Thoracotomy

WHAT YOU SHOULD KNOW:

A thoracotomy is surgery to repair any damage to the blood vessels and organs inside your chest. These organs include your esophagus, heart, lungs, and trachea (windpipe). A thoracotomy is also done to remove a lung tumor or an abscess (infection with pus). A thoracotomy may also be done to remove air or blood trapped inside your chest.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • You may have an allergic reaction to the anesthesia used during your surgery. You may lose more blood than expected during surgery. Some of your ribs may be broken, causing pain after you wake up. After surgery, you may also have pain and trouble moving your arms and shoulders. You may have post-thoracotomy pain syndrome (PTPS). With PTPS you will feel pain at your incision site for 2 months or longer. After surgery, you may feel dizzy, have blood clots, a nerve injury, lung problems, and a decrease in blood pressure. You may get a blood clot in your leg or arm. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. Problems that occur during or after surgery may be life-threatening.

  • Without surgery, damaged organs in your chest may not be repaired. You may continue to bleed and have trouble breathing. Tumors inside your lung may grow and damage nearby tissues, or spread to other parts of your body. Lung infections and pus will remain and may damage your healthy lung tissues. This may lead to worsening lung problems. These problems may be life-threatening.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • General anesthesia: This is medicine that may be given in your IV. With general anesthesia, you will be completely asleep and free from pain during your surgery.

  • Endotracheal (ET) tube: An endotracheal tube may be put into your mouth. It goes down into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube.

  • Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag.

  • Monitoring:

    • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. An arterial line may be used for measuring your blood pressure or for taking blood.

    • CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

During your surgery:

  • You will lie flat on your back or on your side. The way you are placed on the operating table will depend on which incision your caregiver uses. One of the following incisions will normally be used for your surgery:

    • Anterolateral incision: Your incision will start at your sternum (breastbone) and go across to your side, just under your armpit.

    • Median sternotomy: Your incision will be made in the middle of your chest. Your sternum will also be split down the middle and spread gently apart.

    • Muscle-sparing incision: This incision may be used to decrease injury to your chest area. The muscle-sparing incision will start on your side behind your nipple line. Your incision will then go up and across to just under your armpit.

    • Posterolateral incision: Your incision will start at your sternum and go across your side to your back.

  • Your caregiver may need to cut through your muscles and tissues to reach certain areas. Your incision will be kept open to allow your caregiver to work inside your chest. Your caregiver will repair torn blood vessels, organs, or tissues, and remove tumors, pus, or blood. He may place a tube or drains in your chest. The tube or drain will help prevent blood from collecting in your chest and help you breathe better. If you bleed more than expected, you may be given blood through your IV. Your chest wound may be closed with wire, stitches, or staples. A bandage will cover your incision site to help keep the area clean and dry to prevent infection.

After your surgery:

You may be taken to a room or the intensive care unit (ICU) where you can rest. An endotracheal (ET) tube may be left inside your mouth and throat for 1 or 2 days after your surgery. The ET tube is hooked to a machine called a ventilator that will help you breathe. Caregivers will watch you closely for problems. Do not try to get out of bed until your caregiver says it is okay. Caregivers will continue to watch your health and check for any problems. A caregiver may remove your bandage soon after your surgery to check your incision site.

  • Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.

  • Drains and tubes:

    • Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. The chest tube is attached to a container to collect the draining blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let your caregiver know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube.

    • Chest drains: These are thin rubber tubes put under your skin to drain fluid from around your incision. The drains are taken out when your surgery site stops draining blood or other fluid.

    • Nasogastric tube: This is also called an NG tube. This tube may be put in your nose and down into your stomach. The tube is attached to suction that keeps the stomach empty. This tube may help get your bowels working. Sometimes food or medicine can be given through the NG tube.

  • Medicines:

    • Antibiotics: This medicine may be given to help fight infection caused by bacteria.

    • Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.

    • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.

    • Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.

  • Deep breathing and coughing: After your ET tube has been removed, you will need to do coughing and deep breathing exercises. Breathing exercises help to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake, even if you wake up during the night.

    • Hold a pillow tightly against your incision when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. 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 you are awake. Remember to follow each deep breath with a cough.

    • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can and then let out your breath. Use your incentive spirometer 10 times in a row every hour while you are awake.

  • Early mobilization: Caregivers may help you get out of bed to walk after your ET tube has been removed. Ask caregivers if there are exercises that you may do while you are in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is okay to get out of bed. Call your caregiver before you get up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.

  • Shoulder exercises: A physical therapist may teach you exercises to make your arms and shoulders stronger. These exercises will help your shoulders move freely and improve the function of your lungs. These exercises may prevent breathing problems after your surgery.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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