Surgical Intensive Care Unit
For the first 24 hours after your surgery, you will be in the SICU. You may stay longer, depending upon your progress. Here a team of specially trained physicians, nurses, respiratory therapists and others will provide constant care and monitoring. You can expect some of the following as you wake up:
- You may hear unfamiliar sounds, such as machinery to monitor your heartbeat, blood pressure and breathing.
- When you first wake up, you will have a "breathing tube" in your throat. You will not be able to speak. Please remember that the nurses are experts at communicating with patients who cannot talk, and finding out exactly what you need.
- You will be either asleep or very drowsy during most of your stay in intensive care. When you do wake up, you may find soft restraints on your arms and legs. Sometimes, you move around without knowing it as you are waking up. The restraints are there to keep you safe and to make sure the tubes and lines stay in place. Once you are more fully awake, the nurses will remove the restraints and ask you to move your arms and legs around on your own. Your ability to do so will help us check your recovery from anesthesia.
- Some medications may make you very sensitive to the noises around you.
- You might feel nauseated from the anesthesia. Your nurse will give you medication for relief.
- Medication can also help relieve any pain or discomfort you feel from the surgery.
- Nurses will check the dressing on your incision frequently and change it as needed. It is not unusual for fluids to drain from your incision for some time after your operation.
- You will also find thick stockings on your legs. These stockings are used to help your circulation.
- Doctors and nurses in the SICU will continuously monitor how well your new organ is functioning by taking blood tests, measuring and testing the fluids your body produces, and using other testing methods such as X-rays when necessary.
Many of the tubes, intravenous lines, monitoring devices and drains that the transplant team put in while you were under anesthesia will still be in place after the surgery. Here is a little more information about some of them.
The Breathing Tube
Called an endotracheal or "ET" tube, this tube is in your throat and attached to the respirator to help you breathe during surgery. It is typically removed the day after surgery once you are awake, alert, and strong enough to breathe on your own. The nurses will give you pain medications and sedation to help keep you comfortable while the ET tube is in place.
While the tube is in place, a suction device will remove fluid from your mouth and the tube frequently. You will not be able to speak with this tube is in place, but your nurse can help you communicate. You can also "talk" with loved ones by blinking your eyes once for "yes" and twice for "no." Try to relax and let the respirator do the work for you. That way you will conserve energy and feel more comfortable. Remember the tube is temporary and necessary for your recovery.
Your caregivers will remove the tube when the anesthesia has worn off completely and your lungs can function on their own - usually within 24 to 48 hours after surgery. We determine when you are ready to breathe on your own by taking a chest X-ray, by measuring oxygen levels in your blood, and by measuring your breathing strength.
After we remove the tube, you may have a mild sore throat, which goes away in a day or two. You will be given oxygen through a small tube that goes in your nostril or via a mask. You will learn how to support your incision with your hand or a pillow to make coughing more comfortable. Respiratory therapists and your nurses will help you keep your lungs clear by encouraging you to cough, breathe deeply, and with chest therapy (that is, gently tapping your chest and back), and with an incentive spirometer, a device to help you breathe deeply. We take all of these precautions to prevent fluid and secretions from collecting in your lungs, which can cause lung infection or pneumonia.
Intravenous Lines (IV)
The IV lines may remain in place for most of your hospital stay. Some of the specialized lines placed in surgery will be removed before you are discharged from the SICU. Regular IV lines allow us to draw blood for tests, administer any medications that you may need during recovery, and provide you with fluids to promote blood circulation. They also help assess heart and lung function.
You will usually have two tubes or drains going into your abdomen attached to small suction bulbs that collect excess fluid from around your new liver. The drains are usually removed before you are discharged but occasionally will remain in place longer.
The Bladder Catheter
Also called a Foley catheter, this tube will be placed in your bladder during surgery to drain your urine, and will be in place when you awaken. Your nurse will remove it a few days after the surgery.
The Foley catheter allows staff to monitor your urine output every hour to determine how well your kidneys are working and how much intravenous fluid you need.
The EKG/Telemetry Leads
EKG leads used to monitor your heart will remain in place when you leave the SICU. They will remain in place several days after surgery.
T-tube or Roux-en-Y Tube
There may be a small tube going into your bile duct called a T-tube that will drain bile for several days. An X-ray of your bile duct will be obtained 5 to 7 days after your transplant to be sure the bile duct has healed normally. If this X-ray, called a cholangiogram, is normal then the T-tube is capped off. The T-tube stays in for 4 months until the bile duct is well healed. If your bile duct is attached to a loop of intestine called a Roux-en-Y, then a small tube will also come out of your abdomen. This is also in the bile duct and remains in place for 3 to 4 months at which time a cholangiogram is obtained to be sure the duct has healed.