Planning for discharge
The average stay after surgery is seven to 10 days, depending on your child ’s progress. A chest X-ray, echo and an electrocardiogram (ECG) are repeated prior to discharge. Occasionally, a blood test will also be required. The nurses and care coordinator will prepare a discharge plan for your child and arrange any follow-up appointments.
Nursing staff will also provide information to you prior to discharge so that you are aware of what to look for when you return home with your child.
Wound care after cardiothoracic surgery
Wound care following cardiothoracic surgery can be simple, however some steps are necessary.
The dressing applied to your child’s wound will assist with the prevention of water entering the wound; however, the material is not water proof, but simply water repellent. It allows the wound to breathe at the same time as keeping the wound dry.
Bathing is important for your child post-operatively. Your nurses will help you with bathing your child after their surgery.
We recommend removal of the dressing 14 days (approximately) after surgery. You will need an appointment with Queensland Paediatric Cardiac Service (QPCS), a paediatrician, or your child’s GP for this.
For optimal dressing care, be sure to:
- Leave dressing on for 14 days after the procedure.
- Avoid touching the dressing.
- Do not soak the dressing. Please do not shower directly on to the wound until the dressing is removed. We recommend a shallow bath or sponge bath until then. If your child prefers to shower, the nurses will show you the correct way to shower without getting the wound wet.
Dark stain on the wound line noticed underneath the dressing.
This is a stain from blood between the dressing and the wound that does not affect the healing, and is nothing to be concerned about.
White and/or cloudy gel on the wound line noticed under the dressing.
This is moisture absorbed by the dressing material, and should evaporate in one or two days. This does not affect healing. If this cloudiness spreads and begins to ooze out from underneath the dressing, the dressing will need to be replaced by your doctor.
Edges of the dressing begin to peel back.
This will not affect wound healing as long as the wound itself remains sealed by the dressing. To prevent it, please avoid unnecessary touching and soaking of the dressing.
The dressing lifts off completely or partially.
If the seal over the wound is broken, your child will need the dressing changed by the QPCS or your GP.
If there is any form of discharge from the wound (clear, blood stained, pus), a wound breakdown, or any doubt about the wound, contact QPCS as soon as possible. You may be asked to take a photo to send to the Surgical Cardiac Care Coordinators.
If you and your child are out of the Brisbane area, please contact your GP or nearest hospital who will then contact us.
Your child’s post-operative review appointment will be made for two weeks after their surgery or a date closest to the date on your child’s dressing. A doctor or nurse will remove the dressing at this appointment.
Approximately two months after discharge, you will be asked to see your cardiologist. All appointment dates will be given to you on discharge or mailed out to you. If you live outside Brisbane, alternative arrangements will be made for you (for example, with your GP, closest hospital, or the next outreach cardiac clinic).
Your child’s GP will be sent a discharge summary for their records.
Continue to give your child any discharge medications they have been prescribed.
When giving your child medication, especially new drugs, follow the steps bellow:
- check you have the correct bottle/packet (look at label)
- draw up the correct dose
- look at the label again to double check that you have the correct label, dose and time.
Check all discharge medications with your nurse before you go home. The nursing staff will teach you how to give the medications. Our pharmacy staff will also give you instructions for your child’s discharge medication. Ensure that you understand what you have been shown.
Pain relief after discharge
When you go home continue to give your child Paracetamol (Panadol) as needed, following the instructions on the bottle. After the first couple of days at home you will notice that your child is more comfortable and you can reduce the number of Paracetamol doses. Speak to your doctor if your child is still in pain.
Contact your GP, paediatrician or local hospital emergency department, if you notice any of the following:
- temperature greater than 37.5° C
- wound redness, swelling, ooze, excessive soreness, gaping wound edges
- signs of congestive cardiac failure (see below).
Signs of congestive cardiac failure (CCF)
This condition does not mean that the heart will stop working, but that it is not pumping enough blood to supply the body for normal function and activity. Please report any of the following signs and symptoms to your doctor:
- excessive tiring
- laboured or fast breathing (increase in usual breathing rate and effort)
- fluid accumulation (oedema)
- colour of child — marked pallor (very pale) or increasing cyanosis (blueness)
- poor feeding — refusal to feed or continually taking decreased amounts of food, or vomiting which differs from your child’s normal pattern
- decrease in urine output despite adequate liquid intake.
