Post cardiac surgery discharge information - CHW

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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When your child is discharged from hospital you will be given nursing and medical discharge summaries. If the medical discharge summary is not available when you leave, it will be posted to you in the mail. A copy will also be sent to your general practitioner (GP).

Follow-up appointments

Your child will be given follow-up appointments with your child's surgeon and cardiologist about 2 weeks after discharge. Before your follow-up visit to the surgeon, your child will need a chest x-ray. You will be given an     x-ray form together with the appointment cards before being discharged.

Medications

Your child may need medicines for a few weeks or sometimes longer, depending on his or her heart condition and the type of surgery they have had. Your child's cardiologist or surgeon may adjust or stop the medication in follow-up visits.

During your hospital stay the nurses will give you instructions on how to give medications to your child. The more comfortable you feel about giving medications to your child while you are in hospital, the easier it will be at home.

The Hospital Pharmacy will provide a small supply of medications free of charge. Any medications that are not readily available at your local pharmacy may be purchased at the Hospital Pharmacy for a standard fee. You will be given a prescription for the CHW Pharmacy and a separate prescription for your local pharmacy.

Wound care

Your child’s dressing will be removed before he or she is discharged, unless otherwise instructed.  It is okay to clean the wound briefly and gently in the shower, but it is best not to immerse or soak it in the bath (or go swimming) until after your follow-up appointment with your child's surgeon. Please contact the Cardiac Clinical Nurse Consultant (CNC) if you notice any redness, swelling or oozing.

The scar will fade with time. Once you are home you can wash the wound gently and pat dry. Avoid using harsh soaps. At your follow-up appointment, about two weeks after discharge, your child's surgeon will advise you about using moisturisers and ointments.

The breast bone takes about six weeks to mend. Your child should not play contact sports or be lifted from under the arms during this time. Normal activities can start again after six weeks, unless advised otherwise.

Sun exposure can slow the healing of your child’s scars. Protect your child’s scars from direct sunlight for as long as the scar looks pink and raised. It will eventually go back to their normal skin colour.

Activity

It is a good idea to keep strenuous exercise to a minimum in the two weeks after discharge. A rest during the day can also be helpful.

Normal activities can usually start again after the follow-up with your child's cardiologist, unless he or she tells you otherwise. If you have any questions about contact sport, check at your follow-up appointments.

For babies who have already had tummy-time before the operation, this can be resumed seven days after discharge. For babies who have not yet had tummy-time, it is usually okay to start this after the surgical follow-up appointment, but please check with your child's surgeon.

Diet

Your child may eat and drink as usual, unless a different plan has been provided. If a dietitian has helped with your child’s feeding in hospital, it is important to follow this routine at home.

Encourage a healthy, balanced diet that promotes healing and recovery, including fruit, vegetables, meat and dairy products. Continue a nutritious diet throughout their childhood, as this will assist in healthy growth and development.

It is important to watch your child for signs of dehydration. Call the Clinical Nurse Consultant (CNC) if you notice less wet nappies, urinating less or a darker colour, dry mouth or sunken fontanelle (the soft spot on your baby’s head).

Remember to give your child extra drinks on hot days or when he or she has been very active.

School

It is best not to let your child return to school or childcare until after the first post-operative follow-up visit. Your child's surgeon should give you an idea then of when normal activities can be resumed. In most cases your child should be able to return to school four to six weeks after their operation. If a medical certificate is required, please ask your doctor or nurse before discharge.

Immunisation

If your child is due for immunisations, it is better to wait until after the follow-up appointments. Vaccinations may cause a reaction that can be confusing when trying to determine if an illness is due to the surgery, or the side-effects of the vaccine.

Speak to your cardiologist to discuss when to give your child their next vaccination dose.

Current recommendations suggest delaying the measles, mumps, rubella (MMR) or varicella vaccines for six months following cardiac surgery. If your child is due for these vaccinations, please speak to your bedside nurse or the Cardiac CNC before leaving the hospital.

Dental care

It may seem strange, but many of the germs in our mouths are the germs that can cause infections in our hearts. It is important to encourage your child to brush their teeth at least twice every day and have regular dental check ups.

Some children with heart conditions will need oral antibiotic medication before and/or after dental procedures. This is known as 'endocarditis precautions'. Please ask your child's cardiologist whether your child needs these precautions.

The first few weeks at home

The operation and hospital stay may have been stressful for your child and your family. You may notice changes in your child's feelings and behaviours. During this time you need to support and reassure your child. Everything should be back to normal in a few weeks.

Complications can occur after you return home.  Some warning signs of illness are:

  • fever above 37.5 degrees centigrade
  • vomiting
  • increasing loss of appetite
  • lethargy/weakness
  • abdominal pain/back pain/shoulder pain
  • increasing breathlessness
  • dry cough
  • redness/pus/excessive pain at incision site

What to do if you are worried

If any of these develop or if you have any other concerns, please call the Hospital and ask to speak to the Cardiac CNC, or if after-hours, the cardiac fellow on-call.

You can also take your child to the Emergency Department at your closest hospital. Inform the emergency doctor and nurse that your child has had recent heart surgery. Give the admitting doctor or nurse a copy of the medical discharge summary.

If you see your GP or go to another hospital, it is important to let the Cardiac CNC know, especially in the first few weeks after surgery. Please call the Cardiac CNC (phone number listed below) during business hours, or the ward after hours.

If your child looks very sick you should call an ambulance to take your child to the nearest hospital.

Emotional and developmental support

Our psychologists at the Heart Centre for Children specialise in providing emotional care for babies, children and young people with heart disease, and their parents, siblings and grandparents. This includes helping children and young people to cope emotionally with all the different thoughts and feelings they may have about themselves, their heart condition, and their treatment. It also includes helping parents and families to cope with their thoughts and feelings about all that has happened since the time of diagnosis. To talk with one of the Heart Centre psychologists use the phone number listed below.

Phone numbers:

Cardiac Clinical Nurse Consultant:             (02) 9845 2345

Cardiac Department:                                  (02) 9845 2345
(Monday to Friday 8.30am – 5pm)

Edgar Stephen Ward:                                  (02) 9845 1133

Cardiac Psychologists:                                (02) 9845 0088.

The Children’s Hospital at Westmead          (02) 9845 0000
(Switchboard)

Additional information can be found at
www.heartcentreforchildren.com.au
or by calling us on                                     (02) 9845 2345.

Remember:

On discharge your child will receive a number of forms. Keeping all of your child’s medical documents together will help make the weeks following discharge easier. Your child will receive:

  • Medical and nursing discharge summaries
  • Follow up appointments with your child’s surgeon and cardiologist.
  • Chest X-ray request form
  • Prescriptions for both the CHW Hospital Pharmacy and your local Pharmacy. 
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