Post-Anesthesia Care Unit
Following the operation, you initially go to the post anesthesia care unit (PACU) where doctors and nurses monitor you very closely. (Some patients, who may need more intense observation, go to the surgical intensive care unit (SICU), although this is very unusual.) Here's some of what you can expect as you wake up:
- You may hear unfamiliar sounds, such as machinery to monitor your heartbeat, blood pressure and breathing.
- If you have a breathing tube in place, which is very unlikely, you will not be able to talk.
- 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 PACU 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.
- Typically patients are in the PACU for 4 to 12 hours. When you are stable, we will move you to Farr 10, our transplant unit, for the rest of your hospital stay.
More Information about Tubes, Drains, and Monitoring Devices
Many of the tubes, intravenous lines, monitoring devices and drains that the 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 usually removed in the operating room as you are waking up; you usually will not remember it being taken out because of the anesthetic medications. In some cases, however, it might be necessary to leave the tube in to help you breathe as you are waking up. If it is still in place when you wake up, the nurses will give you pain medications and sedation to help keep you comfortable.
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 8 to 24 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 and breathe deeply, and by using chest therapy (that is, gently tapping your chest and back), and 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. They 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 may have a drain placed in your abdomen that lies close to the pancreas. This allows any fluid that collects around the pancreas after the transplant to be removed. The drain is usually removed before you are discharged but occasionally will remain in place longer.
The Bladder Catheter
Also called a Foley catheter, this 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.
If you have had a combined pancreas and kidney transplant, the Foley catheter will allow staff to monitor your urine output every hour to determine how well your new kidney is working and how much intravenous fluid you need. It also helps keep the bladder from becoming too full, which promotes healing at the suture site, where the donor ureter is attached to your bladder.
The EKG/Telemetry Leads
When you leave the PACU, a nurse may remove the EKG leads used to monitor your heart.
Your surgeon may have placed a stent (tube) in your ureter to hold it open during healing if you have had a simultaneous pancreas/kidney transplant. If so, a urologist will remove the stent during an office visit about 4 to 5 weeks after surgery.