Preparing for Your Child's Surgery

Preparing for Your Child’s Surgery

Preparing for Your Child’s Surgery Thank you for choosing us to take care of your child. Below you will find an outline of what to expect before, during, and after your child’s surgery.

Tips for preparing your child for surgery • Keep explanations simple, honest and age appropriate.

• Encourage your child to be involved. Let your child choose items to bring to the hospital (e.g., things to do, comfort items, etc.).

• Have a plan for the return home. Include your child by letting him or her choose a post-surgery treat or activity.

• If you need assistance on how to prepare your child, please contact the Child Life office at (650) 497-8336.

• Only parents or guardians are allowed in the Treatment Center. Please make prior arrangements for supervision of other children.

Before surgery Follow the instructions given to you by your provider, including: • Schedule and complete any tests or office visits the doctor requests.

• Before surgery, you will need to register your child with our hospital. You will get instructions about registration when you schedule your child’s surgery. To pre-register by phone, call (650) 497-8229.

This service is available 24 hours a day, 7 days a week. You will need to have your child’s insurance information available.

• Have non-spicy, non-greasy foods available at home for after the surgery.

• Please trim your child’s nails to prevent infection and reduce scratching.

• If your child is a girl who is 12 years old or older or has started her period, be prepared to have her provide a urine sample to pre-op when she arrives.

If your child develops a fever, rash, cough, diarrhea, sore throat, skin lesions or pink eye within 72 hours of scheduled surgery, call your surgeon or PARC: • Monday through Friday between 9 a.m. and 5 p.m., call (650) 736-7359.

• After 5 p.m. Monday through Friday or on weekends, please call the Operating Room Control Desk at (650) 721-2820.

If you need to cancel your surgery for personal reasons, please call the surgery scheduler. If it is the day before, call (650) 736-7359. procedures.stanfordchildrens.org | 1

Pediatric Anesthesia Resource Center (PARC) phone call appointment You will receive two phone calls from PARC. About 30 days before your child’s surgery, the surgery scheduler will work with you to schedule the first phone call. The appointment will take place one to three weeks before your child’s surgery. Please provide a current phone number to the scheduler. If possible, please provide a cell phone number so that we can send you a text reminder of the appointment. This call will last approximately 20 to 30 minutes, depending on the complexity of the patient’s history.

Patients who are 18 years old or older will need to provide the information during the PARC call, unless they give verbal permission for a parent to provide the information to a PARC nurse.

The following information will be discussed during the call: • Your child’s family, medical, surgical and social history.

• Your child’s diet, and any dietary restrictions.

• The current list of medications your child is taking, including the doses.

• A comfort plan for the day of the procedure/surgery, including anesthesia and pain management.

• The discharge plan.

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The night before your procedure/surgery Second PARC phone call The night before your surgery, you will receive the second phone call from the Pediatric Anesthesia Resource Center (PARC). This call will occur between 1 p.m. and 5 p.m. and usually lasts 5 to 10 minutes.

Please have a pen and paper ready to take notes.

The following information will be discussed during the call: • The time you should arrive at the Treatment Center. Please allow enough time for traffic, parking and visitor badges. It is very important to arrive on time, or your surgery may have to be rescheduled.

Your child’s arrival time is dependent on the age and severity of other patients who are also scheduled that day.

• A brief update on how your child is doing, including any recent fever, cough, cold, etc.

• The eating and drinking instructions specific to your child’s needs, including when to give medications, last time to give foods, and last time to give liquids. This can be written down on the Eating and Drinking Instructions page in this brochure. (Page 6) • The address and location of the Treatment Center.

If you have provided your cell phone number, you may receive a text after 6 p.m., with a reminder of your arrival time, and the time to stop giving your child food and drinks.

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Preparing the skin before surgery A surgical site infection is an infection that occurs in the area where an operation has been performed.

There are some things that you can do to lower the risk of your child developing a surgical site infection, such as reducing the bacteria (“germs”) on your child’s skin. Your clinic may give you some special disposable wipes moistened with 2% Chlorhexidine Gluconate (CHG) antiseptic solution to help prepare your child’s skin for surgery.

Information: • Please read and follow these instructions for bathing and skin care the night before your child’s surgery.

• You might need a second adult to help you with this process.

