Surgery at CHEO. We help children and families be their healthiest

We help children and families be their healthiest Surgery at CHEO Rem D n embert surge eat n ry da Fasti y! ng gu i d s 12 &elines 13 page 401 Smyth Rad Ottawa, ON K1H 8L1 Tel: (613) 737-7600 Fax: (613) 738-4288 @CHEOHspital 29 CHEOkids CHEO vides www.che.n.ca Frm # P5619E Nvember 2013

things t remember the day f surgery: Ntes T prevent yur child s surgery frm being cancelled, d nt let yur child eat r drink n the day f surgery. Please fllw the fasting guidelines n pages12 & 13 carefully. Yu ll need t bring a valid health card with yu. The surgery may be delayed r cancelled if yu dn t bring a valid health card. D nt bring fd r drinks int the Daycare Surgery Unit. Please see page 17. Just 2 adults are allwed t be with yur child n the day f surgery (at least 1 parent r guardian). Brthers, sisters, grandparents, aunts, uncles r friends must stay at hme. Please see page 16. Bring this bklet with yu n the day f surgery.

Resurces Checklist: Leading Up t Surgery Cntact Numbers: CHEO s main phne number 613-737-7600 CHEO Day Surgery Unit Mnday-Friday 6:30 a.m.-7:00 p.m. 613-737-7600 ext. 2347 r 2346 Arrange fr language interpretatin services thrugh yur surgen s ffice if needed. Ask yur surgen if yu will need any special equipment at hme t care fr yur child. Admitting 613-737-7600 ext. 2310 Pre-assessment Clinic 613-737-7600 ext. 2522 Ask yur surgen if yu will need a special car seat (fr example, fr children having rthpedic surgery). Child Life Specialist 613-737-7600 ext. 3077 Parent and Family Representative 613-737-7600 ext. 2203 Rnald McDnald Huse 613-737-5523 Kaitlin Atkinsn Family Resurce Library 613-738-3942 library@che.n.ca Rtel 613-733-1412 tll free 1-800-267-4700 www.rtel.ca Websites: CHEO s Surgery Virtual Tur www.che.n.ca/virtual_tur/index.html Sciety f Pediatric Anesthesia www.pedsanesthesia.rg/patiented/faq.iphtml Children s Hspital f Philadelphia - What it s like t have an Operatin (ages 6-12) www.chp.edu/kidsheathgalaxy/index.html Canadian Anesthesilgists Sciety (patient infmatin) www.cas.ca/english/patient-infrmatin MindMasters www.child-yuth-health.net/en/child-yuthhealth/mindmasters_p280.html Getting ready fr surgery at CHEO (a nurse will cmplete sme f the fllwing n the day f surgery) Name f surgery: Name f surgen: Surgen s Office Phne Number: Pre-assessment clinic (C3) appintment date: time: Date f surgery: Time f surgery: Expected stay in Pst-Anesthetic Care Unit: Return t Day Care Surgery: Expected discharge: Expected time t hspital rm: Please arrive at the Day Surgery Unit, 3rd flr, 2 hurs befre yur child s surgery time. Yur dctr will tell yu ahead f time if yur child needs t be admitted t CHEO the day befre surgery. 26

