S.I.C.U/Post Operative Stay

The information presented here has been developed to help you cope with your stay in the surgical intensive care unit – SICU. After reading the material, hopefully you and your family will feel less stress about your immediate post operative period. It will prepare you for the routines and introduce you to the equipment.


SICU – Surgical Intensive Care Unit

For the first 12 hours after your transplant, there are 2 (two) nurses assigned to your care. This is a very busy time, so visiting will be kept short and may be less frequent than later on. After the first 12 hours, when you become more stable, you will then have one special nurse assigned to your care.

Cardiac Monitoring and Blood Pressure Monitoring

On your return from the O.R. (Operating Room), you will be connected to various machines which help monitor your condition.

A cardiac monitor or ECG machine is used so we can watch your heart rate and rhythm. There is a screen to show the waveform and a number display. A cable from this machine, which has three smaller cables is attached to your chest. There are also some beeps and buzzers that will go off from time to time.

Your blood pressure is also monitored and shown on the screen. There will be an arterial line, like an intravenous line, in your wrist. It will have a dressing on it and will be securely taped in place. There is another purpose for the arterial line. The line has a port where blood can be obtained. This way we don’t have to puncture the skin every time a blood specimen is needed. These blood specimens are needed regularly so we can keep a close watch on how your liver is functioning.


Ventilator and Ventilatory Care

Initially, you will also have a tube through your mouth and in your throat. This is an endotracheal tube. Connected to this is more tubing from a machine called a ventilator. The ventilator breathes for you during surgery and for at least your first and possibly second post-operative day.
At first, the ventilator will do all the breathing. Then, as your condition improves, you will start do so some of the work of breathing. When the doctors feel you can manage, the tube will be removed. You will have to wear a face mask for extra oxygen at this time.

While you are attached to the ventilator you will not be able to clear your lungs of any fluid or mucus. Therefore, it is necessary for the nurse to SUCTION the secretions for you.


Means of Communication

While the endotracheal tube is in place, you will not be able to talk, drin, or eat. The nurses in the SICU have developed many ways to help with communication. Hand signals are used, and we also have special letter boards. When you are well enough, you can write notes. Patience is needed during this time.


Nasogastric Tube

As already mentioned, you will not be able to eat or drink at first. To keep you more comfortable, there will be another tube through your nose, which empties your stomach. This tube is called a nasogastric tube. It is important because it can prevent nausea and vomiting. The nasogastric tube will be removed later in your recovery period.


Incision Site

Your abdomen will be very sore po-operatively because of the large incision made for the transplant. It is held together with sutures or staples, which are removed after healing has taken place (usually two weeks). Over the incision there will be a large dressing which the nurse will change as necessary. You will also have two smaller incision sites – one at the groin and the other under the armpit. Movement will be painful because of the incisions. The nurse will give you pain medication to keep you comfortable. Movement is important: 1) to protect your skin from pressure sores and 2) to help keep your lungs clear.


Jackson-Pratt and T-tube

There will also be some small tubes exiting from the abdomen. Three small tubes called Jackson-Pratt drains, or J.P.’s. are connected to suction bulbs to drain excess fluid from around the operative site, where the new liver sits. As you recover and the excess fluid is removed, the tubes will be removed.

A small bag will also be present. It is called a bile bag, and is connected to a T-tube which sits in the common bile duct. Bile production is important and the collection of bile and its testing helps us determine liver function.


Foley Catheter

In your immediate post-operative period, keeping track of fluid intake and output is critical. To accurately measure your urine output, a foley catheter is necessary. It will be inserted in the O.R. when you are asleep.


Intravenous Lines

Last but not least, you will have intravenous lines – IV’s – in various areas of the body. They are needed for medications and other special functions. Sometimes there is a line in your neck or upper shoulder area. These are called CENTRAL LINES. Through these sites, there is sometimes passed a special line which gives us valuable information about your heart and fluid status. Other IV lines are used to give you fluids until you can take them orally. They are also used for the administration of the special drugs needed post transplantation. Sometimes they are on special pumps which control exact amounts and drip rate.

Some IV’s are also located in your arms. As your condition improves, the IV lines will gradually be removed.

As you can see, your movement will be very limited while you are in the SICU on all this equipment. However, it is important to rmember that this is usually a very short portion of your stay in hospital. The nurses and hospital assistants will be available to assist your movements while in the SICU.


Personnel

Not only will there be unfamiliar equipment in SICU, there will also be new faces. During your stay in SICU there will be many people concerned with your recovery.

Nurses, doctors, and the liver transplant team are but three of many groups. You will also be attended by pharmacists, lab. Technicians, physiotherapists, x-ray technicians, respiratory technologists, and many others. All are important members of the team, there to help you through this part of your post-operative stay.


Post-operative Care

In the initial 24 hours on the transplant unit, you will be nursed 1:1. In this period, your nurse will be paying careful attention to our drains, medications, and general well-being.

During your stay here “self-care” is promoted for optimal well-being. Our goal is to have you knowledgeable about your transplant, post-operative care, and discharge. Family involvement is encouraged.

Visiting is promoted throughout your stay. It is our desire that your family/friends feel as comfortable about the transplant as you. They will play a very important role as you recover at home and prepare to resume the lifestyle you enjoyed prior to becoming sick.

When your progress allows, day passes or weekend passes are granted so that you and your family can get used to being away from the hospital. This helps to decrease anxiety when you are discharged.