Children’s Wisconsin Hospital (Packet 4050)

Your child will be having surgery at Children’s Wisconsin. Here is some information to help you get ready.

Before surgery

Meeting with your surgeon or doctor

• You already may have met with your surgeon. If not, you will meet with someone from your surgeon’s team. They will talk with you about your child’s medical condition and the procedure.  
• A history and physical needs to be done within 30 days of your child’s surgery. It can be done at your child’s doctor’s office or the surgeon’s clinic.  If the physical will not be done in the surgeon’s clinic, talk with the surgeon’s office staff about the details.
• Children’s Wisconsin offers a tour before surgery at the Milwaukee hospital. Please see the invitation card in the folder.

Preparing for surgery

Call before surgery

A nurse will call you 1 to 3 days before your child’s surgery. The nurse will review your child’s health history, final instructions and any possible changes.  It is very important to follow these instructions:

• What time you need to be at the hospital. This will most likely be 1 to 2 hours before surgery.  It takes time for staff to get your child ready for surgery.
• What medicines your child can take the day of surgery.
• What your child can eat and drink the day before surgery.  
• When your child has to stop eating and drinking.

If you have not heard from a nurse by the day before surgery, please call the Pre-op Clinic at 414-266-2762.  Leave a message with your child’s name, date of surgery, and your phone number.  A nurse will return your call as soon as possible.

When to stop eating and drinking before surgery (NPO instructions)
It is very important that you follow these instructions. If your child eats or drinks after the time you are given, the food or drink could get into their lungs when they are given anesthesia. This is called aspiration and could be very dangerous. Your child’s procedure may be cancelled if these instructions are not followed.

Bath before surgery

• Your child should have a bath before surgery. A bath helps keep bacteria from growing on the skin before surgery.
• Your child may need to have a bath with special soap before surgery. If so, the surgeon and clinic staff will tell you how to do the bath and where to get the soap.  

Hospital stay

The staff that will take care of your child

Many staff members with different roles will care for your child.  The Medical College of Wisconsin and Children’s Hospital of Wisconsin staff work together to care for children.  There are many specialists from the Medical College who may care for your child. They are specially trained in the care of children needing surgery.  These include doctors, called anesthesiologists, who give medicine to make your child sleep during the procedure. You will meet them before the procedure. Staff, students and volunteers will be wearing a hospital ID badge. Feel free to ask people their names and roles if needed.

Visiting the Post-anesthesia Care Unit (PACU) 
After surgery, your child will go to a recovery room (PACU).  Your child will stay there until the anesthesia starts to wear off and your child is comfortable.  Most families will meet their child in the PACU after surgery.  Staff will let you know when you can join your child.

Important things to know: 

• Only one parent at a time can be in the recovery room.  
• If for any reason we are unable to let you visit, you will get phone updates in the waiting room.  
• Your child may be more upset than usual as they wake up from surgery.  This is normal.  
• When your child is ready to leave the recovery room, other family members will be able to join them. 
• If your child goes to a Critical Care unit, the visitor guidelines for that unit must be followed.

Your child’s comfort

 We will make every effort to keep your child comfortable during their visit to Children’s Hospital. This pledge is called the “Comfort Zone”. We will help your child cope with discomfort by using relaxation techniques, sedatives and pain medicine. We will give you information on pain management choices. We encourage you to talk with your doctor or nurse about your child’s comfort.

Visiting 

Our main focus is on your hospitalized child. Our goal is to give the best and safest care for your child. To do this, we have visiting guidelines. There may be times when we have to limit the number of visitors. To learn more, please talk with staff. 

• Parents and two adult visitors may go with your child to Day Surgery. No visitors under 18 years of age are allowed in Day Surgery.   Only two visitors will be allowed in the child’s Day Surgery room at a time.
• If your child stays overnight in the hospital, the hospital visitor guidelines will be followed.

