Patent Ductus Arteriosus Ligation In Children

WHAT YOU SHOULD KNOW:

• Patent Ductus Arteriosus (r-teer-e-O-sus) is called a "PDA." It is a channel or path that connects two large arteries that come out of the top of the heart. The two arteries are called the aorta and the pulmonary artery. Before a baby is born, the PDA is called a Ductus Arteriosus or "DA." The DA is important because it causes most of the blood to bypass the baby's lungs. The lungs do not need much blood since unborn babies do not breathe air. The placenta acts like a lung for unborn babies. After birth, babies do not need the DA anymore because they need blood going to their lungs. The DA is supposed to close shortly after birth. A DA that does not close after birth is called a PDA.
  
  
• After birth, a PDA causes some of the blood from the aorta to leak back into the pulmonary artery. This is not supposed to happen since the blood from the aorta has already been to the lungs once. The circling of blood caused by the PDA makes extra work for the heart and lungs. The heart has to pump harder than normal to send enough blood and oxygen out to the body. In time, this may cause congestive (kun-JES-tiv) heart failure.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

There are always some risks with surgery. Your child may bleed in his head or at the places where the PDA was shut. Your child may get an infection. Your child may get air or blood in his chest or stomach area which could cause bad problems. Your child may get stomach problems. Your child's vocal cords (voice box) may become paralyzed or partly paralyzed. Your child may die. Talk to your caregiver if you are worried or have questions about this surgery.

WHILE YOU ARE HERE:

Before Surgery:

• Informed Consent:
  
  
  • You have the right to understand your child's health problem. You should understand what tests, treatments, or procedures may be done to treat your child's problem. Your child's caregiver should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your child. A consent form is a legal paper that gives a caregiver permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your child's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered. This way you will understand what may happen to your child.
  
  
• Blood Gases: This test is also called an arterial (r-TEER-e-ull) blood gas or "ABG." Blood is taken from an artery in your child's wrist, elbow, or groin. The groin is the area where the abdomen (belly) meets the upper leg. Your child's blood is tested to find out how much oxygen, acids, and carbon dioxide (di-OKS-ide) are in it. ABGs may be done if your child has trouble breathing or has other problems caused by the PDA or surgery.
  
  
• Blood Tests: Your child may need blood taken for tests. The blood can be taken from a vein in the hand, arm, the bend in the elbow, or heel. It is tested to see how your child is handling the heart problem and if he is ready for surgery. Your child may need to have blood drawn more than once.
  
  
• Call Button: A call button will be in your child's hospital room. You or your child should use the call button if your child is having problems and a caregiver is needed. You can also use the call button if you or your child have questions for a caregiver. Be sure to keep the call button near you or your child at all times.
  
  
• Cardiac Catheterization (kath-uh-ter-i-ZA-shun): This is a test used to see how well your child's heart is working. Caregivers may do this test to find out the size of your child's PDA. A special tube is threaded into your child's heart through a blood vessel in his leg or arm. Dye may be given so x-ray pictures of your child's arteries show up better on a TV-like screen. Your caregiver may also measure the pressure inside your child's heart.
  
  
• Chest X-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are handling PDA problems. It can show if chambers of the heart, pulmonary arteries, or aorta are larger than they should be.
  
  
• Echocardiogram (eh-ko-KAR-d-o-gram):
  
  
  • An echocardiogram is often called an "echo." Sound waves are used to show pictures of the size and shape of your child's heart on a TV-like screen. An echo and doppler studies can tell how well the heart pumps and how well blood flows through it. It can show fluid around the heart and heart valve problems. This test is done while lying down.
    
    
  • The test is done in a quiet room with the lights turned off. Clear gel will be used so the echo probe can be rubbed easily across your child's chest to get a good picture. The clear gel will be cleaned off after the test.
  
  
• 12 Lead EKG: This test helps caregivers see if there are problems caused by the left side of the heart getting larger. Sticky pads (10) are placed on your baby's chest, arms, and legs. Each pad has a wire that is hooked to a machine. This machine prints a paper tracing of your baby's heart beat. This test is painless and takes about 5 to 10 minutes.
  
  
• Gown: A hospital gown is needed so caregivers can easily check and treat your child. Your child's gown should be put on so it opens in the back. Your child may be able to wear regular pajamas or clothes when he feels better.
  
  
• Heart Monitor: This is a machine used to see how your child's heart is handling the PDA. 3 or 5 sticky pads are placed on your child's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing well.
  