Table f cntents Welcme t CHEO...1 Parking...2 Maps f CHEO...2-3 Resurces and phne numbers... 26 Getting Ready fr Surgery pages 4-10 Getting Ready fr Surgery...4 Giving cnsent...5 Talking abut anesthesia...6 Tls t help children cpe...9 Just fr teens...10 The Day Befre Surgery pages 11-13 Checklist: Day befre surgery...... 11 Fasting Guidelines...12-13 Cnfirming Surgery...14 Ging Hme... If yur child has had day surgery, the nurse will tell yu when it s OK t g hme. Yur surgen r nurse will g ver any instructins, prescriptins and fllw up appintments with yu befre yu leave. If yu dn t have a car, try t ask smene yu knw t drive yu hme, r plan t take a taxi. Taking yur child hme n the bus after surgery is nt allwed. Keep a twel r small pail in the car, sme children thrw up in the car n the way hme. Teens are nt allwed t drive fr 24 hurs after having an anesthetic. Make sure yu r anther respnsible adult stays with yur child r teen fr 24 hurs after the surgery. It is imprtant t watch fr any prblems that culd happen after surgery. Dn t plan any activities fr the rest f the day, let yur child r teen rest. The day f Surgery pages 15-22 Checklist: What t Bring t CHEO...15 Wh shuld cme t CHEO... 16 Preventing the spread f infectins... 16 Cancellatins and delays... 16 In the Day Surgery Unit... 17 What if my child gets really upset?... 18 Child Life Specialist... 18 Ging t the Operating rm... 19 Yur child s anesthesia... 19 Parental Presence at Inductin (PPI)... 20 During surgery... 21 After Surgery pages 22-26 Pst anesthetic care unit (PACU)... 22 Staying vernight... 23 Ging hme... 25 We understand that surgery can be stressful fr yu and yur child r teen. We are here t give yu the best f care befre, during and after surgery. This bklet will help yu t get ready, and we hpe it will answer many f the questins yu may have. 25 After Surgery

Nt frm Ottawa? If yur child r teen will be staying vernight at CHEO, ther family members can stay clse by in ne f the reasnably priced places n the CHEO campus. Make sure t call early t reserve a rm. Manir Rnald McDnald Huse f Ottawa and Eastern Ontari Serves as a hme away frm hme ffering fully equipped rms reserved fr families with children suffering frm cancer r ther serius illnesses. Yur scial wrker, nurse r ther health care team member must refer yu. 613-737-5523 Rtel www.rtel.ca 411 Smyth Rd. Ottawa, ON 613-733-1412 r tll free 1-800-267-4700 Offers accmdatin fr any family and friends f CHEO patients. Welcme t CHEO! We ve created this bklet t help yur family prepare fr surgery and navigate thrugh ur Pre-Assessment Clinic, Day Care Surgery, Operating Rm and Recvery Rm. We will prvide yur child r teen with high quality, family centred care, and this means keeping yu invlved and infrmed. At CHEO, we are always wrking t imprve the quality f ur care. In recent years, we have intrduced new prgrams suggested by families, like: Parental Presence at Inductin (staying with yur child until he is asleep frm the anesthetic) Parental Presence in Recvery Rm On line Virtual Tur We hpe yu ll let us knw if this bklet has been helpful t yu and if yu have suggestins fr hw t make it better. This is the first step in yur surgical jurney here at CHEO. We want t assure yu that we are here with yu every step f the way. CHEO s Address: 401 Smyth Rad, Ottawa, ON K1H 8L1 -The Periperative Executive Team 24 1

Parking CHEO has ne visitr s parking lt, A, beside the Gary Cardiff Wing and the Emergency Department. This lt can becme full, especially between 10 am and nn. Please give yurself enugh time t find a parking spt befre yur appintment at CHEO. Visitr parking csts $3.50 fr each half hur, up t a 24 hur maximum f $13.00. We ffer weekly and mnthly passes fr frequent visitrs, and yu can purchase these in ur Security Department n level 2. T pay fr parking, yu can use cash r credit cards at ne f ur three autmated parking pay machines. Yu can als pay at the exit gate (credit card nly). Please bring yur parking ticket int the hspital with yu if yu wish t pay cash. Fr mre infrmatin n parking rates, passes and hw t pay, please cntact the CHEO Security Department at 613-737-2227 r visit ur web page: www.che.n.ca/en/parking. Level 2 Niveau 2 CHEO s Main Entrance Back t the Day Surgery Unit After waking up frm the anesthetic, yur child will g back t the Day Surgery Unit t rest. Yu ll stay at yur child s bedside until the nurses feel yur child is ready t g hme. We will encurage mst children and teens t have smething t drink befre ging hme, and we ll ffer ppscicles, apple juice and water. Hw lng yur child stays in the Day Surgery Unit after surgery depends n the kind f surgery and hw yur child feels. CHEO s plicy des nt allw children and yuth wh have had teeth r implants remved (fr example, central lines, screws) t take these items hme. If yur child is staying vernight at CHEO... Yur child will g t her hspital rm frm the PACU. One parent r caregiver can stay vernight-we have bed chairs t sleep in, and we ll give yu sheets, blankets and a pillw. Visiting Guidelines Parents, caregivers, brthers and sisters can visit anytime (with n mre than 2 visitrs at ne time). Let the Charge Nurse knw the names f yur immediate family. Other relatives and friends can visit between 3:00 p.m. and 8:00 p.m. each day, including weekends and hlidays. Smetimes we have t limit visits t parents and caregivers when a child is in islatin, r when we have many patients with infectins in the hspital. After Surgery 2 23

