Device Closure Procedure
When the procedure is complete, the catheter(s) will be withdrawn. Several gauze pads and a large piece of medical tape will be placed on the site where the catheter was inserted to prevent bleeding. In some cases, a small, flat weight or sandbag may be used to help keep pressure on the catheterization site and decrease the chance of bleeding. If blood vessels in the leg were used, your child will be told to keep the leg straight for a few hours after the procedure to minimize the chance of bleeding at the catheterization site.
Your child will be taken to a unit in the hospital where he or she will be monitored by nursing staff for several hours after the test. The length of time it takes for your child to wake up after the procedure will depend on the type of medicine given to your child for relaxation prior to the test, and also on your child's reaction to the medication.
After the procedure, your child's nurse will monitor the pulses and skin temperature in the leg or arm that was used for the procedure.
Your child may be able to go home after a specified period of time, providing he or she does not need further treatment or monitoring. You will receive written instructions regarding care of the catheterization site, bathing, activity restrictions and any new medications your child may need to take at home.
In most cases, children will spend time in the intensive care unit (ICU) for several hours, or overnight after an ASD repair. During the first several hours after surgery, your child will most likely be drowsy from the anesthesia that was used during the operation and from medications given to relax him or her and to help with pain. As time goes by, your child will become more alert.
While your child is in the ICU, special equipment will be used to help him or her recover and may include the following:
- Ventilator. A machine that helps your child breathe while he or she is under anesthesia during the operation. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while he or she is too sleepy to breathe effectively on his or her own. Many children have the ventilator tube removed right after surgery but some other children will benefit from remaining on the ventilator for a few hours afterwards or overnight so they can rest.
- Intravenous (IV) catheters. Small, plastic tubes inserted through the skin into blood vessels to provide IV fluids and important medications that help your child recover from the operation.
- Arterial line. A specialized IV placed in the wrist or other area of the body where a pulse can be felt that measures blood pressure continuously during surgery and while your child is in the ICU.
- Nasogastric (NG) tube. A small, flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery.
- Urinary catheter. A small, flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. After surgery, the heart will be a little weaker than it was before; the body may start to hold onto fluid, causing swelling and puffiness. Diuretics may be given to help the kidneys remove excess fluids from the body.
- Chest tube. A drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding may occur for several hours or even a few days after surgery.
- Heart monitor. A machine that constantly displays a picture of your child's heart rhythm and monitors heart rate, arterial blood pressure and other values.
Your child may need other equipment, not mentioned here, to provide support while in the ICU or afterwards. The hospital staff will explain all of the necessary equipment to you.
Your child will be kept as comfortable as possible with several different medications; some of which relieve pain and some of which relieve anxiety. The staff may also ask for your input as to how best to soothe and comfort your child.
After discharge from the ICU, your child will recuperate on another hospital unit for a few days before going home. You will learn how to care for your child at home before your child is discharged. Your child may need to take medications for a while and these will be explained to you. The staff will provide instructions regarding medications, activity limitations and follow-up appointments before your child is discharged.