STEP - Support Through Education Program

All patients who have a liver transplant are transferred to the Intensive Care Unit (ICU). This happens immediately after the transplant operation.

One of the main reasons for needing to be in ICU is to help with breathing. After the long operation and the large incision, the patient is often too tired or sore to breathe as deeply as they need to.

The breathing tube is connected to a mechanical ventilator. Because this tube passes through the vocal cords to the entry of the lungs, it is not possible to speak. Most people find the tube a little uncomfortable, but it is removed as soon as the patient is awake and fully breathing for themselves. Once the tube is removed the throat may be sore and the voice husky.

Due to the high level of monitoring and care needed by patients, one on one nursing support is provided. There is an extremely high level of bedside technology and constant medical supervision.

While the breathing tube is in place, the physiotherapist provides regular support, to ensure that the:

• Lungs remain clear and fully expanded.
• Limbs are moving. This movement helps to prevent blood clots

What else is being monitored?

It is important to monitor the patient closely after the operation and to do this there are many lines coming from the patient to equipment or drainage. Some of these are:

• ECG or heart leads on the chest to monitor the heart continually
• A probe on a finger to monitor oxygen concentration
• An arterial line to measure blood pressure
• A Swan Ganz catheter in the neck to measure blood volume
• Many surgical drains in the abdomen around the wound
• T tube to drain bile
• Indwelling catheter in bladder to drain and measure urine

Do patients need compression stockings?

Yes. To prevent clots in the legs, compression stockings are worn until the transplant patient is up and walking around for most of the day.

Is it possible for a patient to walk in ICU?

Before discharge from Intensive Care, the physiotherapist will assist the patients with deep breathing and supported coughing. The physio will sometimes be able to take the patient for their first post-operative walk on a walking frame. This depends upon the condition of the patient.

Every situation is individually assessed.

Is there much noise in ICU?

As can be imagined, the machines and constant activity can result in the ICU feeling quite noisy. Staff do their best to create the calmest and most peaceful environment for the patient and family, but the machine alarms and beeps can add to the sound level.

Staff will explain to visitors what the alarms and noise means, to help make the experience as comfortable as possible.

Can patients and families see the ICU before the transplant?

ICU offers all future patients and families the opportunity to visit the ICU to see the equipment and surroundings. If interested, please ask one of the liver transplant coordinators organise a suitable time.

Can the family visit?

Visiting is restricted to immediate family and close friends. The child friendly policy ensure that children are allowed to visit. It is generally suggested that no more than 2 people visit the bedside at any one time. There is no visiting before 11am as this is a very busy time during which the ICU doctors conduct their rounds and when routine tests are performed.