A PACU nurse will stay with yur child r teen fr the entire recvery perid, t make sure she is safe and cmfrtable. It is nrmal t have sme pain after surgery. Each child r teen feels pain differently. PACU nurses will: Measure yur child s bld pressure, temperature, xygen level and heartbeat regularly Assess pain and give pain medicatin if needed Use cmfrt measures t ease pain Level 1 Niveau 1 Please speak with the nurse if yu feel yur child r teen is in pain. Yu can help yur child r teen in the PACU by: Letting yur child sleep Sitting by yur child s side Cmfrting yur child by: - Speaking in a quiet, sthing vice - Hlding his hand r tuching him gently - Hlding r rcking yur child in yur arms (check with the nurses first) - Letting yur child suck n a pacifier if this is cmfrting. After Surgery Please remember: We may ask yu t leave the PACU fr a time in case f a medical emergency. Several patients and parents will be in the PACU at the same time. It is imprtant t respect the privacy f thers. N cell phne use r picture taking is allwed. Please help prevent the spread f infectins t ur patients by staying away if yu are sick, and washing yur hands befre yu cme in and after yu leave. Fd and drinks are nt allwed in the PACU. Level 3 Niveau 3 Surgical Waiting Rm Operating Rms Getting Ready fr Surgery 22 36

Getting ready fr surgery Getting ready fr surgery Befre yur child s surgery, yu ll need t fill ut a questinnaire abut yur child s medical histry. Yur child may need t see an anesthesilgist befre surgery in the pre-assessement clinic. This will depend n yur child s medical histry and the surgery r prcedure. Telephne Assessment A visit t the pre-assessment clinic isn t always needed if yur child is healthy and having a minr surgery. In this case, a nurse may call yu a few weeks ahead f time t: Review the questinnaire that yu cmpleted earlier Ask abut any medicatins yur child is taking Ask abut any allergies Let yu knw abut what t expect the day f the surgery Answer any questins yu may have Pre-Assessment Clinic If yu need t see the anesthesia dctr, yu ll have an appintment in the pre-assessment clinic abut 2 weeks befre the peratin. Yu ll find the clinic at C3, n the main flr f CHEO. Please register at the desk when yu arrive. We ffer services in French and English. We have translatin services available if yu speak anther language, but yur dctr s ffice will need t call us ahead f time t make these arrangements. What yu need t bring t the clinic: Yur child s mst recent health card Prf f yur address (like a drivers license) Medical insurance infrmatin (if needed) Yur child s immunizatin recrd A list f medicatins, hmepathic r herbal remedies and dietary supplements yur child is taking. What will happen during the appintment? Yu will first meet the nurse. The nurse will: Ask yu questins abut yur child s health Weigh yur child Check yur child s heart rate, bld pressure and xygen level Let yu knw what t expect n the day f the prcedure r peratin. During surgery... Please wait in the: Day surgery waiting rm 3rd flr (rm 3108 B, just in frnt f the elevatrs). This is where the surgen will lk fr yu when the surgery is ver. Nurses frm the PACU (Pst-anesthetic care unit) will lk here fr yu t re-unite yu with yur child r teen. The waiting rm is a gd place t think abut any questins yu d like t ask the surgen when the surgery is ver. Yu can eat, drink and use yur cell phne in the waiting rm. If time allws during yur child s surgery, yu may visit the: Oasis Cffee Shp n the 2nd (main) flr, acrss frm the Admitting Department (pen frm 7:30 a.m. t 11:00 p.m.) The Gift Shp n the secnd flr, near the frnt entrance Cafeteria n the first flr (pen frm 6:30 a.m. t 2:00 p.m.) After Surgery... Pst Anesthetic Care Unit (PACU) Yur child r teen will g t the PACU (r recvery rm) t fully wake up after surgery. Each patient reacts differently after anesthesia. Sme sleep fr a lng time, while thers are restless and cry as they wake up. Yur child r teen will stay in the PACU until he is awake, cmfrtable and stable. This usually takes 30-45 minutes, but it smetimes takes lnger. We may be able t bring yu int the PACU t see yur child. Only ne parent r family member can visit in the PACU at a time. Yur child r teen may have: An IV Oxygen mask Mnitrs fr heart rate and bld pressure 4 21 The Day f Surgery

