What to Expect in the PCICU After Surgery

Almost all children will go to the Pediatric Cardiac Intensive Care Unit (PCICU) after their surgery, brought there by the anesthesia team. The PCICU team will receive a report and begin caring for your child. Typically the PCICU team will need about an hour before family members can come to a child’s bedside. This amount of time can vary depending on the complexity of the case and your child's medical status.

When you arrive at your child's bedside for the first time, they will likely still be under the effects of anesthesia. They will appear to be asleep.

Your child may look very puffy or swollen. This can happen because of several factors.

• Heart surgery is a very stimulating operation. The body's natural response is to release many substances that cause inflammation. This is a normal response that promotes healing, but it can result in swelling.
• Another cause is the amount of intravenous fluids and blood products given, especially if your child's surgery involved a heart-lung bypass machine.
• The swollen appearance tends to be more obvious in smaller children. How long this appearance remains varies, often depending on your childʼs clinical status.

You will see tubes and catheters that were put in place while your child was in the operating room. The anesthesia team will place an endotracheal tube into your child's trachea (windpipe) to allow normal breathing. Usually this tube is positioned in the mouth, but sometimes through the nose. The tube is attached to a ventilator (respirator), which is a breathing machine.

Your child will likely have an intravenous (IV) catheter placed, if they did not have one prior to entering the operating room. The IV may be inserted in your child’s arms, hands, feet, legs or neck, depending on where the anesthesia team was able to locate the best vein.

In order to monitor your childʼs blood pressure, the anesthesia team places a catheter into an artery (arterial line). The arteries most commonly used are the radial artery (on the thumb side of the wrist where you can feel your own pulse), the femoral artery (in the groin), the posterior tibial artery (in the foot), and the axillary artery (in the armpit). Occasionally if the anesthesia team is not able to place the arterial line, the surgeon will place it by making an incision to expose an artery (a cutdown).

Most children will also have a central line that the anesthesia team puts in, or a transthoracic catheter that the surgeon places. This catheter is placed in a "central vein" (one of the major veins in the body) or directly into a heart chamber in the case of the transthoracic catheter.

There are two uses for this catheter. It allows doctors to measure the pressure in the heart's upper chambers, giving valuable information about what fluids or medications may be given. It also provides a quick and safe route to give the medications and fluids. There are certain medications which can only be given this way. Central line placement is either in the internal jugular vein (on the side of the neck) or the subclavian vein (under the clavicle, or collarbone). They can also be placed in the femoral vein (in the groin area).

The surgeon will place chest tubes to drain fluids from the chest area where the surgery took place. Typically, children have between one and three chest tubes.

After most surgeries, the surgeon will also have placed pacing wires onto the heart. These thin blue wires coming out of the skin in the lower chest can provide an electrical stimulus to the heart if its own natural electrical system is not working after the operation.

Lastly, you will notice that your child will have a bladder catheter. It was put in place to drain urine during the operation.

We hope this information helps ease your concerns and prepares you for seeing your child following the heart procedure. Please feel free to ask your childʼs team members questions.