Download Information about your Lung Operation

Patient information
Information
about
your Lung
Operation
i
Golden Jubilee National Hospital
Agamemnon Street
Clydebank, G81 4DY
(: 0141 951 5000
www.nhsgoldenjubilee.co.uk
Important information for
all patients requiring a lung
operation.
Created: December 2016
Next review: December 2017
Version 1
About this booklet
You have been offered an operation on your lung. This aims to
remove either a lung cancer or a suspicious area from which a
sample of tissue (biopsy) has not yet been taken. In a small number
of people the suspicious area will turn out to be something other
than cancer.
The purpose of this booklet is to help explain what will happen to
you during your stay in hospital. It will also give you advice and
information for your recovery after your operation. You will be given
further information as you go along.
The surgeon will discuss your particular operation with you and the
reason you need this operation. Your care will be tailored to meet
your needs. If you have any questions please ask.
What operation might I need?
There are various types of operation, depending on the size and
position of your tumour or suspicious area.
Lobectomy
2
The lungs are made up of sections called
lobes. The right lung has three lobes
and the left lung has two. If the cancer
or suspicious area is in only one lobe, a
lobectomy may be carried out to remove
the entire lobe. A bi-lobectomy is the
removal of two lobes in the right lung.
Information about your Lung Operation
Pneumonectomy
This is removal of an entire lung. This is
recommended if the cancer or suspicious
area:
• is in the centre of the lung
• involves both lobes of the left lung
• involves all three lobes of the right lung.
People can function well with only one
lung.
Wedge resection or
segmentectomy
Sleeve resection
If your breathing tests show that you
cannot cope with having a whole lobe
removed you may have a wedge resection,
segmentectomy or sleeve resection.
If the tumour is very small and confined to
one area of the lung, a wedge resection
may be carried out. This removes the
affected piece of lung tissue and a margin
of normal tissue around it. If a larger
section needs to be removed then a
segmentectomy is performed.
This is removal of a lobe and part of the
main bronchus. The healthy ends of the
bronchus are re-joined and the remaining
lobe/s are re-attached to the bronchus.
However only a small number of people will
be suitable for this type of operation.
At any of these operations the surgeon will probably take samples of
the lymph nodes (glands) which lie in the centre of the chest near the
lungs.
The part of the lung which was removed, along with the lymph
nodes, are then sent to the laboratory for testing.
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This diagram shows you how the lungs are made up.
How is the operation carried out?
The operation is carried out under general anaesthetic (you will
be asleep during the operation). The procedure used is called a
Thoracotomy. A Thoracotomy is used to diagnose or treat a variety
of conditions, however lung cancer is the most common reason.
The exact location of the thoracotomy depends on the size and
position of the tumour. This involves making a cut in the side of
the chest between the ribs. The ribs are spread apart to allow the
surgeon to see into the chest cavity. A small piece of rib may be
removed to make it easier for the surgeon to operate. The wound
and chest area may be painful for several weeks to months after
surgery. You will be advised on pain relief and exercise to help you
to manage this.
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Information about your Lung Operation
Smoking
If you are still smoking, it is advisable to stop at least 2 weeks
before your operation. It is very important that you do not smoke
after a lung operation. It can complicate your recovery. Stopping
smoking will also give you the best chance in the future. If you need
help to stop smoking, there are contact numbers at the back of this
booklet.
Before your operation
You will usually come into hospital the day before your operation
You may have:
• A chest x-ray
• A tracing of your heart (ECG)
• Breathing tests
• Blood tests
You may have had some of these done already. These are done to
make sure you are well enough to have the operation.
The tests you have had before surgery have shown that you should
be able to lead a reasonably normal life after lung surgery but you
may find you are a bit short of breath at times.
A doctor or nurse will ask you some routine medical questions and
examine you. The doctor will also explain the operation and ask
you to sign a form (consent form) to show that you understand and
agree to your operation.
You will see the surgeon or a member of their team who will explain
the operation. Please feel free to ask any questions you may have.
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The anaesthetist (doctor who puts you to sleep) will come and see
you to explain what they are going to do. They will also discuss
what type of pain relief you will have after your operation.
You will see the physiotherapist who will tell you about exercises
that you need to do after the operation (e.g. deep breathing
exercises and leg exercises). They will see you every day after your
operation to assist you with these exercises and help you get back
on your feet again.
The ward nurses will ask you some routine questions and explain
about your operation and recovery.