Parental Presence in the Operating Rm (PP) We understand that surgery can be a stressful experience fr families. The PP prgram allws ne parent r ther supprt persn t stay with a child r teen fr the start f anesthesia. The anesthesilgist will decide if PP is right fr yu. T take part in PPI: Patients must be at least ne year ld Patients must be medically stable Patients must want a parent t be with them Patients must nt have cmplex medical needs The surgery must be scheduled ahead f time (n emergency surgeries) We may nt be able t ffer this PP ptin if we d nt have a vlunteer r Child Life Specialist available. The anesthesilgist has the final decisin abut whether this prgram is right fr yu. Please ask yur nurse, anesthesilgist r Child Life Specialist abut PP. The anesthesia dctr will... Examine yur child and explain what happens in the perating rm Explain hw yur child will g t sleep and what medicatins will be used t keep yur child cmfrtable Discuss whether yur child needs medicine t relax befre the peratin. The dctr yu meet in the Pre-assessment Clinic may nt be the anesthesia dctr n the day f the peratin. The dctrs may decide yur child needs tests like bld tests r x-rays befre surgery. We ll give yu the frms fr any tests at the time f yur visit. If yur child needs these tests, yur visit t CHEO will be lnger. During yur visit, a research assistant may speak with yu abut taking part in research t imprve surgical care. Giving cnsent fr surgery It s imprtant that yu understand the risks and benefits f the surgery, s that yu can give an infrmed cnsent. The Day f Surgery In the perating rm, yu will help the mst when yu: Allw yur child r teen t g t the OR n her wn if she wants; Hld yur child s hand gently; Sing r talk t yur child in a sthing, quiet vice; Try nt t ask yur child t many questins as he is ging t sleep. As children and yuth becme sleepy frm anesthesia, sme clse their eyes and fall asleep smthly. Others enter a stage f excitement. During this stage, they may mve their arms r legs. Sme may seem dizzy, with nisy breathing r cughing. Yu may ntice their eyes rll back. All f this is very nrmal. Yur child r teen will nt remember this stage. Befre yu sign the cnsent fr surgery, the dctr will explain: What the surgery is Why it is needed Why it will help yur child (benefits) What prblems culd happen (risks) Abut any ther ways t treat the prblem. Learning mre abut yur child s surgery If yu knw what t expect, yu will be better able t help yur child r teen. Ask yur dctr fr resurces t read Ask staff at ur Family Resurce Library t help yu find infrmatin (see the last page f this bklet). 20 5 Getting Ready fr Surgery

