After Pediatric Liver Transplant Surgery:
The PICU Stay
Once your child's liver transplant surgery is over, the pediatric liver transplant team will carefully monitor her recovery. Recovery care will involve a number of steps because your child's doctors want to ensure she is healthy and her new liver is functioning properly.
The Pediatric Intensive Care Unit
Your child's first stop after liver transplant surgery will be the Pediatric Intensive Care Unit (PICU). When your child arrives in the PICU, the nurses and physicians will ask you to wait to see your child so they can get her settled. The PICU is a busy place with many different types of equipment, alarms and sounds. Your child may be hooked up to quite a few pieces of equipment, and you may find it all a bit overwhelming. It helps to know how all this technology is helping your child, so here are some of the things you may see attached to her in the PICU:
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Monitors that check heart rate, respiratory rate, blood pressure and oxygen saturation
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An endotracheal (ET) tube, which was placed in your child's trachea (windpipe) during the operation and connected to a ventilator to help her breathe. Your child won't be able to talk, eat or drink with the ET tube in place, but she can communicate by using hand signals or writing on a pad. The doctors will remove the ET tube when your child no longer needs help breathing, and the nurse will have your child do deep breathing and coughing exercises to keep her lungs clear and prevent them from collapsing (called atelectasis). Sometimes the ET tube is removed in the OR but sometimes it is removed in the ICU.
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An abdominal dressing over the incision. This will be removed on the first day for an ultrasound. The incision may be closed with surgical staples or sometimes with stitches.
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A nasogastric (NG) tube, which passes through the nose and into the stomach, to help drain secretions from the stomach.
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Several JACKSON-PRATT drains in your child's abdomen to help remove extra drainage from the surgical site.
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A FOLEY catheter to drain urine from the bladder.
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Multiple intravenous (IV) lines to provide pain relief, antibiotics and other medications and fluids.
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An arterial line to monitor blood pressure and provide blood samples. It will be removed before your child is transferred from the PICU to a surgical unit.
- A central line — a flexible catheter inserted in a large vein — to give IV fluids and medications and, if necessary, provide blood samples.
Some of these tubes and lines will be removed when your child is transferred out of the PICU; others may stay in longer. If you have any questions, be sure to ask your child's caregivers.
Your child will also be monitored closely with routine studies and tests, such as:
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An ultrasound, performed either the day of or the day after surgery, to check blood flow in and out of the liver
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Chest X-rays to assess your child's lungs
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Blood tests, done daily throughout the hospital stay, primarily to check for elevated enzyme levels, which can indicate rejection or bile duct problems
Once your child is medically stable and doesn't require frequent monitoring, she'll be transferred from the PICU to a surgical unit, where nurses will continue to care for her and assess her recovery.
Find out more about the PICU at CHOP.
Reviewed by: Elizabeth B. Rand, MD
Date: November 2012
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