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Heart transplant process
You can call (352) 265-0751 to make a referral to the heart transplant program at the Shands Transplant Center at the University of Florida. In order to prepare you mentally for the heart transplant, it is important to understand what you can expect. Being informed and prepared for the transplant can improve your recovery. Notification | Preparation | Surgery | CICU | Equipment | Stay | Care | Exercise | Immune system and medication Notification of transplant Inform the coordinator if you have had any of the following in the past week:
Once contacted, you should come to the hospital with as little delay as possible. The coordinator will have estimated your travel time so please use caution while driving to Shands at UF. You may also contact Angel Flight of Florida to arrange transportation. Do not eat or drink anything after you have been contacted about the transplant. When you arrive at the hospital, the coordinator will instruct you where to go for check-in preparation for surgery. Preparation
for surgery
Before surgery, you will be asked to sign a consent form giving the surgeons and anesthesiologists permission to perform the heart transplant and blood transfusions. During most of the preparation period, your family will be allowed to stay and visit with you. Once you go to the Operating Room your family is directed to the waiting room. The coordinator will stay in touch with your family throughout the time of surgery and keep them informed of your progress. Heart
transplant surgery Once you are in the Operating Room, doctors and nurses will further prepare you for surgery. The anesthesiologist will give you medications to help you relax and sleep. There are two specific surgical approaches to the heart transplantation. The surgeon will decide which is best for you depending upon your anatomy, past surgical history and how much time is available before your new heart arrives. You will be supported on a heart-lung (cardiopulmonary bypass) machine while your old heart is being removed and your new heart is being transplanted. When your surgery begins, the doctors prepare you to receive your new heart. The surgery will take six to seven hours from the time you go into the OR and the time you come out. Cardiovascular
Intensive Care Unit During your stay in the CICU you will be cared for and monitored very closely. A nurse will be at or near your bedside 24 hours a day. Inside your room there will be monitoring equipment to track your blood pressure, heart rate, breathing, oxygen levels, urine output and other vital medical information. During your stay in the CICU your heart transplant surgeon will be your primary physician. Your vital signs will be checked hourly for the first day or two in the CICU. Most of this information can be collected without disturbing you while you are resting. Every day you will have a chest X-ray in your room, a bath and have your bandages changed. For the first few days after surgery, you will spend most of your time in bed. You can watch television and listen to music. For the first few hours and days in the CICU, you will be monitored with a lot of different equipment. As you recover from surgery, much of that equipment be removed and you will be able to get up out of bed, sit in the chair and walk around your bedside. Monitoring
equipment An Endotracheal tube is placed in your mouth as a breathing tube. After you are asleep in the Operating Room this plastic tube is placed in your mouth and passed into your windpipe. The breathing tube is taped to your cheek and connected to a mechanical respirator (also called the "ventilator"). The ventilator breathes for you during surgery and in the CICU until you are strong enough to breathe on your own. While you are on the ventilator you will not be able to talk. You will still be able to communicate by nodding or shaking your head. When the tube is removed, an oxygen mask will be used to supply you with additional oxygen. A Nasogastric tube (NG tube) keeps air and fluid from collecting in your stomach. This plastic tube is passed through your nose and into your stomach. The NG tube will be removed as soon as you are ready to take food and beverages, usually once we can hear normal bowel sounds and you have passed gas. A Bandage is placed on the right side of your neck. This bandage covers a special intravenous line or catheter that will be used to monitor you heart and lungs. Over the incisions where the surgery was performed, bandages and tape are placed and changed daily. You will also have patches, about the size of silver dollars, placed on your skin near your shoulders and sides. These patches are connected to the electrocardiogram or EKG monitor above your bed. The EKG monitors your heart rate and rhythm of your heartbeat. Pacemaker wires are placed in the Operating Room and come out your chest wall. Your new heart needs to be paced for a few days after surgery. Chest tubes are below the chest incision. These tubes are flexible, plastic tubes that pass through your skin and are placed around the area where the surgery was performed. The chest tubes keep air and fluid from collecting in your chest and help your lungs expand. These tubes are connected to airtight containers located on the side of your bed. These tubes usually stay in place for only two to three days. After surgery your body may swell - particularly in your face, hands, abdomen, feet or legs. Swelling will worsen over the first one to two days before improving. This is normal and it may take a few weeks until it disappears. A small rubber catheter checks the function of your kidneys after surgery. It is placed into your bladder after you are asleep in surgery. Your urine is collected and measured every hour. The catheter usually stays in place for two to three days after surgery. The amount of liquid you will be allowed to drink will be limited until you move out of the CICU. Two intravenous catheters or IV's on each arm are placed into the artery of your wrist. This measures your blood pressure collects blood samples so nurses don't disturb you while you're resting. Until you are fully awake, your hands will be restrained with soft cotton straps. This is for your own protection so that you don't accidentally move your arms too much and disconnect an IV catheter or monitoring tube. Length
of CICU stay Care