• Have clean, freshly washed bed sheets, towels, and pajamas ready to use the evening before surgery.

• Do not shave any part of your child’s body the day before or the day of surgery.

• If you would like to warm the wipes before using, please place the closed packet in a bowl of warm water at bathwater temperature.

Directions:

After Care:

1. The night before surgery, shower or bathe your child with soap and warm water, and wash his or her hair.

• Throw wipes in trash can.

2. Dry your child with a clean towel.

• Do not rinse CHG off the skin before surgery.

3. Wait at least one hour and let your child completely dry before applying the wipes.

• Have your child put on clean pajamas and sleep in clean sheets.

4. Open the package: Using clean scissors cut off the end seal of the package and throw away the foam piece.

• After applying CHG wipes, do not shower, bathe, or apply lotions, moisturizers, or other personal care products.

5. For each package, remove two cloths at a time, and place onto a clean surface.

6. Wipe your child’s skin as shown in the pictures on the next page. Use one wipe for each area of your skin as shown by the numbers on the diagram.

7. Avoid contact with eyes, ears, mouth, internal genitalia, and any cuts or open areas of the skin. But, DO wipe the superficial skin and groin area (the creases where the legs meet the body).

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• After using the wipes, let skin air dry.

Your child’s skin will feel sticky until dry.

How to use CHG wipes on your child For children less than 22 pounds (<10kg) Use the 1st cloth on your child’s chest, both arms, back and neck Use the 2nd cloth on both legs (back and front), the buttocks, and groin area

Use cloth on groin area Do not use on genitals

For children between 22 and 66 pounds (10-30kg) Use the 1st cloth on your child’s chest, both arms, and neck Use cloth on groin area Do not use on genitals

Use the 2nd cloth on the back and buttocks Use the 3rd cloth on both legs (front and back) Use the 4th cloth on your child’s groin area

For children more than 66 pounds (>30kg) Use the 1st cloth on your child’s chest, both arms, and neck Use the 2nd cloth on the RIGHT leg Use the 3rd cloth on the LEFT leg Use the 4th cloth on the back

Use cloth on groin area Do not use on genitals

Use the 5th cloth on the buttocks Use the 6th cloth on your child’s groin area procedures.stanfordchildrens.org | 5

Eating and drinking instructions We have listed our eating or drinking instructions for surgery patients below. These must be strictly followed to keep your child as safe as possible. If these instructions are not followed, your child’s surgery may be delayed or cancelled. A small number of children will receive special instructions that are different from these. Follow the instructions that the PARC provider has given you.

1. Stop food and candy at midnight. Food includes anything that’s NOT formula, milk, breast milk or clear liquids.

2. Stop formula and milk 6 hours before arrival time.

3. Stop breast milk 4 hours before arrival time.

4. Stop all clear liquids 2 hours before arrival time. Clear liquids include only water, clear apple juice (no pulp, no apple cider), Pedialyte and Gatorade.

5. Continue to take prescribed medications with a small sip of water unless told otherwise to discontinue.

TIME

NIGHT BEFORE SURGERY

12:00 AM MIDNIGHT

STOP all food and candy

TIME

BEFORE ARRIVAL TIME STOP formula and milk

TIME

STOP breast milk

TIME

STOP all clear liquids

ARRIVAL TIME

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Arrival

Day Date

Day of the surgery

What to bring to the hospital On the day of surgery, please bring the following: o

Valid photo identification, such as your driver’s license, California ID or passport.

o

If your child is 18 or older bring a valid photo identification for him or her.

o

Insurance, pharmacy, and Health Savings Account (HSA) card(s) for you and your child.

o

A list of all medications that your child takes regularly, including doses, both prescribed and over-the-counter.

o

Your child’s favorite toy, blanket, or comfort item; a music or game player, and headphones.

o

If your child is an infant, please bring formula or breast milk in a cooler for after surgery.

o

Bring your favorite book or activity so you have something to do while your child is in surgery.

Important tips for the day of surgery • Parents: Please eat on the day of surgery so you are better able to care for your child, but do not bring food into the Treatment Center.

• Please arrive on time to avoid cancellation of your child’s surgery.

• Continue to encourage your child’s involvement, including picking a movie to watch, preparing his or her anesthesia mask, choosing a distraction for IV placement, etc.

