The intensive care unit – commonly called the ICU – is a floor or area of the hospital designed to care for children that require a lot of medical attention and support. The ICU is where your child will begin their recovery after cardiac surgery.

  1. Continuous monitor (Heart rate, oxygen saturation)
  2. Intravenous lines
  3. Endotracheal tube and Ventilator tubing
  4. Ventilator
  5. Chest tube and collection chamber
  6. Foley catheter
  7. Medication drips (via IV lines)

See additional equipment that you might find in the ICU

Nothing can prepare you to see your child for the first time after surgery or for the ups and downs that may happen in the ICU. Your child will have an incision in their chest and many tubes attached to give them medications and fluids, and to help them breathe and eat. Their heart rhythm and oxygen levels will be monitored every second of the day.

The ICU is a very intense environment that most people are not familiar with. Learning what to expect will help prepare you to support your child during the critical time they are recovering in the ICU.

Many people work together in the ICU to help your child through recovery. It may be difficult to get oriented when your child first arrives, but you will gradually become more familiar with the people and routines.

The care team knows that this can be a stressful and emotional time for your family. It’s okay to ask questions so that you understand what’s happening and feel comfortable with your child’s care. It’s important to talk with the care team about any concerns you have or changes that you notice in your child’s condition.

Basic Things to Know About the ICU

Good Hygiene Is a Priority

Preventing infection is a big focus in the ICU because the children are vulnerable while their bodies are trying to heal. To help keep the risk of infection low, you will be asked to wash or sanitize your hands every time you enter and leave the ICU. If you or a family member is sick, please stay home for the health of your child and the other patients.

It’s a Little Different at Every Hospital

At your hospital it may be called the ICU or PICU (Pediatric Intensive Care Unit), or there may be a separate CICU (Cardiac ICU) or CVICU (Cardiovascular Intensive Care Unit). In some hospitals there’s a cardiac ICU that only cares for children with heart problems, while other hospitals treat children with all conditions in one general pediatric ICU.

The Front Desk Can Always Help You

All ICUs have a front desk where someone greets you and can answer your general, non-medical questions. This includes rules like visiting hours, numbers of visitors, and bringing in outside food or personal items. If the front desk clerk cannot answer your question, they can direct you to a person who can.

It’s a Busy Place

An ICU can only run smoothly when a big team works together, because each person has a different focus or specialty. Medical professionals are constantly evaluating and providing care for all of the patients – sometimes this includes performing medical procedures. Patients are regularly arriving and leaving for surgeries and tests in other parts of the hospital.

What to Expect When Your Child Is in the ICU

  • There will be a lot of equipment

    The equipment continuously gives the care team real-time information about your child’s vital signs. This includes monitors to check their heart rhythm and oxygen levels, and machines like ventilators to deliver breathing support through a breathing tube or a facemask. Your child may also have IV pumps – which are machines that deliver medications or fluids – or a temporary feeding tube placed through their nose to their stomach. Some equipment removes fluids.

  • You can stay with your child most of the time

    Your nurse can show you how to comfort and hold your child while keeping the equipment clean and working safely. They will also tell you where to put personal belongings and the best place for you to sit and sleep. Children do occasionally have a medical procedure in their ICU room. If this happens, the team may ask you to temporarily leave so they can focus 100% on performing the procedure. This involves making the room a sterile environment to prevent infection.

  • The physicians do “rounds” every morning

    This is when the nurse, medical team, and other providers come into the room to review your child’s medical condition and discuss the care plan for the day. You should feel free to join and listen in. The team recognizes that you know your child best, and they want to hear your input. Rounds are a great time to ask questions, make sure that you understand the care plan, and to share any thoughts or concerns.

  • Your child will be closely watched

    Members of the care team will check on your child frequently day and night to give medications and treatments, and to adjust the equipment as needed. Nurses may check certain vital signs every hour, or even multiple times an hour. This helps the team anticipate any complications or changes in your child’s health. Your child may also have tests – like lab work and X-rays – done at their bedside.

  • There may be frequent alarms

    Most equipment has a built-in alarm to notify the care team of changes in your child’s vital signs or equipment issues. Often an alarm does not mean a medical emergency. Instead your child may simply need more nutrition through an IV or feeding tube, or more medicine to treat pain and keep them sedated while they heal from surgery.

  • The equipment and activities change over time

    As your child recovers, the team will gradually remove equipment that is no longer needed. Different types of therapists may help your child practice getting up and moving around or eating when they are well enough to do more activities.

  • The ICU is a temporary stop

    Your child is in the ICU because they need complex medical support. You should feel confident that everything your child needs for their medical care after surgery will be at their bedside. Many parents feel overwhelmed at times in the ICU. Remember this is an important but temporary place where your child can heal. After the ICU, most children move to acute care on their road to recovery.

