Inpatient Recovery & Farr Transplant Unit

Immediately after surgery, you receive rigorous monitoring. Where this takes place depends on the type of transplant you have. For example, after a liver transplant or a heart transplant, you initially receive care in a surgical intensive care unit (SICU). Immediate post-op care following a pancreas transplant or kidney transplant usually begins in the post anesthesia care unit (PACU). However, on rare occasions after a kidney transplant, we may have you stay in the SICU initially. Our staff cares for you and communicates with your loved ones to keep them informed.

In our post-op units, doctors and nurses monitor how well your new organ is working with blood and other tests. Occasionally, we rely on imaging tests, as well. If you have pain or nausea, we give you medicine to help. Nurses also check the dressing on your incision and change it as needed. It’s not unusual to have drainage from your incision for some time after surgery.

When you first wake up, you may hear many unfamiliar sounds. These come from machines that monitor your breathing, heartbeat and blood pressure. Sometimes the medications we give you make you more sensitive to noise. You are connected to a number of tubes and other equipment, as well.

Breathing Tube

We place a tube called an endotracheal (ET) tube in your throat during surgery. It’s attached to a respirator that helps you breathe. Usually, we remove your ET tube in the operating room as you begin to wake up. Sometimes, though, we keep it in place a while longer.

If the tube is still there when you awaken, you won’t be able to talk. However, your nurse will help you communicate. For instance, they may tell you to blink once for “yes” and twice for “no” as they ask you questions. Try to relax and let the respirator do the breathing for you. This will help you conserve energy and be more comfortable. Your nurse offers pain medication and sedation to improve your comfort level, as well.

While the tube is in place, we use a suctioning device frequently to remove fluid from your mouth and from the tube. We measure your breathing strength and blood oxygen levels and use chest X-rays to determine when we can remove your breathing tube. When the tube first comes out, you might have a mild sore throat. It will get better in a day or two.

Your nurses encourage you to breathe deeply and cough once you’re breathing on your own. This helps keep your lungs clear of fluids and oxygen flowing freely. Coughing may be painful, but the nurses show you how to use your hand or a pillow to support your incision site. Our nurses and respiratory therapists also use an incentive spirometer (a device to help you breathe deeply) and chest therapy to help keep your lungs clear. Chest therapy involves gently tapping your chest and back.

IV Lines

You may have IV lines in place for most of your hospital stay. The lines allow us to provide you with fluids to promote blood circulation. They also make it easy to give you medication, to draw blood for tests and to assess heart and lung function.

Abdominal Drain

Fluid may build up in your abdomen after surgery. We place one or more drains to remove the fluid. Usually we take your drains out before you go home. At times, we leave them in place for a while longer.

Bladder Catheter

During surgery, we place a tube called a Foley catheter into your bladder. It drains your urine. The catheter will be in place when you wake up and will stay in place for a few days. It helps us monitor your urine output so we can keep track of how well your kidneys are working and how much IV fluid you need.

EKG Telemetry Leads

We place electrocardiography (EKG) leads on your body to monitor your heart. They stay in place for several days after surgery.

Recovery after transplant can be different for everyone. Once you leave the PACU or SICU, you move to Farr 10, our inpatient transplant unit. There, you learn to care for yourself so you feel confident and comfortable when you’re ready to go home. We focus on tasks like making sure you can bathe and walk by yourself, take your medications correctly and change your own dressing.

While you’re in the hospital, we take these steps in your care:

• Adjust your IV lines.
• Check your incision several times a day and change your dressing as needed.
• Draw blood at least once a day for lab tests that help us track your health.
• Empty your catheter and drain bags.
• Explain any needed post-operative care, including care specific to your type of transplant.
• Help you learn about your medications.
• Make sure you know the symptoms of potential problems to watch for at home.
• Take your temperature and blood pressure several times a day.
• Teach yourself about specific diet requirements.
• Weigh yourself daily.

Within a day or two of surgery, we get you out of bed and walking with help. We encourage you to walk around your room and down the hall at least three times a day. Walking increases your blood circulation, helps relieve gas pains and makes it easier to maintain muscle tone. We also encourage you to continue coughing and doing deep breathing exercises to keep your lungs clear. If necessary, we bring in our respiratory specialists to work with you. Pain management specialists are also available, as needed.

Within one to three days of your operation, we provide fluids for you to drink. We allow you to eat solid foods once you can tolerate them. Your appetite and your energy level will be lower than they were before surgery, but should be back to normal within a few weeks.

You might find it hard to sleep in the hospital. Many people report strange dreams that seem real, or issues with their memory. These problems are temporary. If they persist or trouble you, talk with your doctor.

Our Nursing Staff

The nurses at Beth Israel Deaconess Medical Center (BIDMC) are the heart and soul of the care you receive here. Patients, peers and colleagues recognize our nursing team for their valued expertise, proficiency and compassion.

Transplant nurse coordinators and nurses on staff in our PACU, SICU and Farr 10 have extensive experience working with people like you after their transplant. Nurses are often your best resource if you or your family members have questions regarding your care.

To make sure you have high-quality, continuous care throughout the process, a transplant nurse coordinator follows you during your evaluation and after your transplant.

Physical Therapy

A physical therapist visits you after your transplant. The therapist helps you regain your strength and move about more comfortably.

Education and Support

You must take several medications after a transplant. We make sure you understand your medicines and how to take them correctly.

Receiving a transplant is a major life event. A social worker will help you with coping strategies, home arrangements and any other issues surrounding your transplant.

Case Management Services & Preparing for Hospital Discharge

Our case managers constantly monitor your progress. We work with you to develop a discharge plan. This includes helping you decide whether you can safely return to your home, or if you could benefit from a brief stay in a rehabilitation facility. We can help you make arrangements and set up any additional services you might need, such as homecare.

Before you leave BIDMC, we make sure you’re ready. This includes knowing how to care for yourself and recognizing signs of a problem.

Long-term complications are possible, but we do all we can to keep you well. You can do your part by following the healthy lifestyle recommendations we provide and receiving ongoing follow-up care from your Transplant Institute team.