After a Heart Transplant, the Intensive Care Unit (ICU) can be a very intimidating and overwhelming place. It is bright, loud and busy. It may help if you know what to expect in ICU after your transplant.
What To Expect In ICU After A Heart Transplant
The Intensive Care Unit Post Transplant
The Intensive Care Unit (ICU) is designed to provide the highest level of 24 hour care and monitoring for patients who need it most. As a heart transplant patient you will be in ICU for a number of days. The specialised medical staff in the ICU ensure that each transplant patient receives the best possible care and attention.
If you have any questions or concerns, don’t hesitate to ask the ICU staff for clarification or guidance. They are there to help you and your loved ones navigate this challenging time and provide you with the necessary information and reassurance. The ICU team is there to support and care for you every step of the way.
What is it like in ICU?
For patients and their loved ones, it’s completely normal to feel overwhelmed or anxious in such an intimidating environment. The many beeping machines, post surgery drips, drains, tubing, and unfamiliar surroundings can be a lot to take in.
It is bright, loud and busy. You will feel like you are always being watched. ICU is like being on display at the zoo. There is a cast of dozens of people around you all the time.
What Do You Need To Take To ICU?
After you have had the transplant surgery you are moved to the ICU. You may be in ICU for 4 to 7 days, however, I do know of heart/lung transplant recipients who have spent up to 3 months in ICU. This is very rare. Everyone is different.
You do not need to take much with you into ICU. The first few days you will be bed-bound and in a hospital gown. As much as I love to wear my own PJs in hospital it is more practical to wear the hospital gown in ICU as your wounds will bleed and may stain your clothing. The gown is easier to get on and off while you are still attached to drains and IV lines.
Vital items you will need in ICU would be a toothbrush and toothpaste, Face and body moisturiser, lip balm, comb or brush, mobile and charger, headphones/iPods (or similar) and charger.
As you start to recover over the next 3 or 4 days after transplant surgery, you might want your family to bring in more necessities. For a full list of what you need after a Heart/Lung Transplant see the post:
ICU After Transplant Surgery
After the Heart Transplant Surgery you and your new organ will be supported by the use of a ventilator, central venous line, chest drains, pacing box and wires, urine catheter in order to support your body’s functioning during a critical time. These devices are helping to keep you alive and on the path to recovery.
ICU staff will remove these supports one by one as you get stronger and able to thrive without them. Everyone’s recovery rate is different, particularly just after surgery. There is no set time for the removal of these supports. I can only provide a loose guide as to when these will be removed based on my experience and other patients I have heard from.
Waking Up In ICU After A Heart Transplant
When you wake up after a Heart/Lung Transplant you will be heavily sedated to prevent you being overwhelmed and to assist you feel more comfortable and pain free.
Ventilator
You may still be on a ventilator, which is a machine that supplies oxygen and assists you to breath. It is attached to a breathing tube inserted in your throat to assist you to breath. ICU staff will increase your IV sedation while they remove this. I do not remember the ventilator tube being removed. The ventilator was removed on Day 2 after my transplant.
Central Venous Line (CVL)
The Central Venous Line (CVL) is an IV (Intravenous Line) placed into your jugular vein in your neck. This CVL delivers multiple medications directly into your heart and circulatory system. The CVL will be removed once your new organ has recovered from the surgery. The CVL was removed on day 3 after my heart transplant.
Chest Drains
The chest drains act to remove trapped air and fluid from the chest cavity and around the heart and lungs. These drains are removed when there is less fluid draining into the collection bottle/bag. The chest drains were removed after I had been moved to a hospital ward around day 6 post transplant.
Removing the Chest Drains
The nurses will get you to lie on your bed and will walk you through a breathing pattern you need to follow. Essentially the nurses will ask you to breathe deeply 3 to 4 times and then on the last breath exhale fully and hold your breath and bare down into your stomach. At this point the drain is removed. This breathing technique prevents air being sucked back into the chest cavity as the drain is removed. You will need to stay in bed lying down flat for a set period of time. I found this time limit varied depending on different hospital protocols.
