Home Care Instructions following Cardiothoracic Surgery

INCISION CARE:

• Your child should bathe or shower daily. If your child showers, do not let the water spray directly on the incision. Dry the incision well after bathing. Please do not use lotion or powder on the incisions.
  • If your child takes tub baths, do not let them lie back in the water or soak the incision for 14 days. Bath water is
  • considered “dirty.”
  • Keep the bath water shallow, at the level of the hips or below.
• Inspect the incision every day for signs of infection such as drainage, swelling and/or redness. Call your doctor immediately if you see any signs of infection.
• If you see a clear stitch working its way out of the incision, call the cardiac surgery office for an appointment.
• Do not let the incision get direct sunlight for one year after your child’s operation. After the incision has healed, apply sun block, SPF #25-#30, to the scar when your child is out in the sun. 
• Keep fingernails short and clean. 

DIET:

• Your child’s appetite may be poor when they first return home, but it will improve with time. Offer small frequent meals. Make sure they drink plenty of fluid.
• Limit the amount of salty foods (potato chips, pretzels, pizza, hot dogs, ham, pork, French fries, sausage) you give your child. Please do not add any salt to food. Limit soft drinks that contain sodium.
• Give a well balanced diet including milk products, meats, fruits, vegetables and bread.
• Any special diets will be discussed with you before discharge.

MEDICATIONS:

You will receive a list of your child’s medications/medication instruction sheets prior to discharge. Please follow the instructions closely. Call the surgery office if you have questions.

ACTIVITY:

• Do not take your infant or child to crowded places such as church, grocery store, or the mall for up to two weeks after surgery.
• It is safe for your child to wear a seat belt and sit in the back seat of the car. If your child is an infant, it is safe to use his usual car seat.
• Hand washing is important to prevent infections. For the first four weeks after surgery, make sure every person who visits or touches your infant or child washes their hands. This includes family members.

Activity Instructions for Children

• Your child may be tired for a couple of weeks after the operation and may need to rest during the day. However, your child should want to get out of bed for quiet play every day. Notify the doctor if your child does not get out of bed.
• Scoop your child up under the bottom rather than lifting them under the arms. Although the skin usually heals in 2 weeks, the chest bone takes 6 weeks to heal.
• No swimming for six weeks after the operation, or until the incision is completely healed.
• No gym class or sports for six weeks after the operation. Examples of other strenuous activity to be avoided until cleared by Cardiology:
  • Bike riding, rollerblading, skateboarding, surfing
  • Swinging
  • Wrestling, running, jumping, rough play
  • Playing on monkey bars
  • Wrestling
  • Pulling or swinging from the arms
• No wearing backpacks or carrying book bags for 6 weeks after the operation. Your child might need 2 sets of books, one at school and one at home, for 6 weeks.
• No driving 4-6 weeks.
• No lifting over 5 pounds for 6 weeks. No heavy weight lifting for 6-8 weeks.
• No contact sports such as football, basketball, hockey, or wrestling until cleared by Cardiology. 

Activity Instructions for Infants

• Do NOT lift baby by pulling on their arms.
• Do NOT lift baby from under their armpits.
• DO lift baby with a scoop lift – holding them under the buttocks and his upper back.
• It is safe to hold your baby chest-to-chest with their head supported on your shoulder. It is also safe to burp or pat your baby in this position.
• Baby can have tummy time while awake if tolerated. If baby seems to have pain while on tummy, stop tummy time for 2 or 3 days, and then try again.
• It is safe for your baby to roll from front to back or to crawl. He will not do this on his own if it is painful for them.
• Baby can lie on their side while awake if tolerated. If baby seems to have pain while in this position, stop side-lying time for 2-3 days, and then try again.
• All babies less than one-year old should be placed on their backs to sleep. This decreases the risk of sudden infant death syndrome. Your nurse will give you a pamphlet about safe sleeping.
• Your baby may sit up with your hands at their chest for balance.
• If your baby’s shoulder muscles are tense, you can gently lift one arm at a time to move it far enough to maintain motion.
  • Do not lift your baby’s arm above shoulder level.
  • It is OK if your baby raises their own arms above shoulder level. They will not do this if it causes pain.

SCHOOL/WORK:

The surgeon will tell you when it is safe for you or your child to return to school or work (usually after the follow-up visit). 

WHEN TO CALL THE DOCTOR:

If your child has:

• Fever of 101 0 F (38.3 0 C) or higher. (It is not necessary to check for fever unless your child seems sick or feels warm to touch.)
• Poor feeding
• Frequent vomiting or diarrhea
• Excessive sleepiness (lethargy), tiredness, loss of energy
• Shortness of breath, fast breathing, noisy breathing or difficulty breathing
• Persistent cough
• Color change (pale, bluish)
• Fast heart beat
• Increased chest pain
• Signs of infection along the incision (redness, swelling and/or discharge)
• Excessive sweating
• Swelling of the feet, hands or around the eyes
• Irritable, crying for long periods of time, or more complaints of pain
• If you have any questions or concerns about your child

COUGHING AND DEEP BREATHING:

Encourage your child to cough and deep breathe several times a day for one week after the operation. They may have fun deep breathing by blowing bubbles through a straw in a glass of water or blowing store-bought bubbles.

EMOTIONAL BEHAVIOR:

• As a result of this hospitalization and surgery, your child may act like they did when younger. This can be normal and can be due to stress.
• Toilet habits: Your child may wet the bed or soil their pants. Please do not punish your child. It should get better within several weeks. If it continues, call your pediatrician so your child can be examined.
• Nightmares: Your child may awaken during nap time/at night crying or upset. Hold and reassure your child that they are home and safe. Nightmares usually resolve in about two weeks after discharge.
• Demanding: Your child may be more demanding or may be more dependent on caregivers than before surgery. Give your child love and affection, but continue to set limits.

IMMUNIZATIONS:

• Immunizations should not be given for 6 weeks after surgery if your child was on the heart-lung machine (also called “bypass” machine) during his/her operation. Required immunizations may be given any
  time, as recommended by your child’s doctor, if the heart-lung machine was not needed.
• If your child had blood product transfusions, the following vaccines should not be given for 7 months after surgery:
  • Measles/Mumps/Rubella (MMR)
  • Varicella (chicken pox)
• RSV shots (Synagis) may be given any time after surgery as recommended by your child’s doctor.

SUB-ACUTE BACTERIAL ENDOCARDITIS PROPHYLAXIS (SBE Prevention):

Your child may need to take antibiotics to prevent infection of structures of the heart (SBE prophylaxis) before they have certain medical, surgical or dental procedures. This antibiotic protection may be needed for 6 months or longer after surgery. 

We will include all the information about immunizations and SBE prophylaxis in our letter to your doctor.

FOLLOW UP APPOINTMENTS:

• Cardiology follow-up: 1 week after discharge.
• (Your child will have a chest x-ray before seeing the doctor.)
• Pediatrician follow-up: 3-4 weeks after discharge for routine care