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Cardiac admissions fact sheet

Cardiac admissions

The following procedures will require your child to be admitted into hospital.

Cardiac surgery

Some complex congenital heart defects require surgery to correct the heart defect. This is the most common surgical admission at the QPCS. Heart defects that are fixed during surgery are grouped into two categories: open and closed. Closed heart surgery implies that the ‘heart lung machine’ or ‘bypass’ machine is not used and the heart is visualized but not cut open. Open-heart surgery implies that the heart needs to be opened in order to repair the defect and therefore the ‘bypass’ machine is used to oxygenate and circulate the blood without using the heart or lungs. This bypass machine is used so that open heart procedures can be performed safely.

Cardiac surgery will require an admission to the Paediatric Intensive Care Unit (PICU), then transfer to the 10B cardiac ward for recovery and transition to home.

Some medication may need to be stopped a week before surgery. Length of stay for cardiac surgery is approximately seven to 10 days depending on progress or if any complications occur.

Anaesthesia

The anaethetist will usually meet with you the morning of surgery , discuss the anaesthetic with you, and ask you to sign a consent form to give your child an anaesthetic.

Parents and children are encouraged to walk to the theatre doors. If your child has had any sedation they will go in on a bed.

Your child will ‘go to sleep’ either, with a mask releasing pleasant gas or an injection into the vein. Anaesthetists have techniques to make it less scary for children.

Electrophysiology studies (EPS) and radio frequency ablations (RFA)

These surgical procedures are used to diagnose and treat cardiac arrhythmias. If your child has an RFA, they will stay in hospital overnight and be discharged the next morning if no complications occur. If only an EPS is performed, your child may be discharged the day of the procedure.

During the procedure

Once in the Catheter Lab, your child will be given a general anaesthetic and closely monitored. The doctor will numb the groin with a special medication and then insert several catheters into the vein in the groin or neck. The doctor uses an X-ray machine to guide the catheters to the heart. The catheters sense the electrical activity in the heart and are used to evaluate the heart’s conduction system.

The doctor will use a pacemaker to give the heart electrical impulses through one of the catheters to try to induce an arrhythmia. If the abnormal pathway is found this may be removed or isolated by creating a small scar at the site by either heating or freezing the site.

The procedure may take between four and six hours. Once the catheter is removed a clear dressing is put on the area. Complications are rare but will be discussed with you by the electrophysiologist.

Cardiac catheterisation and interventional catheterisation

This procedure allows doctors to assess the finer details of your child’s heart, or to do an interventional procedure and correct a cardiac defect. Most cardiac catheterisations are done as a day case and your child is discharged the afternoon of the procedure. An interventional catheterisation is an overnight admission to hospital and your child is discharged the following morning if no complications occur.

During the procedure

This procedure is also done in the catheter lab. A flexible hollow tube (the catheter) is passed via a large vein or artery, through the groin or neck and moved up to the heart.

The position of the catheter is followed on an X-ray screen. The pressure can be measured, blood samples taken, X-ray dye injected or a device used to correct a heart defect.

The procedure can take up to two hours and your cardiologist will discuss with you the results of the procedure after it has finished. Once the catheter is removed a clear dressing is applied to the area.

After the procedure

The post-operative care for EPS, RFA, and cardiac catheterisations is quite similar.

Your child may be feeling sleepy after the procedure so we try to maintain a quiet environment until sedation wears off. Children are monitored frequently until awake, alert and observations are satisfactory.

All children placed on cardiac monitoring on arrival to the 10B cardiac ward and this will be continued until discharge. EPS children have an electrocardiograph (ECG) on return to the ward.

All children return with an IV bung which may be used to give intravenous fluids or medication if your child is vomiting after the procedure. Children who have had an interventional catheter procedure may require 24 hours of IV antibiotics through the IV bung.

Children are required to rest in bed for four to six hours after the procedure. Once fully awake they can resume their normal diet.

The wound site(s) are checked frequently for any bleeding or bruising. A  clear plastic dressing is left intact until the next morning.

Your child’s cardiologist or electrophysiologist will speak with you following the procedure to explain the findings and/or treatment.

Going home

Most children are discharged the morning after their procedure. Your child must be awake, alert and mobile before being discharged. They must have passed urine, and tolerated food and fluid, and their observations must be satisfactory. Your cardiologist or electrophysiologist will speak to you prior to discharge and follow up appointments will be arranged.

If your child has had an interventional catheter, they will have a chest X-ray and echocardiogram the morning after the procedure and may require low dose Aspirin to be taken for six months after the procedure.

If your child has had an EPS and RFA, they will have an electrocardiograph (ECG) and maybe an echocardiograph (depending on what side of the heart was accessed) the morning after the procedure. Your child may require low dose Aspirin for three months after the procedure.

Your child will be advised when to return to school or activities which is usually one week.

Wound care

Your child may bath or shower as normal. The clear plastic dressing can be removed the next morning.

It is common to notice some bruising following the procedure. If you observe swelling and bruising greater than five centimetres at the wound site, please report this to your doctor.

Panadol may be given for any discomfort, however, please see your doctor if the pain is increasing.

If bleeding occurs at the wound site, lie your child down and apply firm pressure to the wound for at least 10 minutes. Take your child to the nearest hospital if bleeding persists.

Check the wound for any signs of infection such as redness swelling or a high temperature. If these are evident see your doctor.

Do not apply any creams or lotions to the wound until it is fully healed.

If you have any concerns about your child’s procedure, contact the relevant cardiac care coordinator.

Contact us

Queensland Paediatric Cardiac Service (3D)
Level 3, Queensland Children’s Hospital
501 Stanley Street, South Brisbane
t: 07 3068 2790

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS107. Developed by Queensland Paediatric Cardiac Service. Updated: February 2015. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.

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