Going home

 Before you leave the hospital, you will learn how to care for your child at home.  This includes:

• Medicines. The reason your child is taking the medicine, the amount, how often, when it was last given and any side effects to watch for at home.
• Dressing changes. If needed, we will talk with you about wound care, supplies and what is covered by your insurance. 
• Special diet and activity needs. 
• Plans for delivery of any special equipment you will need at home. 

You will get copies of all teaching sheets and instructions. There will be phone numbers on your paperwork in case you have questions after you get home.

Nothing by mouth or tube (NPO)

Your procedure is scheduled for ____________  (date)  ____________  (time)
Your child’s instructions for getting liquids and food are based on when they will get to the hospital which is: _____________ (time)              
No milk, formula or breast milk with additives after _____________ (time) 
No breast milk after _____________ (time)   
No clear liquids after _____________ (time)                                        
The times may need to be changed if unexpected schedule changes are needed.
**Please fill in the blanks after times are provided to you by the Pre-op Call Nurse.

Type of liquid or food allowed and Definition  

• Usual / full meal - Any food and all juices are fine.
• Formula / milk - Cow’s milk, soy milk, infant or adult formulas; expressed breast milk with additives.
• Breast milk - Breast milk, without additives.
• Clear liquids - Enfalyte® / Pedialyte, apple juice, white grape juice, Jell-O, popsicles, only apple juice or white grape juice, water.
  No red or purple liquids
  

• Usual, full meal (by mouth) - 8 hours
• Formula, Milk or breast milk with additives (by mouth or NG/G-tube - 6 hours
• Breast Milk (by mouth or NG/G-tube) - 4 hours
• Clear Liquids (by mouth or NG/G-tube) - 2 hours
• Any J-tube Feeds - 2 hours

Special Information

• If your child has a condition like glycogen storage disease or diabetes, and can’t be without food or liquids for a long time, your doctor will talk with your child’s specialty doctor about a plan. 
• If your child is in the hospital on the day of surgery or procedure, the time to stop liquids and meals may be changed.
• For your child’s comfort and safety, we would like you to offer your child liquids up until their NPO time.
• For your child’s comfort, do not eat or drink in front of your child while they are not able to eat or drink before or after surgery or procedure. 

Preparing Your Child for Surgery

Children’s Hospital

Planning for your child's procedure or surgery can be stressful. Being well prepared can help you and your child feel less nervous about surgery. One way to help you learn what will happen is to write down questions ahead of time. Having your own questions answered will help you as you start to talk to your child.

It is important to help your child understand why surgery is needed. Children cope better if they know what’s going to happen and why.

When preparing your child, information should be given:

• In a way your child will understand.
• To help correct false thinking your child may have about the hospital.
• To get rid of fears and feelings of guilt your child may have.

Use the following tips to help your child: 

Infants (0 to 12 months old)
Familiar objects and people are important to infants.
Bring a favorite blanket, toy or pacifier.
Bring your infants bottle or cup to use after the procedure.

Toddlers (1 to 3 years old)

• Talk about the hospital one to two days before surgery.
• Let your child choose a favorite stuffed animal or toy to bring.
• Help explain what the staff will do before they touch your child.
• Help your child feel less afraid of the medical team. Let staff look at your ears or listen to the stuffed animal's heart first. This may help put your child at ease.

Preschoolers (3 to 5 years old)

• Talk to about the hospital about three days before surgery
• Read books about the hospital together.
• Be honest and explain things in simple terms. Think about the words you use.
• Play is how preschoolers learn, so playing hospital or doctor is very helpful. Stuffed animals, dolls and medical kits can help you to learn what your child understands.

School-Age Children (5 to 12 years old)

• Talk to your child about the hospital one to two weeks before surgery.
• Give your child time to ask questions and talk about concerns.
• Be honest. Reassure and encourage them to talk about what they are feeling.
• Explain what your child will see after the procedure such as stitches or bandages.
• Make sure your child understands. Have your child tell you what they think is going to happen.

