It’s All Over: After Surgery

Cardiothoracic Intensive Care Unit (CTICU) H4B

Once the surgery and transfer are complete to the (CTICU) H4B there will be connections to monitors and IV’s and the incision will be covered with a dressing or bandage. To help better prepare for what to expect after surgery, each piece of equipment is discussed in detail below.

• A central venous line is a special IV that has extra ports (places to give medicines). This line is usually placed in the side of the neck, under the collarbone or in the groin area. Blood samples can also be taken from this line.
• A urinary catheter (Foley) is a tube placed into the bladder that drains urine into a collection bag. This allows us to measure the amount of urine produced each hour.
  A nasogastric tube (NG tube) is a tube placed in the nose and down into the stomach. This will keep the stomach empty to decrease the chance of vomiting. If you/your child has this tube after surgery, it can be used to give breast milk, formula or other nutrition.
• An endotracheal tube (breathing tube) is inserted into the mouth or nose and placed in the trachea (windpipe). The breathing tube connects to the ventilator (breathing machine) that will breathe for you/your child. How you/your child does with the surgery determines when the breathing tube is removed. Every effort is made to remove the tube at the end of the operation if it’s deemed safe by the anesthesiologist and surgeon. The majority of the time, the tube can be removed at the end of the operation.
• Special lines, called right atrial or left atrial lines, are IV’s placed in the top of the abdomen through the skin and into the atria (chambers of the heart) by the surgeon at the end of surgery. Measurements or blood pressures inside the heart can be obtained through these lines. Blood samples and medication can be given in these lines also.
• IV pumps allow medicine and fluids to be given at a specific rate based on weight.
• Soft restraints are made of foam and allow arms to be secured to the bed, if needed, to prevent equipment from disconnecting. Typically, they are used if a breathing tube is being used after surgery or if your child is active and trying to remove any necessary tubes.
• Vital signs are displayed on the monitor located above the patient’s head. This can include heart rate, respiratory rate, blood pressure, oxygen level, temperature and other specialized measurements, if needed.
• EKG leads are three stickers that are placed on the chest and abdomen which display information about the heart rate, rhythm and breathing rate.
• A pulse oximeter is a sticker that resembles a band-aid with a red light that measures the amount of oxygen or “saturation” level in the blood. This is usually placed on the finger or toe. In small babies this may be placed around the hand or foot.
• At least one intravenous line (IV) will be inserted into the hand, arm, foot, ankle or sometimes the head in small infants. This allows for fluids and medication to be given after the surgery, especially when the more specialized lines are no longer needed.
• An arterial line is a special IV inserted into an artery (a blood vessel where you can feel the heartbeat), which will continuously measure the blood pressure. Blood samples are also taken and measured frequently. This line is usually inserted in the inner wrist or the groin area. On occasion, it may be placed in the inner ankle area.
• There will probably be at least one chest tube. A chest tube is a tube that drains fluid or air from the lungs or the sac around the heart into a rectangular collection box. The tube is usually placed through the skin at the bottom of the incision. On occasion, chest tubes are placed on the side of the chest, if there is a need for drainage from around the lungs.
• Temporary pacemaker wires are small wires placed through the skin at the top of the abdomen that attach directly to the top of the heart. These wires attach to a pacemaker to temporarily help the heart beat, if necessary.

Pain Control

One of our priorities is to make sure our patients are as calm and comfortable as possible. Pain is managed in different ways depending on the age of the patient. For babies and small children, pain medicines are given on a scheduled or as-needed basis, or they may have a nurse – controlled analgesia pump. Older children, teenagers and adults will be given a pump to control their own pain called a patient-controlled analgesia (PCA) pump. Other methods include the insertion of an epidural catheter to allow for infusion of medicine along the spine. You can discuss each method with your anesthesiologist.

Another pain control method is distraction. There are TVs and DVD players in each room in the (CTICU) H4B and H4A. Videos are available through a Child Life Specialist. You are welcome to bring any favorite video or CD from home to enjoy. Please label any personal items. Video games are available for patients. They can be brought to the bedside. Ask your nurse if you are interested.