Ging t the perating rm Getting ready fr surgery Talking abut anesthesia (falling asleep fr surgery) It s imprtant t prepare children and yuth fr the anesthetic. Explain that yur child r teen will: Get medicine t help her fall int a deep sleep befre the surgery Breathe the medicine in thrugh a mask r get it thrugh an IV (a sft tube placed in a vein in the hand r arm). We may use numbing cream n the skin befre starting an IV. Be in a special sleep during the surgery, but dctrs and nurses will take care f him the whle time. Nt feel, see r hear anything during the peratin. Talking abut surgery Knwing what t expect n the day f surgery will help yur child r teen cpe. Make sure t: Tell the truth abut what will happen. This helps yur child r teen trust yu and the hspital staff. The truth is ften less scary than what children are actually thinking. Ask questins and let yur child tell yu what he knws. This is a gd way t find ut what he is thinking, s yu can crrect any misunderstandings. These guidelines are based n age, and will help yu prepare yur child r teen fr surgery. Babies (under 12 mnths) Yur baby will be cmfrted by familiar bjects and peple. Bring alng cmfrt items like pacifiers, favurite tys r blankets. After surgery, babies wh are nt breastfeeding are mre likely t drink frm a familiar bttle nipple r sippy cup, s bring empty nes with yu t use after surgery. Let the surgical team knw hw yur baby may react t being away frm yu. Yu can walk with yur child r teen t the perating rm. Yur child may walk, be carried r lie n a stretcher. Yur child can bring a special sft ty r blanket fr cmfrt. Please have slippers r clean shes fr yur child r teen t wear int the perating rm. Outdr shes are nt allwed in the perating rm. Different members f the health care team will ask yu abut the reasn fr yur child s surgery. This ensures that all members f the team have the same imprtant infrmatin abut yur child s surgery. In many cases, the surgen will use a marker t mark the site f yur child s surgery. Yur child s anesthesia During surgery, yur child r teen will have medicatin t keep her in a deep sleep. This is called anesthesia. During surgery, the anesthesilgist is the dctr wh takes care f yur child s: Anesthesia Pain cntrl IV (intravenus) Breathing Bld pressure Temperature Oxygen levels Heart rate Many children and yuth g t sleep by breathing anesthetic gas thrugh a mask. Sme will get medicatins thrugh an IV. All patients having surgery will have an IV, n matter hw the anesthetic is started. Yur anesthesilgist will decide the safest way fr yur child r teen t g ff t sleep. The Day f Surgery 6 19

The Day f Surgery What if my child gets really upset? It s nrmal fr a child t becme upset n the day f surgery. Yu can help yur child by: Being hnest. In a calm, quiet way, explain again why the surgery is needed. Nt making prmises yu can t keep. Fr example, dn t tell yur child that we wn t give them a needle. Reminding yur child that yu will stay clse by. Explaining what will happen next and reassure yur child that yu ve been hnest with him. Helping yur child use distractin r anther cping technique like deep breathing. Child Life Specialist Yu may meet a Child Life Specialist n the day f surgery, wh can help explain what it s like t have an peratin. Children and yuth ften have many questins abut what will happen t them n the day f surgery. Child Life Specialists: Develp ways fr children and yuth t cpe with fear and anxiety. Help prepare children and yuth fr tests and prcedures. Enhance patient s emtinal, scial and intellectual grwth during the hspital stay. Cnsider each child s stage f develpment, family and culture when prviding care. Offer chances fr therapeutic play and rganize playrm prgrams. If yu have any questins r cncerns abut preparing yur child r teen fr surgery, please cntact the Child Life Specialist at 613-737-7600, extensin 3077. Vlunteers (under the directin f Child Life Services) help supprt play activities in the playrm. Tys and activities help t pass the time and help children t feel mre relaxed. Children ften express their feelings best thrugh play. Talking t Tddlers (1-3 years) Prepare yur child the day befre surgery with a simple explanatin, like, We are ging t the hspital tmrrw s the dctr can fix the bump n yur tummy. Try t give yur tddler a little cntrl by ffering realistic chices: Which ty wuld yu like t bring? Shuld we bring the blue r the red cup? Tddlers may react t changes in their rutine. On the day f the surgery, yu can help by: Rcking and hlding yur child. Talking calmly and gently. Distracting yur child with tys r bks. Explaining what will happen just a little ahead f time. ( The nurse is ging t take yur temperature nw, yu need t hld very still ). Explaining that the surgical team is there t help her get better. Talking t Preschl children (3-6 years) Preschl children may nt fully understand why surgery is needed; sme children believe they are being punished. Yu can help by: Talking abut the surgery 2-3 days ahead f time using a calm and relaxed vice Talking abut the hspital and explaining that it is a safe place and the staff are there t help Using play t help yur child understand the surgery (ty medical kits r bks) Aviding bribes r threats. Fr example: On Thursday we ll be ging t CHEO t have tiny tubes put in yur ears t help prevent all thse ear infectins yu ve been getting. Yu ll get sme sleep medicine s yu ll be in a really deep sleep while the dctr puts the tubes in. Yu ll wake up in a wake up rm where nurses will be there t take care f yu. We ll be able t see yu sn after yu wake up. Getting Ready fr Surgery 18 7