Returning to physical activities
Children under three years do not have routine post-operative physiotherapy, but it may be required if the treating doctor feels it is necessary. Young children will usually self-regulate their activity levels, and as they feel better they will do more. If you are concerned for any reasons about the level of activity your child is participating in, talk to your hospital doctor or your GP.
If your child is over three years old, a physiotherapist will talk to both you and your child after the operation about exercises to be performed in the hospital and at home. These include limb and breathing exercises. The aim of these exercises is to ease and prevent back, neck and shoulder pain and stiffness, to improve lung expansion and keep lungs clear of secretions.
Sternal wounds take approximately eight to 12 weeks for the bone to heal (for stability of sternum), therefore it is important during this time to avoid jarring activities, twisting movements, excessively fast movements or using a single arm to strain, push or pull.
Returning to sports
||Weeks after surgery
|Running / jogging
|Rugby union/league, touch football, soccer
|Ten pin bowling
Carrying light objects may commence about four weeks after the operation if your GP thinks the wound is healing normally. Restrict lifting of heavy weights for eight to 12 weeks. School bags will need to be closely monitored for weight during this period. Refer to the table below.
|3 – 4 years
||1.5 to 2 kilograms
||2.5 to 3 kilograms
Most activities may be resumed within a few weeks of returning home. School sports and other activities that may jar the chest, for example skate boarding, diving and trampolining are to be avoided until the wound is fully healed, which will usually take 12 weeks. Discuss contact sport with your child’s doctor prior to recommencing.
Please talk to your physiotherapist if you have any questions about the exercise regime or chest care after your child’s operation.
Guidelines for returning to school
Most children can return to school or childcare within three to four weeks after surgery. You may need to provide the school with a copy of this fact sheet for your child to be excluded from physical education until eight to 12 weeks after surgery as per the returning to sports guidelines above.
The importance of good oral health
Queensland Dental Health research has shown that a high percentage of ‘cardiac’ children have underdeveloped tooth enamel. If oral hygiene is not adequate, the risk of tooth decay is higher. Twice daily brushing, a balanced diet and regular dental checks are important to maintain to ensure good dental health. Discuss this with your Cardiac Care Coordinator.
Continue your child’s immunisations as per the National Health Schedule. However, the following guidelines must be followed by your GP or Health Centre:
- Non-live vaccines need to wait for 2 weeks after surgery if clinically stable.
- Live vaccines need to wait 2 weeks after surgery if clinically stable, where no blood products are used.
- If blood products were given, live vaccines should be delayed by three months except for rotavirus vaccines. The interval between rotavirus vaccination and receipt of the blood product should be as long as possible, but within the suggested age limits for dosing (Rotarix 1st dose between six to 14 weeks and 2nd dose between 10 to 24 weeks with a minimum interval of four weeks between doses).
For all children where vaccines need to be deferred, they should have an Immunisation medical exemption form for temporary exemption completed and lodged to ensure families are not financially disadvantaged.
Queensland Specialist Immunisation Service (QSIS) offers a drop-in Immunisation service at 2G of QCH. All patients can present for their National Immunisation Program vaccinations without prescription or appointment.
Before your child is immunised, tell your GP if they:
- are suffering from any sickness or allergy
- have had a severe reaction to a previous immunisation such as persistent screaming, persistent vomiting, collapse, convulsions or fever exceeding 39.5° C
- have ever had ‘fits’, or if any other members of the family have an illness of the nervous system or convulsions.
Discuss with your cardiologist about additional immunisations that are sometimes recommended for cardiac children.
Settling in at home after surgery
It is normal for young children to be unsettled for a period of time after they come home from hospital. This is a natural reaction to the ‘stress’ of hospital, and separation from home and family routines.
Your child may cling and cry if you leave their sight. ‘Babyish’ habits may start again such as forgetting toileting or wanting to be fed. Nightmares, temper tantrums, aggression or rejection of family members may also occur. Your child is simply testing your love for them and needs reassurance.
Discipline that is too firm at this time may add to your child’s feeling of abandonment. All that is needed is a great deal of patience and understanding until your child feels more secure in their familiar surroundings.
If problems persist past three to four weeks, please contact nursing staff or your family GP.
Queensland Paediatric Cardiac Service
Queensland Children’s Hospital
501 Stanley Street, South Brisbane
t: 07 3068 2597
t: 07 3068 1111 (general enquiries)
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.