This breathing technique is also used when you have PICC lines and CVL removed. A peripherally inserted central catheter (PICC), is a long, thin tube inserted through a vein in your upper arm close to your armpit and passed through to the larger veins near your heart. A PICC also delivers multiple medications directly to your heart. In total I have had 3 PICC lines, 3 CVL, 11 Arterial Lines and 4 drains throughout 11 cardiac/lung surgeries.
Arterial Line
An arterial line is a thin, flexible tube placed into an artery, usually in the wrist. It constantly monitors your blood pressure and can be accessed to take blood samples to prevent regular blood tests being done using your veins. You will have daily blood tests so remember to ask pathology /blood collection staff to use your PICC, CVL or Arterial Line for all blood tests.
You need to protect your peripheral veins from scar tissue. Peripheral veins are the veins close to the surface that can sometimes be seen in your hands or inside elbow for example. The peripheral veins move up to two-thirds of the total blood volume around your body. They are often used for blood samples, IV injections/fluids or to accept or donate blood. This is due to the peripheral veins’ ability to do all of these things with relatively little change in their pressure.
Removing the Arterial Line
Removing the Arterial Line is similar to the removal of a cannula. The nurse will remove the bandage to free up the arterial line cannula. Once it is removed the nurse will apply pressure to the site for 5 to 10 minutes to prevent the artery from bleeding. After my transplant the arterial line was removed on day 2 or 3, I was very sedated at the time.
Protecting Your Veins
Scar tissue means it is harder to use those veins for future cannulation and routine blood tests. After so many surgeries and procedures, I have been told by 5 anaesthetists to protect my peripheral veins in this way. At times I have had to be assertive and direct as pathologists and nurses are busy and want to get things done quickly. I completely understand and respect this, I get it. However, once I respectfully explained my predicament all staff were happy to oblige. As collectors and nurses came to know me it became second nature for them. Do not be shy in asking for similar care.
The Pacing Box and Wires
After a heart transplant your heart is no longer connected to your brain as the Vagus Nerve has been cut during the heart transplant surgery. The pacing box will set your heart rate to a selected set beat. The 2 pacing wires are inserted below your chest under the rib cage.
These wires can be used to jumpstart your heart or correct arrhythmias and pace your heart beat. Before removing the pacing wires, a cardiac ultrasound is done first to ensure there is no extra fluid around the heart or lungs and that the heart/lungs look good. I found these wires were one of the last things to be removed and that was on Day 12, the day I left hospital post transplant.
Indwelling Catheter
An Indwelling Catheter is a catheter which is inserted into the bladder, via the urethra. Its purpose is to drain urine into a collection vessel/bottle. Post transplant you will be too weak to get out of bed. This Indwelling Catheter prevents you needing to go to the toilet or needing a bedpan. I asked for the catheter to be removed on day 6 as I found it irritating to the urethra as well as the container being heavy and awkward to carry around once I was able to get out of bed for physiotherapy sessions and bathroom visits.
I asked a nurse to remove the catheter which made things far more comfortable and easier when moving. Be aware that you will be asked to do a urinary sample for testing infections and ensure your bladder and urethra are all functioning normally.
Depending on your personal journey you may have other procedures and apparatus attached to you or in use to support you after an organ transplant. Please leave a message in the form below if you have an ICU story or feedback to share.
I am very aware that this all sounds like such a daunting process, however, I am forever grateful that I have been given a precious second chance at life. Despite it all, I would do it again. As my Nan would say “It’s better than pushing up daisies”. Yes Nan it is!!
As always your transplant Hospital will give you many online resources to refer to. My favourite sites include: SVH Heart Health and Heart Transplant @Transplant Australia. I will always encourage you to research and read as much about what to expect in the transplant journey.
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