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Lung Transplant

WHAT YOU NEED TO KNOW:

A lung transplant is surgery to replace your lung with a donor lung. Lung transplant surgery may be performed on one or both lungs. If you have severe heart disease, you may have heart and lung transplant surgery at the same time. Ask for more information about a heart and lung transplant.

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.
  • Pre-op care: You will be given medicine right before your surgery. This medicine will make you feel relaxed and sleepy.
  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  • General anesthesia: This is medicine that will keep you completely asleep and free from pain during surgery. It is given in your IV or as a gas that you breathe. You may have a breathing tube called an endotracheal (ET) tube that goes into your mouth and throat. The healthcare provider usually puts the tube down your throat after you are already asleep.
  • When you are asleep from the anesthesia, you will be monitored with the following:
    • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
    • Pulmonary artery catheter: This is a thin tube put into a vein near your collarbone, or in your neck or groin. The tube goes into your heart and through a blood vessel into your lungs. It is used to monitor the fluid in your blood vessels. It also monitors the pressure in your heart and lungs. The catheter may be used to give you medicines or IV fluids.
    • Transesophageal echocardiogram: This is an ultrasound that shows pictures of the size and shape of your heart. A tube is put in your mouth and moved down into your esophagus. Because your esophagus is right next to your heart, your healthcare provider can see your heart clearly.
  • Foley catheter: This is a tube put into your bladder to drain your urine into a bag. When you wake up after surgery, do not move the catheter or pull on it. This may cause pain and bleeding, and the catheter could come out. Healthcare providers will remove the catheter as soon as possible to help prevent infection.

Medicines:

  • Antimicrobials: These are medicines given to prevent infection from bacteria, fungus, or a virus. You may need these medicines for a period of time before and after surgery.
  • Antirejection medicines: These are given to help prevent your immune system from rejecting your new lung. You will begin receiving these medicines during your surgery. Most people who have a lung transplant take a combination of 3 different antirejection medicines. You will need to take them for the rest of your life.

During your surgery:

  • Your surgeon will make 1 or 2 incisions that begin at your armpit and go to or across your chest. Your surgeon will remove your failing lung and place the donor lung into your chest. The donor lung will be stitched to your airway and to the blood vessels in your heart. If you are having a double-lung transplant, your weakest lung will be removed and replaced first. The ET tube to help you breathe may be inserted into one lung while the other lung is removed and replaced. You may also need cardiopulmonary bypass during surgery. This is when a machine pumps blood and provides oxygen in place of your heart and lungs.
  • Your surgeon will insert a thin tube called a bronchoscope down your throat and into your airway. A light and camera on the bronchoscope allows him to check the incisions and stitches inside your airway. You will have 2 or 3 tubes inserted in each incision to drain fluid and air. Your incisions will be closed with stitches and covered with bandages.

After your surgery:

You will be taken to the intensive care unit where you will rest and be monitored. A healthcare provider will check your blood pressure, breathing, heart rate, and temperature often after your surgery.

Breathing support:

You will probably be on the ventilator for 1 or 2 days after surgery, but it may be longer. After you are off the ventilator, you will receive oxygen. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your healthcare provider before you take off the mask or oxygen tubing.

Chest tubes:

Chest tubes will remove air that entered your chest during surgery. They also remove any extra blood and fluid. Your chest tubes will be left in place for about 1 or 2 weeks, or until all of the extra fluid and air is gone.

Medicines:

  • Pain medicine: You will be given pain medicine through your IV or through a needle inserted into your spine. You may also be given pills to decrease pain. Do not wait until the pain is severe before you ask for more medicine.
  • Sedatives: These help you stay calm and relaxed. You may need it while you are on the ventilator.
  • Diuretics: These decrease excess fluid around your heart or lungs and decrease your blood pressure. You may urinate more often when you take this medicine.
  • Heart medicines: You may need medicines to control your blood pressure, help your heart beat in a normal rhythm, and improve the strength of your heartbeat.
  • Bronchodilators: This is given through an inhaler to help open the air passages in your lungs. This helps you breathe more easily.

Tests:

  • Blood tests: These are done to check your organ function and make sure you do not show signs of infection or organ rejection.
  • Pulmonary function tests: You breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time.
  • Chest x-ray: This picture of your heart and lungs allows healthcare providers to look for fluid in your lungs and to check your lung function.
  • Lung scan: You inhale radioactive gas, called tracer, into your lungs. It may also be injected into a vein where it travels to your lungs. The tracer allows healthcare providers to see your lungs better. Healthcare providers take pictures to check the blood flow and air movement of your new lung.
  • Bronchoscopy: Your surgeon uses a bronchoscope to see your incisions and clear any fluid or mucus from inside your airway. This test is done to make sure your incisions are healing properly before your ET tube is removed.
  • An echocardiogram is a type of ultrasound. Sound waves are used to show the structure and function of your heart.

Intake and output:

Your healthcare providers may need to know how much liquid is going into your body each day. They may also need to know how much you are urinating. Healthcare providers may limit your liquid intake for the first couple of days after surgery. This helps prevent fluid buildup in your lungs.

Activity:

Your healthcare providers will help you get out of bed soon after surgery. Movement will help your lungs function better and decrease your risk of infection and blood clots. Your healthcare provider may also bring a stationary bike or treadmill to your room. Use it as directed by your surgeon or physical therapist. Do not twist or bend at the waist when you move around. Do not do any abdominal or arm exercises unless your healthcare provider or physical therapist tells you to.

Incisions:

Healthcare providers will check your incisions daily to make sure they heal properly. Do not remove your bandages. Do not put any ointments or creams on your incisions.

Take deep breaths and cough 10 times each hour.

This will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour.

Visitors:

Visitors must wear a mask for the first couple of days after your transplant surgery. Do not allow children younger than 8 or anyone who is sick with a cold or the flu to visit you in your hospital room. This will help reduce your risk for infection.

RISKS:

  • You may lose more blood during surgery than expected and need a blood transfusion. You could get a life-threatening blood clot. You could get an infection in your lungs or in your incision. Fluid could collect in your lungs or around your heart. Your donor lung could be damaged before or during surgery. Your heartbeat could be irregular for a while after surgery. Your stitches could break open, and you may need another surgery to fix them.
  • You could have nerve damage that makes it hard for you to cough and clear the fluid from your airway. Nerve damage also increases the risk that you will have trouble swallowing, or develop gastroesophageal reflux or infections after your transplant. Your new lung may not function properly. You may need another transplant. If you have a single-lung transplant, the non-transplanted lung could collapse or develop an infection or cancer.

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.

© 2016 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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