WHAT YOU SHOULD KNOW
In a thoracotomy (THOR-uh-KAH-tuh-mee), the surgeon makes a long incision between two ribs, from front to back, on one side of your chest. Once the chest wall has been opened in this way, the surgeon can remove all or part of a diseased or damaged lung. A thoracotomy is typically performed to treat a lung abscess, lung cancer, or the blebs (balloon-like sacs pressing on the lung) that sometimes form in emphysema. The operation requires 6 to 8 days of hospitalization.
Risks
There are always risks with surgery. You might develop internal bleeding or get an infection. Blood clots could form and lodge in the lungs, making it difficult to breath. However, medical personnel are always alert for such complications, and know how to remedy them.
IF YOU'RE HEADING FOR THE HOSPITAL...
Before You Go
The Week Before Surgery:
You'll probably need to stop taking aspirin and ibuprofen; the doctor will tell you when. If you're taking aspirin for your heart, don't stop without asking the doctor first. Also ask whether you can take any over-the-counter medicines.
Your doctor will tell you whether you need to have blood drawn.
The Night Before Surgery:
Your physician may suggest you take a sleeping pill.
Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you when to begin fasting.
Call Your Doctor If...
You have a cold or flu or are running a high temperature. The operation may need to be postponed.
The problems for which you are having the operation get any worse.
When You Arrive
Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
Do not wear contact lenses to the hospital. You may wear glasses.
What to Expect While You're There
You may encounter the following procedures and equipment during your stay.
Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
Chest X-ray: The surgeon will use this picture of your lungs and heart to help plan the operation.
Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
Special Tubes: For this type of operation, a variety of special-purpose tubes may be inserted in your blood vessels.
CVP Line: A CVP line, also called a central line, is an IV tube inserted in a large blood vessel near your collarbone, in your neck, or in your groin. To make insertion easier, the head of your bed may be lowered to help the blood vessel fill up and expand. The skin at the insertion site will be numbed to reduce any pain. Once in place, the line can be used to give medicine and measure the activity of your heart.
Swan-Ganz: This thin tube is passed into a vein near the collarbone or neck, then maneuvered through the heart and into the lungs. One of the tube's outlets is hooked to a heart monitor. Another can be used to give medicine.
Arterial Line: This tube, also called an "art line" or an "A-line," is inserted in an artery, usually in the wrist or groin. Nurses will keep the line filled with liquid to keep it from getting plugged. It can be used for measuring blood pressure or for drawing blood.
General Anesthesia: This type of pain-killing medication puts you completely to sleep during the operation. It is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.
After Surgery:
The operation typically takes 3 to 4 hours. The incision will be closed with stitches or staples, and bandaged to keep the area clean and prevent infection. (A nurse may briefly remove the bandage and check the stitches shortly after surgery.) You'll need to stay in bed until the doctor says it's safe to get up. As you recover, you can expect the following:
Ventilator: This is a special machine that can do your breathing for you. It can be hooked up to an endotracheal (END-o-TRA-kee-ull) tube in your mouth or nose, or a tube called a trach (trayk) that's passed into your airway through an incision in the front of your neck.
Wrist Restraints: These are strips of cloth or leather that tie your wrists to the sides of the bed. Restraints are used to keep you from accidentally pulling out your breathing tube. The restraints will be taken off as soon as the tube is removed.
Day or Night Confusion: Patients recovering in the ICU often can't tell whether it's day or night, since the lights are on 24 hours a day. This problem will disappear once you are moved to a room on a regular floor.
Blood Gases: This test measures the amount of oxygen, acids, and carbon dioxide in the blood---measurements that are especially important if you're having any trouble breathing. The blood sample for the test is taken from an artery in the wrist, elbow, or groin.
Chest Tubes: After the operation, these tubes may be left in your chest to remove air, blood, or fluid from the area around your lungs. This will make it easier for the lungs to refill with air when you inhale. The tubes will be attached to a container of bubbling water.
Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
Hold a pillow tightly against your abdomen to help reduce pain from your incision. Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
Incentive Spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
Pressure Stockings: These tight elastic stockings keep blood from collecting in the legs and causing clots.
Pneumatic Boots: For extra insurance against blood clots, these plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens and loosens different parts of the boots, helping to push the blood back up to the heart.
Activity: You may need to rest in bed for a while. But even if you are confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
Nasogastric Tube: This type of tube, also called an NG tube, is threaded through your nose and throat and down into your stomach. It is attached to suction, which will keep your stomach empty. It may also help to get your bowels working. Food or medicine is sometimes given through the tube.
Eating: When your doctor can hear bowel sounds (stomach growling) through a stethoscope, you'll be able to eat. You will probably get ice chips first and then liquids (water, broth, apple juice, or soda). If you do not have problems with the liquids, you'll then be allowed to eat soft foods such as ice cream, applesauce, or custard. If these foods agree with you, you can return to a regular diet.
Bowel Movements: Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
Foley Catheter: This is a tube that is sometimes inserted into the bladder to drain your urine. The catheter may make you feel as though you have to urinate. Relax and the catheter will drain the urine for you.
Don't pull on the catheter because this could cause injury.
Don't kink the catheter; this will stop the flow.
Don't lift the bag of urine above the catheter. If you do, the urine will flow back into your bladder, possibly causing an infection.
The catheter will be taken out when you can urinate on your own.
Strict Intake or Output: Your doctors may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Care givers often call this "I&O."
Medicines:
Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
Stool Softeners: These medications make bowel movements softer so you won't need to strain.
Breathing Treatments: To open your airways and make breathing easier, you may need to inhale medicine from a special machine. Right after the operation, you'll probably receive the treatments on a regular basis. Later, they'll be given only when you have trouble breathing.
After You Leave
Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
You may use heat for pain or swelling. Apply a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need relief. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area of the operation and helps it heal faster.
When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water. Then put on a clean, new bandage. Change the bandage any time it gets wet or dirty.
To keep your lungs free of infection, continue your deep breathing exercises. You may also be asked to keep on using an incentive spirometer.
If you are on oxygen at home, a nurse will teach you how to set the controls on the tank. Smoking around oxygen can cause a fire. For safety, you must not smoke or let anyone smoke around you. If your nose becomes dry and sore, use Vaseline® ointment on it.
Eat healthy meals from all 5 food groups: fruits, vegetables, breads, dairy products, and meat. This will increase your energy level and promote faster healing.
Unless instructed otherwise, drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day. Limit caffeinated beverages, such as coffee, tea, and soda.
Slowly start to do more each day, resting as needed. Once you feel stronger, start a regular exercise program. Exercise makes the heart stronger, lowers blood pressure, and keeps you healthy. Your doctor can help you plan the program. Do not lift anything heavy until your doctor says it's OK.
If you smoke, this is certainly an ideal time to quit. If you have trouble, ask your doctor for help.
Call Your Doctor If...
You have trouble breathing.
Oxygen doesn't help your breathing.
Your incision is red and swollen, or has pus coming from it. These are signs of infection.
Your stitches or staples come apart.
Your bandage becomes soaked with blood.
You develop a high temperature.
You cough up yellow, green, or bloody mucus.
You develop itchy, swollen skin or a rash. You might be allergic to your medicine.
Seek Care Immediately If...
You have chest pain or sudden trouble breathing.
You are coughing up blood.
