The post-operative period

After the transplant surgery, your child will go directly to the Pediatric Intensive Care Unit. What you should expect during this time:

• Approximately one hour after arrival in the PICU, you will be able to visit.
• Your child will be on pain medications and strong sedatives to keep him or her comfortable. Additionally, he or she will have several IV's, special tubes in the abdomen (called JP drains), a catheter into the bladder, a tube through the nose into the stomach and a breathing tube in the mouth attached to a ventilator. The PICU nurse will explain the purpose of all monitors and tubes at your first visit.
• Before you see your child, you will be asked to wash your hands because hand washing is the most important way to protect your child from infection after transplant.
• The breathing tube will stay in place until your child is stronger and awake enough to breathe independently.
• Your child should be able to eat and drink within a few days after the breathing tube is removed.
• Your child will receive many IV medications while in the PICU. All of these medications will eventually be changed to oral doses when your child begins to eat and drink.
• A typical stay in the PICU is three days. This will vary depending on the severity of your child's illness prior to transplant.
• While in the PICU, your child will have a nurse constantly monitoring his or her status. The nurse will encourage you to participate in your child's care as much as possible.
• Visiting hours in the PICU are from 10 a.m. to 8:30 p.m. for friends and relatives, but parents and legal guardians may visit 24 hours a day. Due to the large amount of equipment and limited space in the room, we ask that only two people be at the bedside at a time.
• Anyone who has been exposed to communicable diseases or who is ill (cold, flu, etc.) is restricted from visiting, and we do not recommend that any child under the age of two years visit the PICU. We suggest that a sibling's first-time visit be coordinated with the bedside nurse to ensure each child is prepared for what he or she will see and hear. This also allows for planning quiet time with the patient during the visit. Due to limited space, we do not allow parents to sleep at the bedside. However, we have a parent/family waiting area where cots are provided.

When the transplant team feels your child is ready, he or she will be transferred to the transplant unit on the 6th floor. At this time:

• Your child should begin to eat a regular diet.
•  Most of your child's IV's and tubes will be removed within a week after transfer.
• The staff on the transplant unit and the liver transplant team will prepare your family for discharge, either to your home or to Kohl's House , the hospital's dedicated transplant residence facility nearby.
• Your child may go home with a PICC line—an IV designed for long term use—and the nurses on the transplant unit will teach you how to care for this line at home.

You will know your child is ready to go home when:

•  He or she is taking all medications by mouth and is eating and/or drinking enough to grow.
• The immunosupression levels are therapeutic.
• He or she has normal vital signs without fever.
• And, most important, your family is able to give the medications appropriately, provide all necessary care for your child independently, and clearly understand the signs and symptoms of rejection and infection, and who and when to call with any problems. 

Most local families will be ready to go home within two weeks. Families from out of town or from more than an hour away will stay at the Kohl's House nearby for three to four weeks after discharge from the hospital.