Teens (12 to 18 years old)

•  Teenagers are learning independence and decision-making.
• Teens are concerned with body image, privacy and relationships with friends.
• Talk about what is going to happen. Encourage your teen to take part in decision-making.
• Be honest. Your child may be upset if they feel people are keeping secrets from them.
• Encourage your teen to ask the doctor or nurse questions.
• Respect your teen's need for privacy.

What to tell other children in the family

Your other children may have questions. They may be worried and upset. How to help:

• Talk about the procedure. Use simple, honest language that they can   understand.
• Explain where you will be and why it’s important.
• Stick to structure and schedules with them as much as possible.

The Day of Surgery

Stay relaxed
Children notice how their parents react to a new situation. It is normal for you to be anxious about surgery, but it is important to not let your child see how you are feeling. If they see you are worried, they will be too. Children are surprisingly able to interpret body language, tone of voice and facial expressions. Nothing calms a child more than a confident parent.

Offer distractions
Make a plan to distract your child until it’s time to get ready for the procedure. If possible, pack a bag of new toys to keep them occupied. Keep the conversation upbeat and light; don’t let them pick up on your anxiety.

Work with the surgery team
The anesthesiologist and surgery team have your child’s best interest in mind. Be open and honest with them so they can make the best decisions for your child. Remember that the anesthesiologist has experience with preparing children for surgery, so take your cues from him or her to keep your child calm.

Child Life Specialists
Child Life Specialists have studied child development and how children react to health care settings. They help make the hospital less stressful for patients and families. They can help ease the fear and worry your child and their siblings may have. They can also help your child understand and cope with being in the hospital.
If you would like to meet with a member of the child life team during your stay, please ask your nurse to have them paged.

Wound Infection after Surgery

What are surgical site infections or SSIs?

A Surgical Site Infection (SSI) is an infection of a wound from surgery.  Most infections are caused by germs (bacteria) found on and in the body. Germs are everywhere. They can be found on the skin, in the air, and on surfaces.  Fortunately, only 2 out of 100 patients who have surgery, get a surgery wound infection. 
What are the symptoms?
• Pain or tenderness. 
• Redness around the wound or a red streak coming from it.
• Swelling or hardness around the wound.  
• Green, yellow or bad-smelling fluid (pus, drainage) from the wound.
• Fever of 101°F (38.3°C) or higher.
• A tired feeling that doesn’t go away.
Symptoms can come at any time- hours to even weeks after surgery.  Call your child’s healthcare provider if you think there is an infection.

Who has a greater chance of getting an infection?

Patients who:

• Have a weakened immune system.
• Have serious health problems such as diabetes, heart or kidney problems.
• Smoke.
• Have nutrition problems or do not eat enough healthy foods.
• Are over or under weight. 

How are the infections treated?

Treatment depends on where the wound is and what type of germ is causing the infection.  A small amount of wound drainage may be sent to the lab to see what germs are in the wound.  Most infections are treated with antibiotics.

What can you do to help prevent an infection?

•  Keep the wound site clean and dry.  
• Always wash your hands before and after caring for your child.
• Remind others to wash their hands before and after visiting.
• Let others know that if they are sick they should not be visiting your child. 
• If antibiotics are ordered make sure to give them until they are all gone.

What is done in the hospital to prevent SSIs?  

Healthcare providers should wash their hands with soap or an alcohol-based cleaner before and after touching your child.  If you do not see them wash their hands, please ask them to do so.

Before surgery: 

• All operating room (OR) staff’s arms and hands are scrubbed carefully with germ killing soap.   
• Your child’s skin is cleaned where the surgery is done with a germ killing liquid.
• Hair is clipped rather than shaved if it needs to be removed from your child’s skin.  This prevents tiny nicks and cuts that can be a place where germs can enter the body.
• Antibiotics are given before some surgeries. Your child’s doctor will decide if antibiotics are needed for your child. 

During surgery: 

• Your child will be kept warm during surgery. Getting too cold during surgery is one risk factor that can lead to an SSI.
• To keep your child warm:
  – Warm IV fluids are given. 
  – The temperature is raised in the OR. 
  – Warm blankets are used.