THE SURGERY BEGINS
Once you learn that a donor’s lungs are a viable match, you will be hurried into the pre-surgery area within minutes. You will be prepped with IVs in both arms and consulted by the doctors and nurses about what to expect next. Your groin area may be shaved to make a clean site for a femoral artery line insertion. Then you will be wheeled into the operating room, where you will be put to sleep. Nurses will insert the femoral catheter as well as one in your jugular vein. These lines will help the surgeon monitor your vital signs during the operation.
The surgeon will make an incision based upon the type of lung transplant you are having. For a single lung transplant, you will be cut on the coinciding side of your chest or back. For a double lung transplant, you will typically be incised under the breast line, from armpit to armpit, and across the sternum. This is called a clam-shell incision. In rare instances, during heart/lung transplants, the patient’s sternum is sawed in two, opening the chest up vertically for a maximum work area. You will be completely sedated for the duration of the surgery, with mechanical ventilation and/or cardiopulmonary bypass to oxygenate your blood.
You will undergo a lung perfusion test before the transplant to assess how well each of your lungs is functioning. In a single lung transplant, your worst lung will be removed. In a double lung transplant, your worst lung will be removed first, followed by your other native lung while your body “lives” off of the newly placed organ.
Once the lungs are in, your sternum will be wired with transverse wiring to reinforce your chest cavity. You will then be sewn up, and the surgeon will staple the outer layer of your skin together. You will still be ventilated, sedated, and heavily medicated during your surgery and immediate recovery. You will be connected to several machines. A patient’s instinct is to pull out tubes and catheters when he or she is sedated, so to prevent you from harming yourself, nurses may gently tie your arms to your bedside until you are fully awake and aware.
WHEN YOU AWAKEN
When you wake up in the recovery room or ICU, you will be closely monitored for at least several days. You will have a tube in your throat so that your breathing can be assisted with a ventilator until you are stable enough to breathe on your own. You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, breathing rate, and your oxygen level.
Your immediate family members should be able to see you when you wake up. Each hospital has its own policy on visitors, so it is advisable to check on your transplant center’s policy before your surgery.
You may have a thin, plastic tube inserted through your nose into your stomach to remove air that you swallow. The tube will be removed when your bowels resume normal function. You will not be able to eat or drink until the tube is removed. You will also have four to eight chest tubes in the sides of your torso to drain fluid around your new lungs. These will be removed before you leave the hospital.
Blood samples will be taken frequently to monitor the status of your new lung(s) and to check the functioning of your body’s other organs such as your kidneys, liver, and heart. You may be on special IV drips to control your blood pressure and your heart rhythms, and to control any problems with bleeding. As your condition stabilizes, these drips will be gradually weaned down and turned off as you can tolerate it. You will have several chest tubes protruding from your skin near your ribs that are inserted to drain air, blood, or infection from the space surrounding your lungs. You will receive pain medication as needed, administered either by a nurse, through an epidural catheter, or by clicking a device connected to your intravenous line.
Your immunosuppression (anti-rejection) medications will be closely monitored to make sure you are receiving the optimum dose and the best combination of medications. Once the breathing and stomach tubes have been removed and your condition has stabilized, you may start drinking liquids. On occasion, a patient’s vocal chords are damaged during surgery, which can impair your ability to swallow. If this happens, you will be required to add a thickener to all liquids until your vocal cords are repaired. Afterward, your diet will gradually advance to more solid foods.
Your physical therapy will begin as soon as possible after you wake up. It may begin when you are still in the ICU or on a ventilator. Typically, when you have been off of the ventilator for 48 hours, you will be moved to a regular nursing or transplant unit. Nurses, respiratory therapists, and physical therapists will continue to help you with physical therapy and breathing exercises. Your activity will be gradually increased as you get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as tolerated. Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital. Lung transplant surgery typically requires an in-hospital stay of at least seven days.