Getting Ready fr Surgery Talking t Schl aged children (6-12 years) Schl aged children have a basic understanding f hw their bdies wrk. Start preparing yur child a week r mre ahead f time. They need time t ask questins and talk abut their feelings. Yu can help by: Encuraging yur child t ask questins and express feelings. It s OK t feel angry r afraid. Preparing yur child fr any stitches r bandages they will see after the surgery. Aviding bribes r threats. Talking t Yuth (12-18 years) Yuth are mre independent and shuld becme invlved in their health care. They may ask fr detailed explanatins. They are ften wrried abut privacy. Yu can help by: Being hnest. Yur teen has a right t knw abut everything that will happen. Encuraging yur teen t ask questins f yu r hspital staff. It may help t write ut questins fr the dctr r nurse ahead f time. Giving space s yur teen can speak t the dctr r nurse alne. Reminding yur teen that it s OK t feel angry r wrried. In the Day Surgery Unit Please arrive 2 hurs befre yur child s surgery time. Arriving early is imprtant s that: We will have plenty f time t get yur child ready Yu will have a chance t talk with the surgical team Yur child r teen will nt feel rushed. Yu can find the Day Surgery Unit, n the 3rd flr f the main CHEO building. In the Day Surgery Unit, yu will: Meet and register with a patient service clerk Prvide yur child s health card Cnfirm infrmatin abut yur child Receive an ID badge t wear fr the day t identify yu as yur child s parent r caregiver. Keeping Health Infrmatin Private At the registratin desk, ur clerk will ask parents questins abut their children s health and surgery. Parents may feel uncmfrtable answering these questins if thers are standing clse enugh t hear. Please give ther families enugh space fr a private cnversatin with the registratin clerk. Be kind...please dn t eat r drink in frnt f thse wh can t! While yu are waiting fr surgery with yur child r teen, please dn t eat r drink. This is hard fr ur patients wh can t eat r drink befre surgery. If yu bring a lunch with yu, keep it in a bag and yu can eat after yur child r teen ges in fr surgery. We have lckers in the unit fr yur cats and yur child s clthing. These lckers dn t have lcks, s dn t leave anything valuable inside. Yu are respnsible fr yur belngings. In the Day Surgery Unit, the nurses: Will give yur child r teen a check up and ask abut earlier experiences with hspitals and surgery May apply an anesthetic n t the skin t numb the area fr the IV Will give yur child hspital pajamas t wear Will shw yu t the playrm, where yur child can play befre surgery May give yur child medicatin befre the anesthesia if the anesthesilgist has rdered it. If we give yur child a sedative befre surgery, she will rest in bed until surgery. The sedative quickly makes children and yuth drwsy. 8 17 The Day f Surgery

