Inova Lung Services — Programs and Services — Lung Transplant — The Transplant Process: Surgery and Post-Op
Surgery and Post-Op
We will notify you as soon as compatible donor lung(s) become available. Once you receive your call, plan to arrive at Inova Fairfax Hospital within 4 hours unless told otherwise by our staff.
Please do not eat or drink anything. You can take your regularly-scheduled medications with a small sip of water.
Prior to surgery
A final evaluation of the donor lungs is made before you are prepped for surgery. During this time we perform your pre-operative blood work and chest X-ray and administer antibiotics. Once we receive approval to proceed, you are taken to the operating room and prepared for surgery.
Surgery
Lung transplantation involves removing one or both diseased lungs and surgically placing the healthy, new donor lung(s). During surgery, some patients are put on a heart-lung bypass machine to support blood circulation until the new lung(s) are placed.
For a single lung transplant, an incision is made below the shoulder blade and along the side of the chest. The old lung is removed and the new lung is connected both at the mainstem bronchus level and the vessels (pulmonary artery and pulmonary vein). The ribs are then brought back together and the incision is closed.
For a bilateral lung transplant, the incision is made across the middle of the chest, from one underarm to the other. The lungs are placed and connected one at a time before the ribs are brought back together and the incision closed.
Post-operative care
Following the surgery, you will receive attentive care from our highly-trained staff in the 18-bed cardiovascular surgical intensive care unit (CVICU). On average, patients remain in the ICU about 3 days.
Once you are fully stabilized, you are transferred to a private room on a nursing unit where staff is experienced in the care of transplant patients. This portion of your hospital stay averages about 10 days. This may vary based on your post-op course.
You will still be sedated when you arrive in the surgical CVICU and breathing with the assistance of a ventilator. We will perform a bedside bronchoscopy to clear blood clots and secretions from your lungs. Most patients are taken off the ventilator (extubated) within 24 to 48 hours after surgery.
Once you are breathing on your own, it is important to actively participate in the breathing exercises and other forms of pulmonary rehabilitation that will be demonstrated by your therapists. Ambulation is important to prevent blood clots, clear secretions, and fully expand your new lung(s).
All transplant patients have chest tubes inserted into the pleural space surrounding their new lung(s). These flexible tubes remove fluid and air from the chest cavity and are removed 3 to 5 days following surgery. As your recovery progresses, we will remove other catheters placed before and during surgery. These include the Foley catheter that drains urine from the bladder and IV catheters used to deliver fluids and medications and monitor vital signs.
Pain management
Our goal is to help you effectively manage pain you experience as a result of your surgery. Most patients complain of discomfort at the incision site and entry point of chest tubes. Your nurses will administer intravenous pain medications immediately following surgery.
Once you are off the ventilator, anesthesia will place catheters in the paravertebral space in your back that allows for a continuous infusion of numbing medications. You will also receive intravenous Tylenol for a short time after extubation. Other medications will be available as needed for pain. Narcotics are used sparingly and tapered off as you approach discharge due to side effects. Pain decreases as healing continues. At the time of discharge, all patients go home on oral pain medication.
Teaching
You will receive an education binder post- transplant. The transplant team will teach you and your caregivers what to expect during the recuperation period and especially once you return home. When you get close to discharge, a formal education session will be scheduled for you and your caregivers to meet with the transplant nurse practitioner, pharmacist, and dietician. This education session will take approximately 3 hours. You will learn about the medications you will be taking, diet, exercises and how to monitor your progress at home.
Distance to Inova Fairfax Hospital
If you live more than an hour's driving distance from Inova Fairfax Hospital, please make arrangements to stay close to the hospital for the first 4-6 weeks after discharge. Out-of-state patients should make arrangements for close-in temporary housing for at least 3 months after transplant surgery.