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Patient Information

Post-Procedure Instructions

The team of the Section of Thoracic Surgery 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 chest surgery. Please read it before your surgery. It’s designed to give you as much information as possible so you’ll be knowledgeable and informed about your upcoming procedure.

In addition, members of the thoracic surgery team are available to help you with any concerns or questions you might have, and are committed to making your stay at BMC as comfortable as possible.

Recovering in the Hospital

Following your surgery, you’ll be transferred to the Post Anesthesia Unit, a recovery area near the operating room where you’ll be connected to several monitoring devices. Members of the team will watch your condition closely as you awaken from anesthesia.

When you have recovered enough, we will transfer you to the Surgical Intensive Care Unit, which is located on Newton 3 West, or the Progressive Care Unit on Newton 6 West.

Nurses in these units are specialists in caring for thoracic surgery patients.

Monitoring

While you’re in the hospital, we’ll watch your condition closely. You may have the following procedures and equipment during your stay:

  • Endotracheal tube: This tube is connected to a ventilator, or breathing machine, and put through your mouth and into your windpipe to control your breathing during your surgery. You won’t be able to speak while the tube is in place, so you’ll communicate by nodding and writing. We’ll remove the tube as soon as you’re able to breathe on your own. This is often before you leave the recovery room, but the tube may remain in place longer, depending on your condition.

  • Oxygen: If you need it, you’ll receive oxygen, which is usually given through a small tube in your nose or through a facemask placed over your nose and mouth.

  • Heart monitor: We’ll put three to five sticky pads on your chest that are attached to wires, and a will monitor trace your heart rate and rhythm.

  • Epidural catheter: This small tube is attached to a device that delivers pain medication. The tube is inserted into your back by the anesthesiologist. While it is in place, you should have effective pain control. To assess your pain control, your nurse will ask you to rate your pain on a scale of 1 to 10.

  • Patient-controlled anesthesia (PCA): Another method for managing pain, this device is attached to an intravenous line (IV) in your arm and has a small button 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 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, small pieces of metal used to close the incision, in your skin. They will be removed before you leave the hospital or when you return to see your surgeon about two weeks after your discharge. Your nurses will change your dressings and check for drainage.

  • Intravenous lines: A small tube, referred to as an IV, is inserted into one of your veins (blood vessel), so you can receive fluids or medications.

  • Other special lines: Similar to intravenous lines, there are several other types of lines that we may use to collect critical information. For example, an arterial line is inserted into an artery, or blood vessel, to measure blood pressure, obtain blood, and get information about the amount of oxygen in your blood. These special lines are generally used only in the first day or two after your surgery.

  • Chest tubes: One or more chest tubes are inserted in your side during surgery to drain fluid, blood, and air from your chest. The tubes are attached to a container, which collects the fluid and removes air from your chest. Tubes are taken out when there is no air leak or drainage, usually about four or five days after surgery.

  • Foley catheter: This tube is inserted into your bladder to drain urine, and is 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. Don’t pull the catheter; it could cause injury.

  • Nasogastric (stomach) tubes: This small tube is inserted into your stomach through your nose. It removes air from your stomach, helps prevent vomiting, and is usually removed within the first day or two after surgery.

  • Taking (monitoring) vital signs: We will take your blood pressure often, and will also monitor your heart rate, respirations (number of breaths) and temperature.

  • Pulse oximeter: A pulse oximeter is a small probe we attach to the tip of a finger, an earlobe, or a 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 and pneumatic boots for your legs. The boots inflate from time to time to help push blood to your heart so clots don’t form. We will ask you to walk as soon as it is safe for you, because walking helps your circulation. When you are walking several times a day, you won’t have to use the boots any longer.

Important Things to Know

There a lot 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, and we use several methods to control pain and keep you comfortable. It’s important for you to be relatively pain free so that you can cough and take deep breaths. We pay a lot of attention to managing pain, and your nurses will closely monitor your level of pain and your need for pain medication. Several methods of pain control are available, including epidural catheters, 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, and we will ask you to rate your pain using a pain scale. This means assigning a number to your pain to help your nurse understand how much pain you are feeling.

  • 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 regain muscle strength. The day of your surgery or the day after, you will sit up in bed and possibly get out of bed. Then you’ll progress to sitting in a chair and walking to the bathroom with the help of a nurse. A physical therapist will take you for your first walk, and you’ll then progress to walking several times a day.

  • Diet: It’s normal not to feel hungry after having surgery. You begin by taking sips of liquids. You then begin eating solids when you feel able to. 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’s important to clear the lungs of secretions. Clearing the lungs promotes good oxygenation and helps prevent the collapse of the lungs, as well as infection. Taking deep breaths and coughing helps accomplish this.

  • Using your incentive spirometer: An incentive spirometer is an instrument that encourages you to take deep breaths. You’ll be given one after your surgery. It’s important for you to use it several times—at least 10—an hour for several days after your surgery. Deep breathing and coughing exercises after surgery will help keep your lungs healthy. Here’s how to use an 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’s important to breathe in slowly.

  • Continue to breathe in, and when it feels like you can’t breathe in any more, hold your breath for three to five 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. This provides support and helps to decrease some of the pain you may feel when you cough. Your nurse can help you with this.

  • Keep your incentive spirometer within reach so you remember to use it often. One way to remember is to do a set of five breaths whenever there is a commercial break on television.

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