What to Expect

For the first 24 hours after your surgery, you will be in the SICU. You may stay longer, depending upon your progress. Here a team of specially trained physicians, nurses, respiratory therapists and others will provide constant care and monitoring. You can expect some of the following as you wake up:

You may hear unfamiliar sounds, such as machinery to monitor your heartbeat, blood pressure and breathing.
When you first wake up, you will have a "breathing tube" in your throat. You will not be able to speak. Please remember that the nurses are experts at communicating with patients who cannot talk, and finding out exactly what you need.
You will be either asleep or very drowsy during most of your stay in intensive care. When you do wake up, you may find soft restraints on your arms and legs. Sometimes, you move around without knowing it as you are waking up. The restraints are there to keep you safe and to make sure the tubes and lines stay in place. Once you are more fully awake, the nurses will remove the restraints and ask you to move your arms and legs around on your own. Your ability to do so will help us check your recovery from anesthesia.
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 SICU 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.

Many of the tubes, intravenous lines, monitoring devices and drains that the transplant 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 typically removed the day after surgery once you are awake, alert, and strong enough to breathe on your own. The nurses will give you pain medications and sedation to help keep you comfortable while the ET tube is in place.

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 24 to 48 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, breathe deeply, and with chest therapy (that is, gently tapping your chest and back), and with 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

Abdominal Drains

The Bladder Catheter

The EKG Telemetry Leads

T-tube or Roux-en-Y Tube

There may be a small tube going into your bile duct called a T-tube that will drain bile for several days. An X-ray of your bile duct will be obtained 5 to 7 days after your transplant to be sure the bile duct has healed normally. If this X-ray, called a cholangiogram, is normal then the T-tube is capped off. The T-tube stays in for 4 months until the bile duct is well healed. If your bile duct is attached to a loop of intestine called a Roux-en-Y, then a small tube will also come out of your abdomen. This is also in the bile duct and remains in place for 3 to 4 months at which time a cholangiogram is obtained to be sure the duct has healed.

Moving to Farr 10

Your Stay on Farr 10

Although recovery times vary from patient to patient, and complications are unpredictable, you can anticipate being in the surgical intensive care unit (SICU) for the first 24 hours following your surgery. Once you leave the SICU, you will move to Farr 10, our inpatient transplant unit for the rest of your hospital stay. You will learn how to care for yourself here so you will feel confident and comfortable when you are ready to go home.

Out of Bed You will be out of bed and walking with assistance by the second or third day after your operation. We will give you fluids to drink 48 to 72 hours after the surgery, and you can begin to eat solid foods when you can tolerate them. Barring any complications, you could go home from the hospital within 7 to 14 days.

While in the hospital, staff will: Order blood tests to be drawn at least once a day Take your temperature and blood pressure several times a day Weigh you every day Check your incision several times a day and change the dressing as needed Empty the catheter and drain bags Adjust your intravenous lines Help you learn about your medications; symptoms to watch for at home; specific diet requirements; and any needed post-op care Help you prepare in numerous ways to go home or to another facility, such as making sure you can bathe and walk by yourself, take your medications properly, change your dressing, and empty any drains

More about Your Daily Care While you are on the transplant unit, you will continue coughing and deep breathing exercises to keep your lungs clear of fluid. Your nurses will also encourage you to get out of bed and walk around your room and down the hall at least three times a day. Walking increases your blood circulation, helps relieve gas pains, and helps maintain your muscle tone.

Some people have trouble sleeping while in the hospital, and some people experience strange dreams that seem very real. Many transplant recipients also report memory problems after the surgery. These problems are temporary. Talk with your doctor if this persists or troubles you. Your appetite and energy level will not be the same as it was before the surgery. In general these will return to baseline within a few weeks of the transplant.

For a detailed, day-to-day description of your care on Farr 10, click here to download "A Guide to Your Daily Care."

Our Nursing Staff Our nurses at BIDMC are the heart and soul of patient care delivery. Nursing's dedication to compassionate care is one of the medical center's guiding strengths. Patients, peers and colleagues recognize our nurses for their valued expertise and proficiency.

Patient satisfaction surveys applaud nurses throughout the medical center, including those who are part of our Transplant Center, for their exemplary efforts in meeting patient needs.

Transplant Center nurse coordinators and nurses on staff in PACU, SICU and Farr 10 have extensive experience with the post-transplant patient. They are often the best resource for patients and families when there are questions regarding your care.

The transplant nurse coordinator will follow you during your evaluation and after transplant to ensure continuity of care.

Physical Therapy A physical therapist will visit you post-transplant, and may have seen you pre-transplant. Our therapists will help you regain your strength and teach you how to move about more comfortably.

Case Management Services Case managers constantly monitor your progress. They help develop a discharge plan, including decisions about whether you should move to a facility for rehabilitation or arrange for home care services. They work with you and your family to set up these and any additional services you might need.

Social Work Services A social worker will also see you, and perhaps your family, to help with coping strategies, home arrangements, and any other issues surrounding your transplant.