Your family
When you come in to hospital your family may be shown the High
Dependency Unit where you will be after your operation. They will
also have the chance to ask any questions. There is a direct line
telephone number for the High Dependency Unit and the ward.
These numbers can be obtained from a member of staff.
It would be very helpful if only one member of your family makes
enquiries about your progress by telephone, and then passes this
information on to the rest of the family. This helps reduce the time
spent answering the telephone and increases the time the nurses
can spend with the patients.
Only short visits by close family are advisable for the first two
days because you will tire very easily after your operation. It is
important that you rest to help your recovery.
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Information about your Lung Operation
Night before your operation
If you have any valuables, money or jewellery, ward staff will lock
them away for safe-keeping while you are in the operating theatre.
If possible it is better to send them home.
You will have a bath or shower the night before your operation. A
nurse will help you if required.
Usually you will have nothing to eat or drink for a number of hours
before your operation. A nurse or the anaesthetist will tell you when
you have to stop eating and drinking.
You may be given a sleeping tablet to help you get a good night’s
sleep before the operation.
The day of your operation
You will be given stockings to wear to reduce the risk of clots in
your leg veins. Staff will advise you on how long you need to wear
them, usually it is until you are up and about as normal. You will
also be given a theatre gown. You will put these on before you go to
theatre. A nurse will help you if required
.
You will be given a pre-medication (pre-med) usually about one
hour before the operation. This will either be a tablet or an injection
which will help you to relax before the operation. This may make
you feel sleepy but does not put you to sleep. When it is time for
your operation, you will be taken to the theatre area.
A nurse will then ask you some routine questions and take you
through for your operation. The anaesthetist will put a needle into
a vein in your hand. Through this needle you are given the drugs
which will put you to sleep for the operation.
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The operation can take up to four hours. When you wake up after
your operation, you will be in the theatre recovery room. You will stay
in theatre recovery until you are more awake. Then you will be taken
to the High Dependency Unit.
After your operation
The doctors will see you every day to check how you are getting on.
You will also see the surgeon regularly. If you have any questions,
please feel free to ask the doctors or nurses.
You will be nursed in the High Dependency Unit for about one to
three days depending on your progress.
In the High Dependency Unit you will be attached to monitors
that check your heart, blood pressure and breathing. The monitors
regularly make noises to show that they are working properly.
The High Dependency Unit has more staff to patients than a normal
ward. This is because of the increased care you require in the first
few days after your operation.
Oxygen
You will need oxygen through a face mask or nasal prongs for at
least 48 hours. The nurses will gradually reduce this until you no
longer need it. Remember to do your breathing and leg exercises.
Pain relief
You may have PCA (patient controlled analgesia) which allows you
to give your own pain relief when you need it. The PCA machine is
set so that you can press the button to receive pain relief regularly.
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Information about your Lung Operation
However you cannot get too much pain relief as there is a safety
mechanism. So please use this regularly when you are sore, or
before moving and coughing.
For pain relief you may have an epidural (around the spinal area)
or paravertebral block (which involves giving an injection into your
upper back beside the spine on the side of your operation). These
types of pain relief involve you having a thin tube in your back
through which you receive pain-relieving medication. Other forms of
pain killer may also be used. Please let the nursing staff know if you
are in pain so they can give you something to help.
The physiotherapist will show you how to support your wound when
coughing.
Chest drains
You will have either one or two tubes called chest drains coming
from below the wound area. The drains are placed in the chest
cavity and extend out through the chest wall and skin through small
cuts between the ribs on the side of the operation.
They drain any fluid or air from your chest. These tubes drain into a
bottle on the floor which contains sterile water.
The nurses will check these tubes regularly and you will have a
chest x-ray every one to two days to check when they can come
out. This varies for each patient.
If your whole lung (pneumonectomy) has been removed then the
drain/s will come out one to two days after the operation. If part of
the lung has been removed the drain/s will be in place for two to
seven days or sometimes longer, depending on the result of your
chest x-ray.
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These drains may be attached to suction (a mild vacuum) so this
may prevent you from moving around and walking freely. You will
be encouraged to walk on the spot and around your bed to exercise
and help prevent any complications after your operation. The nurses
and physiotherapist will advise you about this. If the drains are not
on suction you may be allowed to walk around but you must keep
the drain bottle below your chest and keep it upright. If the bottle
gets knocked over, please inform the nurses so they can check it.
When the drains are ready to be removed you will be given pain
relief beforehand to reduce any discomfort. There will be stitches
where the drains were. These will be removed after about five days.