Key Members of Your Child’s ICU Care Team

Learning how to communicate with your care team in the hospital is critical as you partner with these and other medical professionals to support your child’s recovery.

1. Nurses

A charge nurse is always on duty in the ICU to oversee the many types of nurses and the medical unit. A key member of the nursing team is the bedside nurse assigned to your child. They closely monitor your child, give medications, and communicate any issues with the rest of the ICU team. The bedside nurse also helps keep you generally informed about your child’s condition.

2. Physicians

The physician team cares for a group of patients. This team may include physicians, residents or fellows (physicians getting extra training in an area of medicine), and physician assistants. They are led by the attending physician, who is a physician with specialized training in ICU care or pediatric cardiology.

3. Surgeons

The surgical team may also visit your child in the ICU. This team may include surgeons, resident or fellow surgeons, physician assistants, and nurse practitioners. They may help manage your child’s surgical wounds, perform minor procedures at the bedside if needed, and discuss care with the medical team.

4. Other Medical Professionals

Many people work in the ICU. Respiratory therapists manage breathing equipment and provide respiratory treatments to help your child’s lungs recover after surgery. Your child may also have a dietician, social worker, physical therapists, pharmacist, and child life specialist, among other support.

PARENT TIPYou Are Essential to Your Child’s Recovery

The care team encourages parents to be at their child’s bedside. You are a source of familiarity and comfort for your child during this hard time. You know your child best and can help the team understand their needs and feelings.

Expect Ups and Downs in the ICU

There may be complications as your child recovers. This is common in the ICU, but it can be frustrating for you and your child. The ICU is designed to allow the team to identify changes quickly and respond as needed. Your ICU team is there to talk with you about any issues that arise – whether they are expected or unexpected, how they might change your hospital stay and child’s recovery, and how best to treat them.

FAQs

The team members change at regular intervals – called a shift change – to give the care team a break and ensure that they are alert to provide the best care possible. Many parents find this confusing because it makes it hard to learn what roles different members of the team have when they keep changing. The team understands this confusion. It is completely okay to ask a provider if they are a nurse or a physician, and what their role on the team is – even if you have met them before.

While every child’s needs are different after surgery, here’s a list of some things you commonly see in an ICU room.

  • Art-erial line (“Art line”): A type of IV line placed in an artery to monitor blood pressure and draw labs
  • Central line: A long-term IV where the tip ends by or in the heart
  • Endotracheal tube (Breathing tube): A tube placed in the windpipe, also called the trachea, and connected to the Ventilator to help with breathing
  • Foley catheter: A tube leading to the bladder to get urine out
  • Intravenous lines (“IV”): A small, flexible tube that sits in your vein to give fluids and medicines
  • Medication drips: Medicine that runs non-stop into the body through an IV
  • Nasogastric tubes (“NG/OG/ND/NJ”): A tube placed by a nurse or physician through the nose or mouth for short-term feeding. NG tubes end in the stomach. NDs and NJ tubes end in the small intestine past the stomach.
  • Peripherally inserted central catheter (“PICC line”): A type of IV that sits close to your heart placed by specially trained nurses to gives fluids or medicines for a longer time
  • Ventilator (“Vent”): A machine that helps with breathing

The bedside nurse or other members of the care team can explain or remind you what all the pieces of equipment are for and how they are helping your child. They can also show you how they are connected to your child.

Each day the care team will have certain goals for your child to meet before they can move on to the next step in recovery. For example, a first goal might be for your child to breathe on their own with minimal support from a machine. A next goal might be to gradually take your child off of pain medications. Understanding the care plan and recovery goals for your child can help you see the path out of the ICU. Be sure to celebrate the successes as your child meets big and small milestones in their recovery.

This is difficult to predict because every child’s situation is unique. Some children are in the ICU for a few days while others stay for several weeks or more. It can be challenging when you are managing uncertainty and not able to plan for the future.

Here are potential signs that your child may soon be able to leave the ICU:

  • Your child needs less help with breathing
  • Your child is on fewer IV medications
  • Your child’s condition is very stable and unchanging

Before surgery the care team may give you an idea of the recovery time based on your child’s age, heart condition, and the type of surgery. Some children recover quicker than expected. For other children, progress is slower and feels like “two steps forward, one step back.”

Your child’s body needs time to heal as they recover from surgery. Medical decisions will be made based on how your child’s body is healing. The physicians will not let your child leave the ICU until they feel confident that your child is stable and steadily improving.

Even outside of rounds, the team is always communicating with each other about change and progress that is happening. Feel confident that if your child’s condition changes throughout the day, the team will discuss and update the plan as needed. Your bedside nurse or another provider will update you as plans change. Always ask questions if you have them – the team expects and values your input.

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