How to Prepare for Your Child’s Heart Surgery

How to Prepare for Your Child’s Heart Surgery: A Guide for Parents

 

(This information is provided by Children’s Heart Link)

 

Many families find that learning and talking about what to expect before their child’s surgery can help decrease anxiety.

 

Your Child’s Healthcare Team

 

At your hospital, you and your child will meet with many healthcare providers.

 

Meet the Healthcare Providers & Their Roles

 

Pediatric Cardiac Surgeons

These doctors have long experience and expertise in performing

heart surgery on children.

 

Pediatric Cardiologists

These doctors specialize in caring for children with heart conditions. They often order tests to get specific information about your child’s heart problem and then refer your child to a pediatric cardiac surgeon, if it should be required.

 

Pediatric Cardiac Anesthesiologists

These doctors work closely with the cardiac surgeons; they pro-

vide children and infants with medicine to make them sleep during

heart surgery. The anesthesiologist carefully monitors your child

throughout the surgery.

 

Pediatric Intensivists

These doctors specialize in caring for infants and children while

they are in the Cardiac Intensive Care Unit (CICU). The intensivist works closely with the surgeon and cardiologist to care for our

 young patients as they recover from surgery.

 

Perfusionist

This technician operates the heart-lung machine, which temporarily replaces the patient’s heart and lungs’ functions during open heart surgery.

 

Social Worker

These specialists provide psychosocial support to patients and

families, and help plan for patients’ needs after discharge from

hospitals, so they can cope with the illness.

 

Registered Nurse (RN)

The RN has primary responsibility for planning, coordinating, and

providing your child’s care in the hospital, and to teach you about

caring for your child and answer any questions.

 

Preparing your Child for Surgery

 

  • a few days before surgery tell your child that he or she will be coming to the hospital for a heart operation

 

Keeping your Child Healthy for Surgery

 

Once the surgery date is scheduled try to keep your child away from people who may be sick. This can be difficult if your child is in school or childcare.

 

You may want to keep your child home a few days before surgery to decrease the chance of exposure to a cold or the flu.

 

Important note: Your child must be healthy at the time of surgery. Take your child to your pediatrician for an examination if your child appears sick, has a fever, cold, cough, vomiting, diarrhea or has recently been exposed to chickenpox. Your pediatrician will help to decide if your child is too sick for the operation. Your child’s surgery will be rescheduled for another day if your child is too sick. Also call to report your child’s symptoms and any medications the pediatrician has prescribed to your doctor at your hospital.

 

The Preoperative Visits and Tests

 

It is important for your child's surgeon to know specific information. To gather this information many tests are done during a preoperative visit at the hospital.

 

Many tests are done during a preoperative visit at the hospital. Plan for this to be a long, busy and often tiring day. Plan to bring extra diapers, formula, any medications that might be needed, a few toys, books and snacks.

 

Avoid all immunizations one week before surgery.

 

Keep your child's fingernails short and clean.

 

Any dental problems need to be discussed before surgery. Surgery will be cancelled if there are dental caries or dental work has been done recently. Please inform the cardiac team.

 

Your child may have the following tests or meetings at the preoperative visit:

 

- oral cavity assessment and dental history

- fingernail assessment

- history and physical exam

- blood tests

- chest X ray

- electrocardiogram (EKG) if needed

- echocardiogram (echo) if needed

- cardiac catheterization if needed

- meeting with an anesthesiologist

- meeting with the pediatric heart surgeon if available

 

It is very helpful to bring a list of any medications your child is taking including the dose and how often the medication is given.

 

Types of Heart Surgery

 

Your child's heart condition requires surgery to repair the problem. In some cases, the surgery will be an open-heart procedure.

 

This type of operation requires an incision through the skin straight down the center of the chest, separation of the breastbone, and attachment to a heart-lung bypass machine so that the surgeon can operate inside the heart.

 

Another type of operation is the closed-heart procedure. This approach is used when the repairs are made to the outside of the heart. The incision is made between the ribs on either the

left or right side of the rib cage and the heart-lung

bypass machine is not necessary.

 

The Night Before Surgery

 

You will be given instructions on how to prepare your child the night before surgery.

 

It is very important to know when your child should stop eating or drinking. His/her stomach must be empty before surgery. Surgery will be cancelled or delayed if your child’s stomach is not empty. It is very important that your child stop eating and drinking at the time you were given in your instructions.

 

Eight hours before surgery Child should stop eating solid foods.

 

From eight to four hours before surgery Clear liquids (water, apple juice) and breast milk are allowed from eight to four hours before surgery

 

Four hours or less before surgery Nothing by mouth.

 

If your child has a regularly scheduled medication that needs to be given on the day of surgery, ask about how and when to give the medication.

 

The Cardiac Intensive Care Unit (CICU)

 

What to expect when visiting:

 

Your child will still be quite sleepy. There may be many tubes and wire lines connected to your child. You may hear beeping noises and see medical equipment with flashing lights. This equipment monitors important functions of your child's body. The devices will be gradually removed over the next few days as your child grows stronger.

 

Your child may also be connected to:

 

  • a breathing tube and ventilator (breathing machine), which helps your child breathe but prevents your child from talking. It will soon be removed and replaced with oxygen delivered through a small tube that rests under the nose.

 

  • Intravenous (IV) lines will provide fluids and medications until your child begins to drink and eat again.

 

  • One or more tubes in the chest to drain blood and fluid at a catheter tube to collect urine.

 

When visiting your child in the CICU, always wear clean clothes, keep your fingernails short and clean and wash your hands and arms up to the elbows.

 

Seeing your child in this new environment may be frightening but the team will orient you to all of the vital devices. They will also monitor your child closely for pain and make certain that any discomfort is relieved. Medicine to relieve pain and anxiety is given through the IV lines and works quickly.

 

 

The Cardiac Ward

 

As your child recovers from the surgery and grows stronger your child will be transferred out of the cardiac intensive care unit or ICU to another infant or pediatric unit at the hospital. This is usually the cardiac ward. On this unit your care team will begin preparing both you and your child to return home.

 

Things to think about in preparing for when you are going home from the hospital:

 

Your child’s energy level may be somewhat lower than normal following surgery but it should improve every day.

 

Your child may:

 

-be more tired than usual

 

-need to rest more often during the day

 

-need less active play than usual such as watching TV or reading

 

After about two weeks or so your child will probably have more energy, be able to be more active with their play and not be so tired. Your child should steadily increase activity until they can return to normal or even increased activity four to six weeks after surgery.

 

Your child should stay at home for a while after coming home from the hospital but can typically return to school in two to four weeks after discharge. When you visit your child’s heart doctor after surgery, he or she will tell you exactly when your child can go back to school. When your child comes home from the hospital you may see changes in behavior. These changes may mean you need more support at home during the first two weeks and that might include:

 

  • some children become more demanding of attention and want to stay close to their mother and father.

  • some children may start behaving in ways that they did when they were much younger.

  • some children may become quieter while others may show more anger towards other people.

 

If your child shows some of these changes you should know that many of these changes in behavior improve after some time. However, if your child's behavior does not get better, gets worse or if it is causing a big problem you should ask for help from your child’s doctor or someone you trust.