When Can Monitoring Devices Be Removed?

When determining whether to remove monitoring lines and tubes, several factors must be considered such as how well the surgery was tolerated, vital sign measurements since the surgery and any medications continuously received (called a drip). The amount of drainage from the chest tube and the Foley (urine tube), and the appearance of the chest X-ray are also taken into consideration. Removal of tubes can occur as early as the first day after the surgery. Sometimes all of the tubes are removed on the same day and sometimes one or two tubes are removed at a time. Removal of the lines and tubes occurs at the bedside in the (CTICU) H4B after pain medicine is given. Portions of the procedure can cause discomfort, however, most patients tolerate the procedure well after they receive the pain medicine. Parents may stay during these procedures if they wish. Transfer to the cardiology step down floor, H4A, usually occurs after removal of the majority of the monitoring devices.

Cardiology Step Down (H4A)

Cardiac step-down care on H4A includes a staff trained in management of congenital heart problems. This includes cardiologists, cardiology fellows, nurse practitioners, nurses, patient care assistants, telemetry monitor technicians and unit coordinators. The unit has the ability to handle heart and lung transplant patients, open and closed heart surgery patients, cardiac catheterization and electrophysiology patients, temporary pacemakers and post-operative permanent pacemaker/internal defibrillator patients. Patients with chest tubes, patients
requiring continuous EKG monitoring and those on continuous cardiac medication infusions (drips) receive care on H4A.

Healing Within the Hospital

We provide a variety of activities for patients to participate in during recovery time in the hospital. There are playrooms and teen rooms available on all floors. An adult must supervise children at all times while using these activity spaces. Organized activities are planned for each week. Information about activities and special events can be found on Nationwide Children’s television channels or postings on each patient unit. Please check in with your nurse prior to taking your child to the playroom.

Visiting Guidelines for (CTICU) H4B and Cardiac Step Down H4A

Upon admission to Nationwide Children’s, parents will be issued a “parent” badge, key card and ID band in Admitting. Spouses will be issued a “spouse” badge and keycard. This badge is your identification. When other visitors arrive, they must stop at the Patient Information Desk in the Main Lobby, prior to visiting to receive a “visitors” badge. For security reasons, everyone must wear a badge while inside the hospital.

Visiting times are important to you, your child and us. We will work with you to plan for a visiting schedule to meet your needs. To help make this a better experience for everyone, we need your cooperation with the following guidelines:

• Parents/spouses are encouraged to be at the patient’s bedside at any time.
• Grandparents are also encouraged to visit as often as they like, with parent or guardian consent.
• Siblings of any age and other visitors over the age of 12 may visit between 8:00 a.m. and 8:00 p.m., with the parent’s permission.
• On H4A, siblings of any age may visit as long as they have no signs or symptoms of illness. Siblings age 12 and over may visit the (CTICU) H4B as long as they have no signs or symptoms of illness. Occasionally, the hospital may place additional visiting restrictions on all visitors (other than parents) during peak times of illness in the community. We ask that siblings stop by the nurse’s station prior to visiting to have
• We ask that siblings stop by the nurse’s station prior to visiting to have their temperature checked. Siblings may NOT spend the night. Sibling care is available for children 3-11 years in the Nationwide Children’s Clubhouse from 8:00 a.m. to Noon and from 1:00 p.m. until 8:00 p.m. on weekdays, excluding holidays. Please give other family members and friends the family phone number in the room. Incoming calls must not take place between 10:00 p.m. and 6:30 a.m. If you/ your child is in isolation, visitors will need to follow the
• If you/ your child is in isolation, visitors will need to follow the guidelines posted on the door. For safety reasons, please remember to wash your hands each time you
• For safety reasons, please remember to wash your hands each time you visit and be sure to ask for a mask to wear, if you are ill during the time of your visit.
• Please do not use cell phones on the unit; they interfere with our medical equipment. You may use them in the lobby.