Wh shuld cme t CHEO? Just 2 adults can cme alng with a child having surgery at CHEO. Please make sure t arrange child care fr yur ther children. D nt bring them t CHEO with yu. Grandparents, uncles and aunts shuld als stay at hme. At least 1 parent must stay at CHEO during the surgery. Preventing the spread f infectins We want t make sure ur patients get well quickly. Please help us prevent the spread f infectins by: Staying hme if yu are sick (a fever, cugh, runny nse, sre thrat, diarrhea, a new rash r are feeling ill). Cleaning yur hands ften with sap and water r alchl-based hand gel. Yu must wash with sap and water if yu can see dirt r if there is mucus n yur hands. Tls t help children and yuth cpe with surgery 1. CHEO s surgery virtual tur Our virtual tur will explain hw t get ready, what t expect and will allw yur family t see ur clinics, perating rms, and recvery rms. Visit: http://www.che.n.ca/virtual_tur/index.html 2. MindMasters and Mini-MindMasters CHEO s Partnerships and Advcacy Prgram has develped these prgrams t help children master psitive living skills. MindMasters was tested at CHEO with children cming fr tests and treatments. MindMasters and Mini MindMasters will help yu teach yur child hw t: Relax Cntrl stress Lk fr the gd things in each experience Think psitively Use psitive imagery The Day f Surgery Surgery cancellatins r delays Yur time is imprtant, hwever, surgeries are smetimes delayed r cancelled because: We need t d emergency surgery n a seriusly ill r injured child. Anther child s surgery takes lnger than expected. We may nt have an inpatient bed available fr children r yuth needing t stay in hspital after surgery (caused by high numbers f patients in ur inpatient units). We will d ur best t keep yu infrmed abut any delays. We nly cancel surgeries if we have n ther chice. If yur child s surgery gets cancelled, we will bk a new surgery date as quickly as pssible. We appreciate yur understanding! Visit: http://www.child-yuth-health.net/en/child-yuth-health/ Publicatins_and_Resurces_p233.html 16 9 Getting Ready fr Surgery

Getting Ready fr Surgery Just fr teens... Getting Ready Yu prbably have a lt f questins abut yur surgery. Make sure yu talk with yur parents r caregivers and yur surgen s they knw what s n yur mind. If yu smke.. Try t stp fr at least a week befre surgery. Smking r using drugs r alchl befre yur surgery can cause risks that culd make yur surgery unsafe. Piercings and jewellery (metal and plastic) Make sure t remve all studs and jewellery befre surgery, t prevent prblems like: Chking n r swallwing tngue studs r lip rings. Jewellery in and arund the muth can becme lse r get accidentally pulled ut during surgery, and can get stuck in yur windpipe r end up in yur stmach. Piercings getting caught r pulled ut when we are psitining yu n the perating rm bed. Burns. Wearing metal jewellery can cause burns if we use certain equipment during yur surgery (like cautery t stp bleeding). Driving after surgery Yu are nt allwed t drive fr 24 hurs after having an anesthetic. Teen girls If yu have yur perid, use a pad instead f a tampn n the day f surgery. If there is a chance yu may be pregnant, it is very imprtant fr yu t tell yur nurse r dctr. Tell yur dctr if yu use Dep Prvera r any ther hrmnal birth cntrl methd. If yu are taking birth cntrl pills, ask yur dctr if yu shuld take ne n the day f surgery. Yu ll need t remve yur bra when yu put n the hspital pajamas- nurses in the perating rm will need t place heart mnitr stickers n yur chest befre yu fall asleep. We will keep yu cvered thugh! Checklist: This bklet! Yur child s health card (yu will need t pay with a credit card if yu d nt have the health card with yu r if it has expired) Legal guardianship papers (if yu are nt the child s parent) Private insurance infrmatin A list f yur child s medicatins and dses Cmfrtable clthes fr yur child r teen t wear hme Eye-glasses (make sure yur child r teen leaves cntact lenses at hme) Elastics t tie lng hair back (metal hair clips are nt allwed) Slippers r clean indr shes Bathrbe r zip-up hdie t wear ver hspital pajamas A bag fr clthing Pacifiers and diapers if yur child uses them Special ty r blanket yur child can take int the perating rm (we will label this with yur child s name) Prtable music r DVD players (with ear phnes), r hand held electrnic games t pass the time (we als have tys and activities in the Day Surgery playrm fr children t enjy while waiting) Bks r magazines fr parents t read What t bring n the day f surgery Remember! Yu are respnsible fr yur child s valuable items. We d nt have lcked areas t stre them fr yu. 10 15 The Day f Surgery