after surgery After your stay in the CICU you will be moved to a private room. It is necessary to stay in a private room in order to decrease the number of people with whom you come into contact and limit your exposure to infection or illness. During the first few weeks after the transplant you will be especially vulnerable to infections. During the remainder of your hospital stay we again ask that visitors be limited to immediate family and clergy members. Family members and any other visitors with a cold or any other kind of illness should be asked not to visit with you directly, but use the telephone instead. You may walk around the hospital floor during low-traffic periods in the morning and late evenings after visiting hours. You should always wear a mask when you are outside your room and especially when you go to have any tests such as an X-ray. Unfortunately, we can not allow fresh flowers or plants of any kind in your room after the transplant because they contain bacteria. Please let your family and friends know about the "no flowers" policy. During your hospital stay after surgery, you and your family will be involved in a number of activities designed to:
The first step in the recovery process will involve a combination of chest physiotherapy, proper nutrition and exercise with appropriate periods of rest. Chest physiotherapy (CPT) is extremely important after a heart transplant. CPT involves activities designed to keep your lungs clear of secretions and prevent lung collapse and pneumonia. Deep breathing exercises expand your lungs to their fullest capacity. These exercises help to open up even the tiniest airways in your lungs. They also help to strengthen your breathing muscles, especially the diaphragm and muscles between your ribs. The incentive spirometer is a small, portable breathing exerciser that helps you to breathe more effectively. By setting the indicator on the incentive spirometer you set your goal of how much air you want to breathe in. Next, you simply place your lips around the mouthpiece and inhale until the blue disk moves to the mark of your goal. You should use the incentive spirometer five to seven times every two hours while you are awake (about eight times per day). Deep breathing exercises, use of the incentive spirometer and chest percussion all may produce coughing. Though at times uncomfortable, coughing itself is important because it helps to clear secretions from your lungs. One activity you can do to help make coughing easier is to splint your chest with a pillow or rolled up blanket. Simply hold or "hug" the pillow against your chest whenever you cough. In addition to splinting, your doctors will be sure to provide you with medicines to help ease the aches and discomfort associated with chest therapy. After your hospital discharge, you must make regular visits to the clinic. An important part of these visits is a check of the amount of Cyclosporine in your blood stream. A blood sample will be taken to check this. On the day of a regular clinic visit do not take your Cyclosporine before clinic. Bring your Cyclosporine and other medications with you. After two years, follow up clinic visits are required every six months. Exercise At first, your ability to exercise will be limited. Once you are out of bed you will start with short walks (50 to 100 feet) assisted by others or with a walker. By gradually increasing the distance you walk each day, most patients can walk a mile a day by the end of the third or fourth postoperative week. For the first several weeks, as your body gets used to your new heart, it is common to fatigue easily and to become short of breath quickly. This can be frustrating. It will take your body and your mind a little while to get used to the new heart. Immune
system, rejection, infection and medications Your body's immune system works to prevent, limit the spread and fight infections. It also rids your body of foreign living substances. Bacteria live all around us and inside of us, especially in our mouths and intestines. If these bacteria are not controlled by the immune system, they could overwhelm us. Normally, if you cut yourself and bacteria enter the wound, these bacteria usually do not spread to other areas of your body. This is because the immune system causes white blood cells to rush in and hold the bacteria in place until they are destroyed. The immune system is very helpful in limiting the spread of infections from one place in our body to another. If you have a bad cold or flu that affects your entire body, your immune system works to rid your body of the bacteria or virus. Proper nutrition and medications such as antibiotics, also help the immune system fight a whole-body infection. Rejection is an important issue in transplantation. A special way that the immune system works is to fight foreign substances that may enter your body. Foreign living objects can include bacteria, viruses or living tissue from another human being (such as a transplanted organ). The technical name for a foreign living object is an antigen. When the body recognizes an antigen, it tries to make specific cells to fight the antigen called antibodies. Different antigens require different antibodies to fight them. Think about an antigen as a lock on a door that needs exactly the right key to open it (antibody). Your immune system has the ability to make a lot of different antibodies for a lot of different antigens. Unfortunately, your body may recognize your new heart as an antigen and will try to make antibodies to fight against it. Therefore, after the transplant your immune system must be suppressed to prevent the formation of antibodies that would cause your body to reject your new heart. Medications can suppress of your immune system through immunosuppression. It is important to remember that when trying to prevent rejection of your new heart by immunosuppression, you become vulnerable to infections with bacteria and viruses. Some medications must be take every day for the rest of your life. Statistics Related Links |
Transplant NavigationHeart Transplant NavigationMake an AppointmentTo make an appointment or find out more information about transplant services offered at Shands at the University of Florida, please call 352.265.8000 or toll-free 1.800.749.7424 You may also email our Consultation Center (consult@shands.ufl.edu) or use our secure online form. |
