After surgery, the patient is transferred to the
cardiovascular intensive care unit (CVICU)
by the cardiovascular anesthesiologist and OR nurses.
The CVICU is adjacent to the cardiovascular operating
rooms to maximize patient safety, making the transition
from the OR to the CVICU a smooth process.
Once the patient is in CVICU, a
thorough report of the surgical procedure is given to the
cardiologist and CVICU nursing team. The surgeon updates
the family on the operation once the patient is settled.
Family members usually may visit the patient within one
hour after his or her arrival to the CVICU.
While in the CVICU, the patient
is monitored closely. In addition to monitoring heart rate
and rhythm, and respiratory rate, the monitor displays
other pressures and waveforms that assist the
cardiologist in managing care. A chest X-ray (CXR) and lab
work are performed on arrival and periodically
throughout the stay in the CVICU.
The CVICU is open to visitors 24
hours a day (except during rounds and emergencies). No more than two visitors are permitted at a time, and no children under 14 are allowed
on the 18th floor of Texas Children’s Hospital. A limited
number of rooms are available for overnight stays, and these
are assigned on a first-come, first-served basis.
The CVICU team continually
assesses the patient’s comfort level. Medication is given
to reduce any pain or anxiety after surgery. These
medications initially are given by IV, then gradually
changed to oral medications. Parents can help their
children feel more comfortable by talking quietly to them,
even if the ETT still is in place and the patient can’t
speak. Hearing a parent's voice usually will reassure the
patient. Other comfort measures such as listening to soft
music or helping patients change their positions in bed
regularly may decrease anxiety or pain.
Once the patient is awake enough
to breathe on his or her own, the breathing tube is
removed. Depending on the surgery, this may be from a few hours to a few days after surgery. Once the
surgical dressing is removed, the incision remains
open to air. The nurses cleanse the incision with a betadine solution twice a day and a small gauze dressing
is placed over the insertion sites of the chest
tubes, intracardiac lines and pacing wires. The
tubes, wires and IV lines gradually are removed.
When the patient has a stable
blood pressure, stable heart rate and rhythm and can
breath well without the ventilator, he or she is
transferred to the cardiac inpatient floor on the 15th
floor of West Tower. As
the patient improves, activity level will increase until
the physician authorizes hospital release.
Before leaving, the family is instructed in how to care for the patient at home,
including information on medications, incisional care and
activity limitations.
Before the patient is discharged
from the hospital, the family is given detailed
instructions for his or her care.
In general, patients should contact their doctor
if any of the following occurs after congenital heart
surgery
-
Redness, swelling or
oozing/bleeding from incision
-
Fever
-
Altered mental status, excessive
fatigue
-
Feeding and/or eating problems
-
Prolonged or worsening pain
Patients who have had a
sternotomy should avoid any activity that causes strain on
the chest for at least six to eight weeks so the
breastbone can heal. Avoid
picking infants up by their arms; scoop them up instead.
For older children and adults, avoid activities that
involve pulling or pushing with arms as well as contact
games and sports.
