In the first week after surgery, where are you likely to be, what problems are you encountering, and what “tasks” do you need to accomplish with your doctor?
Coughing up sputum is the first priority
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Coughing up sputum is the first priority
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The most important thing to do during this week, and the one that needs to be on your agenda from day one, is to cough up sputum.
This is because there may be a constant production of sputum and even some bloody secretions in the postoperative trachea, all of which need to be expelled by active coughing. Patients try to sit up after surgery, and experienced caregivers and nurses can help stimulate your pharynx, develop a cough reflex, or promote sputum expulsion by patting your back.
However, your active participation is the key. Many patients do not try to expel sputum because of pain or weakness, and family members insist that patients rest because of pain, which can be a “trigger” for postoperative pulmonary insufficiency and complications. The first thing you need to do is to practice as many deep breaths as you can to fill the remaining lung tissue as soon as possible (“reopening”) to restore as much lung function as possible.
Some patients who were coughing before surgery suddenly “stop” after surgery, even after adequate analgesia and nutritional supplementation. This is not a case of laziness on the part of the patient, but rather some paralysis and disruption of the nerves needed for the cough reflex (which is often necessary) during surgery, resulting in a weakened cough reflex and a “no” cough.
Then, depending on your condition, your doctor will choose the right time to aspirate the sputum with a tracheoscope, which is a thin tube that is inserted through the nostrils deep into the trachea to suck out the sputum. Usually after 3 to 4 days after surgery, nerve function will gradually recover and the cough reflex can be re-established, and tracheoscopic aspiration is usually not needed.
Postoperatively, to help expel the sputum, your surgeon will give you a medication similar to amiloride to break up the tight junctions between the sputum. In addition, saline nebulization is done several times a day to moisten the airway and thin the mucus.
What medications may be needed postoperatively?
In addition to the tranylcypromine, which is used to break up the sputum as discussed above, there are a number of medications that may be needed postoperatively.
Because the airway is connected to the outside world, pulmonary surgery is theoretically not a completely sterile operation, and antibiotics are also administered prophylactically after surgery. The surgeon will also apply some anticoagulants to the postoperative patient to prevent thrombosis in the veins of the lower extremities. If you have any previous medical problems, you can continue to take your medication after surgery as prescribed by your doctor.
Move the lower extremity
Move your legs and feet more after surgery. Once you wake up on the day of surgery, you can consciously move your legs in bed, and your family can help knead your calves to improve circulation and reduce the occurrence of blood clots. After surgery, doctors also recommend getting down and moving around as soon as possible, while keeping an eye on both legs to see if they are the same thickness. If you find that one leg is swollen and significantly thicker than the other, you need to inform your doctor or nurse immediately and undergo ultrasound and other related tests.
Three to four days after surgery, you may have gradually adjusted to your postoperative life, whether eating, sleeping and moving around, or passing sputum, which is considerably better than one or two days after surgery. At this point, the drainage will gradually change from dark red to light red and may eventually turn clear and light yellow. If there is not much drainage, you are ready to remove the drainage tube and discharge from the hospital. Your doctor will advise you to be more active again, or even to climb stairs, to encourage your body to absorb the pleural fluid.
What to do if there is more fluid after extraction
As mentioned earlier, it is important to continue to maintain your activity level after the drainage tube is removed. It is important to note that after extraction, the pleural fluid in your body has to be reabsorbed by your body, and if you are not active enough to reabsorb it, you may experience some degree of fever. If your body temperature is within 38.5°C and there is no abnormal blood picture (white blood cells), it can be considered as “absorption fever” and only physical cooling (e.g. warm water bath) is needed. If there is a large amount of fluid in the chest cavity and there is difficulty in breathing or other discomfort, the doctor may re-drain the fluid by puncture at his discretion. However, with adequate activity, this is generally rare.
Summary: Usually, the urinary catheter is removed on the first day after surgery, and you can begin the daily activities of eating, going to the floor, and going to the bathroom on your own. Your doctor will encourage you to increase your activity level and respiratory function, and you will need to be accompanied by a relative, cooperate with the nurse for basic care, and help protect your tubes (such as IV fluids, drains, etc.).
With a general understanding of what is going to happen and what to do, you will feel less anxious about communicating and working well with your doctor every day to get out of the hospital.
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Xie Liang, deputy chief physician Dr. Dong Song Dr. Zheng Shaopeng
Co-Author: Peking University Cancer Hospital Dr. Wang Xing