After cardiac surgery, children are usually transferred to the Paediatric Intensive Care Unit (PICU) for close monitoring by specialist nurses and doctors. Immediate family members are encouraged to visit children in PICU, however, please note that visitor numbers are limited. Overnight accommodation is very limited for parents of children in PICU so you will need to be prepared to return home (or to your accommodation if you are not from Brisbane).
During this phase, your child will have several tubes and wires attached to them which can be confronting at first but it is important to remember that this is part of the normal recovery process for children who have had heart surgery. As they recover, these will be removed. Once stable, your child will be transferred to the cardiac inpatient ward. The staff in the PICU will support you through your child’s stay. PICU also has a Social Work Team who are available to provide support to you and your family.
All babies and children are given pain medicine through a drip for approximately 24 to 48 hours after surgery. This can vary according to your child’s needs. Your child’s pain needs will be monitored by the Acute Pain Service daily. Oral medicine will be given as required after surgery.
For children over five years of age, patient controlled analgesia (PCA drip machine) is available. This is a very safe, self-controlled method of pain relief.
Usually the child will have a drain or drains in their chest, which drains fluid from the operation site. For a short period of time, the child will also have a tube called a catheter which goes into the bladder and drains urine. This means the child will not need to go to the bathroom. The nurses will monitor and chart how much fluid is going in and out of the child’s body.
Removal of tubes
The removal of tubes is necessary in order for your child to get well. This can be quite upsetting to your child, but your support is vital to helping your child and staff. Various methods of pain-relieving therapies are utilised to make the removal of tubes as least traumatic as possible. One drug we often use is called Midazolam, which is a very short acting sedative, that helps your child relax and often forget about the procedure. With older children, tubes are often removed in the treatment room, so that their bed is a positive place to return to.
Sometimes children will have a feeding tube in their nose. This tube goes all the way to the stomach and is called a nasogastric tube. Having tubes in the nose is not always comfortable, however as soon as your child is well enough to eat and drink for themselves, the tube is removed.
Your child’s chest wound can take eight to 12 weeks to fully heal (for stability of sternum). There will be a dressing over the wound that will stay in place for approximately two weeks after surgery. There will be a date marked on the dressing which is the date the dressing should be removed. It is normal to have some dark brown looking ooze under the dressing. This helps promote healing.
It is important to avoid ‘jarring’ activities such as trampolining, contact sports, swimming laps, and activities where your child may fall on their chest. An underarm wound (thoracotomy) will take less time to heal but you must take care when lifting your child.
New scars may be raised, red, thicker, or harder, than normal skin. Most surgical scars will soften and fade over time. If you are concerned about how your child’s scar looks or feels, please contact your care coordinator or the QPCS Occupational Therapist.
Physiotherapy after surgery
Encourage children to do:
- arm and leg exercises three to four times each day
- breathing exercises – 10 deep breaths every hour that your child is awake
- cough, sit out of bed, change position in bed regularly
- walk in the corridor three to five times each day.
Aim to increase the distance walked each day and gradually increase the speed.
Do not lift your child under the arms—this will pull on the wound. Place your arm around their back, and under their thighs, as in an arm chair to lower them to the floor, or if they are old enough to move themselves to the floor, let them do this.
Handling your baby after surgery
To ensure your that baby’s wound heals evenly, it is important not to pick them up under their arms for a period of 6 weeks. The nursing staff will teach you how to pick you baby up using the “scoop” technique. When you go home it is important that you teach anyone who might pick up you baby how to do so correctly.
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.