Other equipment
You may have a drip in your arm and neck after the operation to
give you fluids and medications if required. You may also have a
fine line (drip) in an artery in your arm for monitoring purposes and
taking blood.
You will have a tube in your bladder to drain your urine. This will be
in place for about 48 hours.
Wound
Your wound will run from the side of your chest, under your arm
and round to your shoulder blade on the affected side. It will be
covered with a dressing for the first two days. The nurse will then
remove the dressing and possibly leave the dressing off. However, if
there is any leakage from the wound a new dressing will need to be
applied. The nurses will check your wound regularly and will remove
or change any dressings as required.
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Information about your Lung Operation
You may have stitches in your wound which will dissolve over time.
However if you have any stitches which need to be removed this
will usually be done about ten days after the operation. If you are at
home by then, it is best to arrange for the practice nurse to remove
these at the GP’s surgery. If this is not possible, the ward will
arrange for the district nurse to come to your home. The ward
nurses will discuss this with you before you leave hospital.
Eating and drinking
You can eat and drink as you feel able. This can start about four
hours after your operation. You would usually start with sips of
water and gradually add to this. If you feel sick let the nurses know
and they will give you something to help this. You will probably find
your appetite will be poor, but try to take fluids and a little food as
this all helps with your recovery.
Personal hygiene
The nurses will help you get washed for the first few days after your
operation, and then you will gradually be able to do this for yourself.
The stockings you were given should be changed regularly – you
may need some help with this at first.
Getting up and about again
The nurses and physiotherapist will help you get out of bed, usually
the day after the operation. You will sit in the chair and will be
helped to have a short walk. The distance you walk will be
increased each day as you are able.
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You will be given a heparin injection daily, (to help prevent blood
clots forming) usually starting the night before the operation, until
you are up and about as normal. This is to help the blood flow freely
around your body. You should be able to walk around without help
within four to seven days.
When in bed it is important that you exercise your legs as shown by
the Physiotherapist. This will help your blood circulation.
Preparing to leave hospital
You will be in hospital for five to ten days after your operation. This
varies depending on your progress.
We understand this can be a worrying time for you and your
family so please ask the nurses if there is anything you are
unsure of.
Before you leave the Ward
You would usually go straight home once you have recovered from
the operation. Very occasionally you may need to go to another
hospital to recover for a short time before you go home.
If you have nobody to take you home by car then the hospital will
arrange an ambulance. Please let the nurses know if this is the case.
You will be given a letter to take to your GP (family doctor) which
explains your operation and lists the tablets you have been given.
Please hand this letter in to your GP surgery as soon as possible
after you go home. A friend or relative may do this for you.
You will be given a 7 day supply of tablets to take home. The nurse
or pharmacist will explain these to you before you leave. If you
need more tablets, you will need to get a prescription from your GP.
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Information about your Lung Operation
Remember that your GP may need 48 hours to arrange this for you.
An Out-patient appointment will be sent to you to come back and
see the surgeon or chest doctor. It is important you attend this
appointment to receive the final results of your operation.
Home
You will feel quite tired when you first go home but this will
gradually improve over the next few weeks to months. You should
have somebody at home with you at first if possible.
Pain relief
You must take your pain relief regularly, especially at bedtime.
After a couple of weeks you may feel ready to cut down your
painrelieving tablets. Do not cut them down if you are still sore.
You may find the pain relief will make you a bit constipated. Try to
take a well-balanced diet with extra fruit, vegetables and plenty of
fluids to drink as this will help your bowels. You may need to take a
laxative.
You may have muscular pain in your neck, shoulders, arms and
back for up to six weeks after your operation and mild aches and
pains for several months. If part of a rib has been removed during
your operation you may have occasional stabbing pains. Numbness
or tingling along the scar line is also common.
If you feel that your pain relief is not working then contact your GP
or district nurse.
Bathing
You can have a bath or shower as soon as you feel able. It is alright
to get the wound wet. Gently pat it dry. Do not use perfumed
sprays or talcum powder on the wound area until it has completely
healed.
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Wound
Your wound may appear a bit swollen. This is normal and will
gradually improve. If there is any discharge from the wound or any
redness, or if you feel the wound very hot, then please contact your
GP or district nurse promptly.
It will take six to eight weeks for the wound to heal properly. Try to
avoid tight clothing around the wound area during this time.
Exercise
Everybody recovers at a different pace. Take activity at a gentle
pace at first and gradually build up.