  
• IV: An IV is a tube placed in a vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pulse Oximeter (oks-IH-mih-ter): This is a machine that tells caregivers how much oxygen is in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. Tell a caregiver if the sticky strip or clip comes off of your child. The machine will alarm if the machine cannot read the oxygen level or if your child needs more oxygen. Tell a caregiver if the machine is alarming. Never turn the pulse oximeter off unless a caregiver has said it is OK.
  
  
• Transport: Your child may need to be put onto a cart or crib to be taken to surgery. You may want to take a special toy or blanket along to surgery for your child.
  
  
• Vital Signs: This includes taking your child's temperature, blood pressure, pulse (counting the heartbeat), and respirations (counting your child's breaths). To take your child's blood pressure, a cuff is put on his arm and tightened. The cuff is attached to a machine which will give the blood pressure reading. Caregivers may listen to your child's heart and lungs by using a stethoscope (STETH-uh-skop). Vital signs are taken so caregivers can see how your child is doing before, during, and after surgery.
  
  
• General Anesthesia (an-iss-THEE-zuh): This is medicine to make your child comfortable and sleep during surgery. The medicine may be given as a liquid or in an IV.It can also be given as a gas through a facemask. It may also go through a tube placed in your child's mouth and throat. This tube is called an endotracheal (end-o-TRA-kee-ull) tube or “ET tube.” Ask your child's caregiver for the CareNotes™ handout to learn more about anesthesia.

During Surgery:

• Your child may lie on his back during surgery. He may be turned on his side after he goes to sleep. A caregiver will clean his chest with soap and water. This soap may make your child's skin yellow, but it will be cleaned off later. Sheets will be put over your child to keep the surgery area clean. An incision (cut) is made between 2 ribs on the left side of your child's chest.
  
  
• Suture (thread) or metal clips are used to close the PDA. The PDA is closed at the aorta end and at the other end close to the pulmonary artery. The incision in your child's chest is closed with wire and stitches (thread) or staples. The surgery usually lasts 1 to 2 hours.

After Surgery:

Your child will be taken to the recovery room until he wakes up and is comfortable. You may be able to visit your child in the recovery room after caregivers get him settled. Your child may be able to go home after surgery. If not, your child will be taken to his room in the hospital. Your child may be sleepy and have some pain after surgery. Your child should not get out of bed until caregivers say it is OK.

• Bandages: A bandage may cover your child's stitches or staples. This bandage keeps the area clean and dry to prevent infection. A caregiver may remove the dressing shortly after surgery to check the incision.
  
  
• Chest Tubes: These are tubes that may be put into your child's chest during surgery. Chest tubes remove air, blood, or fluid from around the lungs. This lets your child's lungs fill back up with air when breathing. The chest tubes are attached to a container with bubbling water. After the chest tubes are removed, your child's lungs should be normal.
  
  
• Comfort and Support: You may stay with your child for comfort and support. Your child may need to stay in the hospital for more than a day. Ask a caregiver if you or another family member can stay with your child. If you or another family member cannot stay, bring in something from home that your child likes. This may include a blanket, a favorite toy, or clothing. You may want to bring one of these items for your child even if you can stay.
  
  
• Intake and Output: Your child's caregivers may need to know the amount of liquid your child is getting. They may also need to know how much you child's is urinating. Caregivers often call this "I&O."
  
  
  • If your child is on I&O, tell your caregiver how much liquid he drinks.
    
    
  • Ask your caregiver if it is OK to flush your child's urine down the toilet. It may need to be measured before it is thrown away.
    
    
  • Caregivers may also need to weigh your child's diapers.
  
  
• Medicines: Your child's caregiver may give your child one or more of the following medicines.
  
  
  • Antibiotics(an-ti-bi-AH-tiks): This medicine may be given to help your child's body fight infection. Infection germs are called bacteria (bak-TEER-e-uh). Antibiotics may be given by IV, as a shot, or by mouth.
    
    
  • Anti-Nausea Medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after surgery or taking pain medication. Anti-nausea medicine will usually be given through an IV or in your child's rectum (rear-end).
    
    
  • Heart Medicine: This medicine may be given to make your child's heart beat better or more regularly. There are many different kinds of heart medicines. Talk with caregivers to find out what your child's medicine is and why he is taking it.
    
    
  • Pain Medicine: Caregivers may give medicine to help your child's pain go away. This medicine can be given by mouth, through an IV, in the rectum (rear end), or by shot. Tell a caregiver if your child's pain does not go away or comes back after taking this medicine. Pain medicine can have some side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset tummy. Tell a caregiver if you know your child is allergic to pain medicine.

Learn more about Patent Ductus Arteriosus Ligation In Children (Inpatient Care)