Timeline to Surgery Lung Volume Reduction Surgery
First visit: Meet with Surgeon
- Complete history and physical exam.
- Review medical records and test results.
- Discuss treatment options.
- Plan for surgery, if needed.
- Do other tests before surgery, if needed.
- Share review of findings with referring doctor.
Second visit: Pre-op Work-up
Your pre-op work-up may be done by your primary doctor. For work-ups here with members of your lung surgery team, please see below and map on last page of this timeline.
- Meet with a nurse practitioner or physician’s assistant to:
Update history and physical.
Review medicines and discuss plans for taking them.
Discuss what to expect during surgery.
Sign consent for surgery.
- May have blood drawn in Outpatient Lab in room G5/240 on the 2nd floor.
- May have a chest x-ray done in Outpatient X-ray in J5/2 on the 2nd floor.
- May meet with a Learning Center nurse in the Surgery Clinic on the 2nd floor.
- Meet with an Anesthesia Screening Clinic nurse in the Outpatient Surgery Center on the 2nd floor.
Days before surgery – Vitamins, Herbs, Diet Supplements, and Medicines
- Your doctor may ask you to stop taking pills that “thin” your blood. You may need to stop taking these pills for 1-7 days before surgery.
- If you take any medicines or supplements that “thin” your blood, please talk with your doctor who prescribed these for you. Ask if you should stop taking them before surgery. If your doctor tells you to stop them, ask when you should stop taking them.
- Please let us, your lung surgery team members, know if you take any medicines or supplements that “thin” your blood.
- Medicines and supplements that “thin” blood include these:
Aspirin, Excedrin®, Ascription®, and Ecotrin®
Plavix®, Pradaxa®, and Effient®
Coumadin® or warfarin or Jantoven®
Ibuprofen, Advil®, Motrin®, Nuprin®, and Aleve®
Some vitamins and herbs
- It is all right to use Tylenol® (acetaminophen), if you can normally take it.
Day before surgery
- Someone from First Day Surgery (FDS) calls the day before surgery (or the Friday before if your surgery is on Monday) with your surgery time and instructions. If they do not call by 1 p.m., please call 608-265-8857.
- The night before surgery, eat a light supper – small amounts of low-fat foods unless you are given special instructions. Stop eating solid foods and milk-type drinks at midnight. Most patients are allowed to drink clear liquids after midnight up until 4 hours before surgery starts. Clear liquids include water, soda pop, coffee and tea (no creamer), clear broths, clear juices (no orange juice because of pulp), and popsicles. Do not chew gum, tobacco, or have candy for 4 hours before surgery.
- Do not drink alcohol after 8:00 pm the night before surgery. It can cause problems with anesthesia.
- Shower twice before surgery using Hibiclens® soap. Use it the night before and the morning of your surgery. You may get this soap during your clinic visit. First, shower with your own soap. Rinse. Pour the Hibiclens® soap on a damp, clean washcloth or new shower sponge. This soap is thin and tends to run down the drain. Wash the area where the incisions will be for 2-3 minutes. Do not scrub. Rinse well. Do not use lotions, powders, or perfumes. Do not use Hibiclens® on your face, hair, rectal area, or genitals. Use your own soap in these areas. If you do not get Hibiclens® at your clinic visit, you may buy it at your drug store. If your doctor advises you to use a different soap, please
- Do not wear make-up. Please remove nail polish from at least one finger.
- Please leave all jewelry, rings, large sums of money, and credit cards at home. You will be asked to remove all jewelry. Please remove all body piercings.
Day of surgery
- Please bring in a list of all the medicines, herbal supplements, and vitamins that you take. For each item on your list, please be sure to have the name, amount you take, and the time of day or night that you take it.
- Please bring your BiPAP or CPAP machine from home on the morning of surgery, if you use one.
- Please bring non-skid slippers or slip-on shoes and a few personal items. You do not need to bring pajamas or a robe. You may want to bring a book or something to do. TVs are in each room at no charge. Bring a calling card or your cell phone if you wish to make long distance calls. You may bring in your laptop. All of the rooms have patient internet access. Please have your family member leave your belongings in the trunk of your car the day you check in. Once your room is ready, they can bring your things to you. The hospital is not responsible for theft of personal items.
- Arrive at First Day Surgery (FDS) with your family member. Arrival time for a first start surgery is 5:30 a.m. You are told a different time if your surgery starts later in the day. Please see the Health Facts for You in your binder called “Your Lung Surgery and Hospital Stay” for details.
- Meet with surgeon before surgery for questions.
- A person from Anesthesia takes you to the operating room (OR). Your family is guided to the waiting area. This is on the second floor in the C5 section (C5/2, just past the D elevator lobby on the 2nd floor).