• Occasionally you may have to wait longer than expected. Please understand that we will do everything we can to make you and your child comfortable during this wait.

Arrival • Please park in the new Main Building • Valet parking is free on the day of your procedure/surgery.

• You will need to get a badge at the front desk of the hospital when you arrive.

• Go to the Treatment Center to check in.

Once you arrive at the Treatment Center • While you are checking in, we strongly encourage you to change your pharmacy to the hospital’s pharmacy for your discharge medications. This will guarantee you have your medications with you when you leave. Also, some medications will be difficult to fill at your local pharmacy. You can change it back at your next appointment.

• After check in, you will be taken to an exam room, where a nurse will review your child’s medications, health and allergies. The nurse will also ask you when your child last had anything to eat or drink, and you will be asked to review the consent form you signed.

• For safety, you will be asked many times to provide your name, your child’s name, the type of surgery being done and the last time your child ate or drank anything. procedures.stanfordchildrens.org | 7

Important information to know • Y our child may also be seen by Child Life Specialists, who will help your child understand and cope with his or her visit to the hospital.

• Before surgery, your child may be given medication to help him or her relax.

• Y our physician will decide the safest way to provide anesthesia to your child. Please ask about pain management options.

• F or some children, an IV will be placed. An IV is a tube that goes in your child’s vein to deliver fluids and medications, we will talk about ways we can help your child cope with this IV placement.

• W hen your child goes into surgery, you will be taken to the Treatment Center Waiting Room, located near the check-in area. In this waiting room, you will be shown how to track your child’s journey during surgery.

• Y ou will be told when your child’s surgery should be completed. Plan to return to the Treatment Center at or before that time so you can meet with your child’s surgeon.

During surgery • To keep your child asleep during the surgery, he or she will be given anesthesia medicine through a mask, an IV, or both.

• Monitors will be placed on your child’s body to read vital signs during surgery. These include blood pressure, breathing, blood oxygen level and heart rate.

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After surgery • When the surgeon is finished, he or she will meet with you in one of the consult rooms located near the Treatment Center Waiting Room.

• Once the surgery is completed, your child will be taken to the recovery area, where he or she will rest under the care of nurses until the anesthesia wears off. The length of time your child will spend in the recovery room may be different from other patients because some children take longer than others to wake up completely after anesthesia.

• Our goal is to get you back with your child as soon as possible. Once your child is settled, a staff member will come and take you to the recovery area.

• Children wake up from anesthesia in different ways (sleepy, excited, having an upset stomach). Your anesthesia provider and recovery room nurses will make sure your child is safe during this time.

• Medication may be given to your child to help ease their pain.

• Your child may be offered something to drink.

Going Home • Before you go home, a nurse will give you instructions on how to care for your child at home.

• A parent or legal guardian must take your child home.

• Your doctor may prescribe a medication, which may be filled at our outpatient pharmacy located here in our hospital.

We want to make sure we answer all your questions before you go home, so please ask!

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MyChart

Your Secure Online Health Connection

Use MyChart to easily manage the health care needs of you or your family at any time from your computer or smartphone. For no additional cost, with MyChart you can:

Message Your Doctor

Schedule Appointments

Refill Prescriptions

Access Personal Health Records

View Lab and Test Results

Pay Your Bills

New Users: How to Create Your MyChart Account Your health provider’s office will send you an instant activation email, active for 24 hours.

Follow these 3 easy steps to activate!

Access the email sent by Stanford Children’s and tap the activation link

Complete Account Details •

• •

• •

•

Create a Username and Password Enter YOUR date of birth Choose a security question and enter an answer Confirm your e-mail address Check the box to agree to the Terms and Conditions Tap Submit button

Log in!

• Tap the link to navigate to the MyChart website • Or download the app

MyChart support is available 24 hours a day, 7 days a week. Spanish-speaking representatives are available.

For questions or concerns, or to add more than one child under an account, please call (877) 339-9895 or chat with an online representative.

Visit mychart.stanfordchildrens.org or download the MyChart app for your mobile device.

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Notes

Medical Acronyms • CHG = Chlorhexidine Gluconate • IV = Intravenous, a solution administered directly into the vein • NPO = Nothing through the mouth, withhold food and fluids • OR = Operating Room • PARC = Pediatric Anesthesia Resource Center

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