
You may see two coiled wires coming from their chest, these are called pacing wires and are routinely used. They are attached directly to the heart, and should a problem develop with the rhythm of the heart, they can be temporarily attached to a pacemaker to help settle the heart back in to its normal rhythm.
The patient will be attached to numerous monitors, which keep a check on their heart rate, blood pressure and blood oxygen levels. All of these are set with minimum and maximum levels, if the readings go outside of these an alarm will sound. This happens quite frequently and is not a cause for worry, the monitoring equipment is there to help the doctors and nurses give the best possible care, and give early indication of any changes in their condition so that appropriate action can be taken quickly, if needed, to prevent any complications.
Patients are generally sedated quite heavily whilst in I.T.U., and most will remember little of their time there.
Visiting in I.T.U.
Parents are usually allowed to visit their child after surgery, as soon as they have been attached to all the equipment needed for their care. Visits can be for as long and as often as you like, although on occasions you may be asked to wait if there is an emergency or the unit is very busy. The I.T.U. staff are there to answer your questions, and will be happy to show you how best to hold your child whilst they may be sore. They will encourage you to assist with their care as far as possible.
Although it is very natural to want to sit with them all the time, this is very tiring mentally, and you should try to ensure that you get proper rest and nourishment so that you are able to cope with their demands once they are no longer sedated - many parents are amazed by the speed of their child's recovery! Rules relating to visiting by siblings and other family members may vary between units, so it is worth asking the policy on your particular unit.
Gradually the various lines and tubes will be removed as the patient regains their strength and drugs etc. are reduced. Most will be off the ventilator within a few days of surgery, and depending on the policy at that unit, they may then be transferred back to the normal ward, or perhaps to a high dependency ward before they are allowed home. In a few cases they may need to be transferred back to your local hospital for a few days before they are fit enough to go home, this may well be done if you live a long way from the cardiac unit.
"On first sight it was difficult to see our baby for all the tubes and wires attached to him. The way things happened we didn't have chance to visit I.T.U. so we'd been told to expect a shock when we saw all the equipment; in fact it wasn't as bad as we'd imagined. The nurse took time to explain what all the tubes and wires were for and what the monitors did - when we understood they were all there to help him, we felt much better. We could still touch him, talk to him and give him a goodnight kiss!".