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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 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 CXR 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 lungs. During surgery, many patients are put on a heart-lung 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 surgery, you will receive attentive care from our highly-trained staff in the 18-bed cardiovascular surgical intensive care unit (ICU). 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.

You will still be sedated when you arrive in the surgical ICU 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 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. This activity is important to prevent blood clots, clear secretions, and fully expand your new lung(s).

All transplant patients have a chest tube 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 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 anesthetics immediately following surgery.

Once you are off the ventilator, you will use a patient-controlled anesthesia device (PCA) to manage your pain. The PCA allows you, at the push of a button, to receive a prescribed dose of pain medication when you need it. Pain decreases as healing continues. At the time of discharge, all patients go home on oral pain medication.


Teaching

The transplant team teaches you and your caregivers what to expect during the recuperation period and especially once you return home. 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 several weeks after discharge. Out-of-state patients should make arrangements for close-in temporary housing for at least 3 months after transplant surgery.