Walking
• Walk regularly and gradually increase the distance you go.
• Start on the flat and work up to slopes and gentle hills.
• As a general rule it is normal to be comfortably out of breath when
you are out walking, but you should always be able to speak. It is
important to listen to your body and rest when you are tired.
Other suitable exercise may include:
For the first six weeks: Light housework
Light gardening
Exercise bike
From approximately six weeks: Swimming
(if your wound is well healed)
Carrying shopping
Cycling
After eight weeks: Golf
Mowing the lawn
Badminton
Digging
If you have had part of your lung removed there can be a change in
your buoyancy. So when you first go swimming it may be helpful to
take someone with you and have a flotation aid to hand in case you
need it.
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Information about your Lung Operation
Avoid heavy lifting until at least six weeks after your operation.
Keep supporting your wound with a towel or pillow when you cough
or sneeze, if necessary.
Arm exercises
Try these at home every day for the first few weeks:
• Stretch both arms up over your head.
• Stretch both arms out in front of you.
• Stretch both arms out sideways.
Posture
It is important to maintain good shoulder posture and avoid
hunching your upper body. The physiotherapist will advise you of
this.
Rest
You will feel quite tired when you go home at first. You should plan
to gradually increase your activities each week. You should take a
rest in bed for an hour or two during the day. Try to make sure that
you have a good night’s sleep. You may find it easier to sleep sitting
upright to help your breathing.
Your mood
You may find that you feel a bit low in mood some days. You may
feel that you are not making progress, or you may have difficulty
concentrating or feel very tired. This is normal after an operation.
You will have good days and bad days. This will gradually improve
as you get your strength back.
Work
Returning to work depends on how you are feeling and the type of
job that you do. If it is light work then you may be able to go back
after about six weeks. If it is heavy manual work then it may be
longer. You can discuss this with your GP or with your surgeon or
chest doctor at your out-patient appointment.
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Driving
Do not start driving until you feel able, which will be around four to
six weeks after your operation. Remember that you must be able to
do an emergency stop or reverse the car if required. You must also
be able to wear a seat belt.
At first you would be better to have another driver with you in
the car as you may still feel quite tired. Remember your insurance
may be affected if you drive while unfit. Check with your insurance
company if in any doubt.
Travelling
Check with your doctor before flying. You should also check with
your travel insurer to make sure that you are covered to travel.
Alcohol
You can take alcohol in moderation but be careful while you are still
on medication.
Sexual relationships
These may resume when you feel able. Remember that everyone
recovers at different rates.
Further treatment
It is quite common to be offered further treatment once you have
recovered from your operation. If this applies to you, the doctors will
discuss it with you in the ward or at the out-patient clinic.
The hospital/s you are attending participate in clinical trials to try
to improve patient care. You may be asked to take part in a clinical
trial (study). If so, this would be fully explained to you. Taking part
in any trial is voluntary and your care would not be affected if you
decided not to participate.
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Information about your Lung Operation
Useful contacts and telephone numbers
Roy Castle Lung Cancer Foundation
Rothesay House, 134 Douglas Street, Glasgow, G2 4HF
Helpline: 0800 358 7200
Website: www.roycastle.org
Macmillan Cancer Support
Scottish Office, 132 Rose Street, Edinburgh, EH2 3JD
Helpline: 0808 808 0000 (Mon–Fri 9am–8pm) for access to benefits
helpline and cancer information nurse helpline.
Website: www.macmillan.org.uk
Maggie’s Cancer Caring Centres
Maggie’s, The Stables, Western General Hospital, Crewe Road,
Edinburgh, EH4 2XU
Tel: 0131 537 2456
Website: www.maggiescentres.org
British Lung Foundation
73-75 Goswell Road, London, EC1V 7ER
Helpline: 08458 50 50 20 (Mon to Fri 10am to 6pm)
Website: www.lunguk.org
National Cancer Alliance
PO Box 579, Oxford, OX4 1LB
Tel: 01865 793566
Website: www.nationalcanceralliance.co.uk
Services to help you stop smoking
Smokeline helpline: 0800 84 84 84
www.canstopsmoking.com
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Local telephone numbers:
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Information about your Lung Operation
Notes
Information about your Lung Operation
19
(: 0141 951 5513
Please call the above number if you require
this publication in an alternative format
Reproduced with kind permission from The Scottish Lung Cancer Nurses Forum
Golden Jubilee National Hospital Charity Number: SC045146
HL33