The Day Befre Surgery Cnfirming surgery time We will call yu 1-2 days befre surgery t cnfirm what time yu shuld arrive at CHEO. If we d nt call yu by 8:00 pm the evening befre yur child s surgery, please call CHEO s Admitting Department: 613-737-7600, extensin 2310, befre 11:00 p.m. What if my child r teen is sick befre surgery? Call yur surgen s ffice if yur child has been in cntact with these illnesses in the 3 weeks befre surgery: Measles, Mumps r Chicken Px Whping Cugh Scarlet Fever TB (tuberculsis) Cntact yur surgen s ffice if yur child: Has a cld r cugh with mucus (and desn t feel like eating r is very tired) Is wheezing Has a fever Is vmiting r has diarrhea Has any cntagius disease, like pink-eye, chicken px, mumps, measles, tuberculsis (TB), whping cugh r scarlet fever (call yur surgen as sn as pssible). Between 4:00 p.m. and 11:00 p.m. the evening befre surgery (r if yu can t reach yur surgen): Call Admitting 613-737-7600 extensin 2310 and tell them yur child r teen is ill. We will have t cancel surgery and re-schedule it later if yur child has any f the illnesses listed abve. If yur child has mild cld symptms, but n fever, we may ask yu t cme t Day Care Surgery in the mrning t have yur child assessed by the anesthesilgist t decide if we will g ahead with the surgery. After 11:00 pm the evening befre surgery: Call 613-737-2346 (Day Care Surgery) and leave a message. Be sure t include yur child s name, date f surgery, surgen s name and the illness (fr example, a cld r fever). 14 Checklist: Make sure yur child r teen: Fllws the fasting guidelines carefully (see page 13-14) Takes a bath r shwer the evening befre (r the mrning f) surgery Remves all make up and nail plish Remves all jewellery (including plastic jewellery) frm piercings (frm nse, tngue, belly buttn, eyebrws, ears...) Make sure yu: The day befre surgery Help yur child pack a bag with cmfrtable clthes, slippers, music, bks and a special cmfrt ty. Arrange child care fr yur ther children. Speak with CHEO staff t cnfirm the time yu shuld arrive at CHEO. Arrange fr a ride hme frm the hspital. Patients wh have had surgery are nt allwed t take public transprtatin (day surgery nly). Prepare yur child r teen s she has an age apprpriate understanding f what s ging t happen at the hspital. Have acetaminphen (Tylenl r Tempra ) and Gravl n hand at hme. Remind yur daughter t use a pad instead f a tampn n the day f surgery if she is having her perid. 11 The Day Befre Surgery

Fasting guidelines Fllw these directins carefully, even if yur child has tube feedings.! If yur child is having an endscpy, please fllw the special fasting guidelines that yur dctr gives yu. If yur surgen r anesthesilgist tells yu t give yur child regular medicatins the day f surgery, give them with a very small sip f water nly. D nt give medicatins with applesauce, yghurt r ther fds, even if yu usually give medicatins this way. Offer yur child r teen a healthy snack befre bedtime the night befre surgery. Babies and tddlers under 2 years: N fd after midnight. Yur child may have: Frmula, milk r frtified breast milk up t 6 hurs befre surgery Breast milk up t 4 hurs befre surgery Water, clear diluted apple juice r clear jell gelatin and nthing else up t 3 hurs befre surgery. D nt give gum, candies r any fluids with red r purple fd cluring (like red jell r sprts drinks). Parents and caregivers shuld nt fast with their children. Please eat as yu nrmally wuld, s yu will have the energy yu need t supprt yur child. The Day Befre Surgery Sme children and yuth with n-ging health prblems may need t fast fr 3 hurs lnger than ther children. Yur dctr will let yu knw if this is needed. Why can t my child eat r drink befre surgery? Everyne having anesthesia (sleep medicine fr surgery) must have an empty stmach. While yur child is in this deep sleep fr surgery, any fd r fluid in the stmach can cme back up int the thrat, and drain int the windpipe and lungs. This can cause breathing prblems and infectin, which can be very serius. Fllw fasting directins carefully. We may need t delay r cancel yur child s surgery if yur child has smething t eat r drink by mistake. Children and yuth (2 years and lder): N fd, milk r dairy prducts after midnight. Yur child r teen may have: Water, apple juice, ginger ale r jell gelatin and nthing else up t 3 hurs befre surgery. D nt give gum, candies r any fluids with red r purple fd cluring (like red jell r sprts drinks). Children wh are still breastfeeding can have breastmilk up t 4 hurs befre surgery. The Day Befre Surgery 12 13