Center for Thoracic Oncology
The team at the Center for Thoracic Oncology at Boston Medical Center, thanks you for choosing us for your care. We pride ourselves on offering exceptional care, without exception.
This section provides information that will help you after your upcoming chest surgery. Please read through it before your surgery. It is designed to give you as much information as possible so that you will be knowledgeable and informed about your upcoming procedure.
In addition, members of the thoracic surgery team are available to assist you with any concerns or questions that you might have. We are committed to making your stay as comfortable as possible.
Recovering in the Hospital
Following your surgery, you will be transferred to the Post Anesthesia Unit, a recovery area near the operating room where you will be connected to several monitoring devices. Members of the team will watch your condition closely as you awaken from anesthesia.
When you have recovered sufficiently, you will be transferred to a bed in the Surgical Intensive Care Unit Newton 3 West or the Progressive Care Unit on Newton Pavilion 8 East. Nurses in these units are specialists in caring for cardiothoracic surgery patients.
While you're in the hospital, you will be closely monitored. You may have the following procedures and equipment during your stay:
- Endotracheal tube: This tube is put through your mouth and into your windpipe to control your breathing during your operation. It is connected to a ventilator (breathing machine). You will not be able to speak while the tube is in. You will be able to communicate by nodding and writing. The tube is removed as soon as you are able to breathe on your own. This is often before you leave the recovery room. It may be in place longer depending on your individual condition.
- Oxygen: You will be given oxygen if you need it. It is usually delivered through a small tube in your nose or through a facemask placed over your nose and mouth.
- Heart monitor: Three to five sticky pads will be placed on your chest. The pads are attached to wires and a monitor that traces your heart rate and rhythm.
- Epidural catheter: This small tube that is inserted into your back by the anesthesiologist, and attached to a small device that delivers pain medication. While it is in place, you should have effective pain control. Your nurse will ask you to rate your pain on a scale of 1 to 10 to assess your pain control.
- Patient controlled anesthesia (PCA): Another method used for managing pain, this device is attached to an intravenous line (IV) in your arm. It has a small button that you can push to give yourself pain medication when you need it. It is programmed so you receive an appropriate dose. Your nurses will explain how to use the PCA.
- Incisions: If you had a video-assisted procedure (VATS, thoracoscopy) you will have three small incisions with small dressings. You may have a chest tube in one of the incisions. If you had a thoracotomy, you will have a larger incision that will be covered by a bulky dressing. You may have surgical staples in the skin. These are small pieces of metal used to close the incision. They will be removed before you leave the hospital or when you return to see your surgeon approximately two weeks after you are discharged. Your nurses will change the dressing and check for drainage.
- Intravenous lines: A small tube (IV) is inserted into one of your veins (blood vessel) so that fluids or medications can be given.
- Other special lines: Similar to intravenous lines, there are several other types that may be used to obtain critical information. For example, an arterial line is inserted into an artery (blood vessel) and used to measure blood pressure, obtain blood, and get information about the amount of oxygen in the blood. These special lines are generally used only in the first day or two after your surgery.
- Chest tubes: One or more chest tubes will be inserted in your side during surgery. The tubes are used to drain fluid, blood, and air from your chest. The tube is attached to a container that is placed next to your bed. The container collects the fluid and removes air from your chest. The tubes are taken out when there is no longer an air leak or drainage, usually four to five days after your surgery.
- Foley catheter: This tube is inserted into your bladder to drain urine. It will be removed when you can urinate on your own. While it is in, you may have the sensation of needing to urinate. Relax and the catheter will drain the urine. Do not pull on the catheter as this could cause injury.
- Nasogastric tubes (stomach tubes): This is a small tube that is inserted through your nose into your stomach. It removes air from your stomach and helps to prevent vomiting. It is usually removed with the first day or two after your surgery.
- Taking vital signs: Your blood pressure will be taken frequently. Your heart rate, respirations (number of breaths) and temperature will be also be monitored.
- Pulse oximeter: A small probe is attached to the tip of a finger, your earlobe, or toe to measure the amount of oxygen in your blood.
- Chest x-rays: Following lung or chest surgery, chest x-rays provide valuable information about your lungs.
- Measures to prevent blood clots: You may receive special medication (heparin) that helps prevent blood clots. Special boots (pneumatic boots) will be put on your legs. The boots inflate periodically, helping to push blood to the heart so that clots do not form. You will be asked to walk as soon as it is safe for you to do so. Walking helps your circulation. When you are walking several times a day, you will no longer have to use the boots
Important Things to Know
There is much you can do to participate in and speed your recovery. Your understanding is important so you know what to expect.
- Pain management: Chest and lung surgery causes pain. Several methods are used to control the pain and keep you comfortable. It is important for you to be relatively pain free so that you can cough and take deep breaths. We pay a great deal of attention to managing pain. Your nurses will closely monitor your level of pain and your need for pain medication. Several methods of pain control are available. These include the epidural catheter, patient-controlled anesthesia (PCA), medication administered by injection, and medication taken by mouth. You will receive pain medication when necessary and as your condition allows. You will be asked to rate your pain using a pain scale. You will assign a number to your pain and this will help your nurse understand how much pain you are experiencing.
- Activity: Getting out of bed and walking will help your recovery and prevent complications. Walking and activity will help clear secretions from your lungs, help your circulation, and help you to regain muscle strength. You will be sitting up in bed and possibly getting out of bed the day of surgery or the day after. You will progress to sitting in a chair and walking to the bathroom with the assistance of your nurse. A physical therapist will take you for your first walk and you will then progress to walking several times each day.
- Diet: It is normal to not feel hungry after having surgery. You will begin by taking sips of liquids. Your diet will then be advanced to solids as you can tolerate them. Good nutrition is important for healing. As you begin to eat a regular diet, try to eat foods with fiber to prevent constipation.
- Clearing secretions: After lung surgery, it is important to clear the lungs of secretions. This promotes good oxygenation, helps to prevent collapse of the lungs, and helps prevent infection. Taking deep breaths and coughing helps to accomplish this.
- Using your incentive spirometer: The incentive spirometer is an instrument that encourages you to take deep breaths. You will be given one after your surgery. It is important that you use it several times an hour (at least 10) for several days after your surgery. Deep breathing and coughing exercises after surgery will help keep your lungs healthy.
How to Use Your Incentive Spirometer
- Sit up as much as possible.
- Hold the incentive spirometer upright.
- Breathe out normally.
- Place the mouthpiece in your mouth and seal your lips around it.
- Breathe in slowly and as deeply as possible, raising the piston toward the top of the column. It is important to breathe in slowly.
- Continue to breathe in and when it feels like you cannot breathe in any more, hold your breath for 3 to 5 seconds and breathe out slowly.
- Breathe normally for a few breaths.
- Do this at least 10 breaths an hour.
- After you have taken a series of breaths, you should cough to remove secretions from your lungs. You may place a pillow or folded blanket over your incision and apply gentle pressure as you cough. You nurse can help you with this. This provides support and helps decrease some of the pain you may feel when you cough.
- Keep your incentive spirometer within reach so you remember to use it frequently. One way to remember is to do a set of five breaths whenever there is a commercial break on television.