- For family members: Please check in at the desk in the waiting area and get a pager. You may also leave a phone number. The OR staff will tell you when the surgery starts and when it is done. They may also contact you with updates during your loved one’s surgery.
- When your surgery is done, you are taken to the Post-Anesthesia Care Unit (PACU). Here you begin to wake up. Your nurse notes your vital signs (heart rate, breathing, blood pressure) and watches you closely. You may hear beeps from monitors or IV pumps. This is normal. Please let your nurse know if you need anything so he or she can help you. When you want some, you may have some ice chips.
- When it is time for you to leave the PACU, you are taken to the Cardiothoracic Surgery Unit on B4/5 (5B West). Your family members may visit as soon as your nurse has helped you get settled in your room and finished the first assessment. This may take 1-2 hours. You stay here for a few days to recover from your surgery.
- For family members: You are guided to the Cardiothoracic Surgery Unit on B4/5 when your loved one’s surgery is done. Your nurse will let you know when your loved one is ready for you to visit. Patients are often ready to have a family member visit about 1 hour after they are brought to the unit. Children may visit. However, this may be scary for some children. We ask that parents use their judgment to decide what is best for their children.
- You have a number of lines and tubes in after surgery. Please see the Health Facts for You in your binder called “Common Tubes and Lines” for details.
- You may sit in a chair and walk the evening of surgery.
Day after surgery (Post-op Day #1)
- The thoracic team sees you in the morning to check on your progress. This is called rounding. It may involve several members of the thoracic team. They first meet outside your door to discuss your progress. Then they come into your room to update you and answer your questions. Please see the Health Facts for You in your binder called “Your Health Care Team” for a list of the people caring for you.
- Please let your team know how you are feeling. If you have pain or don’t feel well in another way, please let us know so we can help you. Before you get out of bed to sit or walk, you will be offered pain medicine.
- You have blood drawn and a chest x-ray done every morning. These are often done early between 5 and 6 am.
- Tubes and lines start to be removed based on how you are doing. Your arterial line will likely be removed. Your chest tube will stay in place. It may be changed from wall suction to water seal. Water seal allows fluid and air to drain from your chest by gravity.
- You get out of bed to sit in a chair in the morning. Your goal is to get out of bed and sit in a chair at least 3 times per day.
- You start walking in the halls. Your goal is to walk in the halls at least 4 times per day. The number of walks and the distance of them increase over time.
- You learn how to cough and deep breathe using an incentive spirometer (breathing tool).
- If you do not have trouble with nausea, you are able to eat and drink.
Post-op Day #2-3
- The thoracic team rounds on you every day. During the morning rounds, the team looks at your chest tube to see if it can be removed. They ask you to blow on your thumb or cough to see if it is ready to come out.
- If your team thinks your chest tube can be removed, they clamp your chest tube for 4 hours and get a chest x-ray. If the x-ray looks good and your lung is still fully inflated, they remove the tube.
- You may have to go home with the chest tube if your lung goes “down” while it is clamped or if you have an air leak (a small hole in the lung where air goes into the chest). If this is the case, your nurse or CNS will teach you and your family how to take care of your chest tube before you go home. You will have time to practice taking care of your chest tube in the hospital. You will also get written handouts about chest tube care to take home with you.
- You continue to use your incentive spirometer and cough and deep breathe. This is good for your lung and helps prevent pneumonia.
- You also continue to build strength by helping with your daily care, sitting in a chair, and walking a number of times every day.
- Your epidural will also be removed during this time frame and you will begin taking pills for pain. Once your epidural is removed, your Foley catheter will be removed shortly after.
- You should keep building strength by walking, sitting in chair, and taking part in your daily care.
Post-op Day #4 – Discharge Home
- Keep building your strength by walking, sitting in the chair, and taking part in daily care.
- You must keep using the incentive spirometer and coughing and deep breathing to keep the one remaining lung healthy and free of pneumonia.
- During these last two days before discharge, you and your family member meet with a pharmacist, nurse, and other members of your health care team to learn more about your care. You learn about your medicines, incision care, when to call the doctor, and other things. Please see the Health Facts for You in the binder called “Homeward Bound” for details.
First follow-up visit (about 1 week after discharge)
- You may need to have blood drawn in the lab and a chest x-ray or other tests done before your follow-up visit.
- You meet with a nurse practitioner or physician’s assistant to discuss progress since discharge and questions you or your family have. You may not see your surgeon at this visit.
Follow-up with your primary care provider in 2-4 weeks from discharge.
Follow-up with Pulmonary Rehab in 3-6 weeks after surgery.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 08/08/2012
Copyright © 08/08/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7394
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