Procedures
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Procedures







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Procedures. Intermediate Format: Pericardiectomy/Pericardial Window. Objectives. Assess the related terminology and pathophysiology of the heart. Analyze the diagnostic interventions for a patient undergoing a pericardiectomy.
Procedures

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Slide 1

Procedures

Intermediate Format:

Pericardiectomy/Pericardial Window

Slide 2

Objectives

  • Assess the related terminology and pathophysiology of the heart.

  • Analyze the diagnostic interventions for a patient undergoing a pericardiectomy.

  • Plan the intraoperative course for a patient undergoing_____________.

  • Assemble supplies, equipment, and instrumentation needed for the procedure.

Slide 3

Objectives

  • Choose the appropriate patient position

  • Identify the incision used for the procedure

  • Analyze the procedural steps for pericardiectomy.

  • Describe the care of the specimen

Slide 4

Terms and Definitions

  • Pericardium

  • Decortication

  • Pericardial effusion

  • Cardiac tamponade

Slide 5

Definition/Purpose of Procedure

  • Partial excision of adhered, thickened fibrotic pericardium to relieve constriction of compressed heart and large blood vessels

  • Removal of a segment of pericardium, permitting pericardial fluid to drain into the pleural space for treatment of cardiac tamponade

  • Surgical stripping of the pericardium

Slide 6

Pathophysiology

  • Chronic pericarditis

    • Tubular

    • Rheumatic

    • Viral

    • Neoplastic

    • Constrictive

Slide 7

Pathophysiology

  • Signs & Symptoms

    • Chest pain

    • Fever

    • Cough

    • Dyspnea

    • Palpitations

    • Friction Rub

Slide 8

Surgical Intervention:Special Considerations

  • Patient Factors

    • anxiety

  • Room Set-up

    • For heart surgery

  • Possibly cardiac bypass on standby

Slide 9

Surgical Intervention: Positioning

  • Position during procedure

    • Supine, arms on armboards at 90 degrees

  • Supplies and equipment

  • Special considerations: high risk areas

Slide 10

Surgical Intervention: Special Considerations/Incision

  • Special considerations

  • State/Describe incision

    • Median sternotomy

    • # 10, # 15 blades

Slide 11

Surgical Intervention: Supplies

  • General: Cardiac pack

  • Specific

    • Suture

      • 4-0 & 5-0 Prolene, wire for sternum

      • Pledgets

    • Medications on field (name & purpose)

      • Heparinized saline solution and other meds as indicated on preference card (may have protamine on standby)

    • Catheters & Drains: Chest Tubes

Slide 12

Surgical Intervention: Instruments

  • General: Chest and Heart sets

  • Specific

    • Have all cardiac bypass instrumentation available if needed

Slide 13

Surgical Intervention: Equipment

  • General

  • Specific

    • Cardiac defibrillator on standby with internal and external paddles

    • Cardiac bypass on standby

Slide 14

Surgical Intervention: Procedure Steps

  • The lungs are displaced laterally, and the right and left phrenic nerves are identified and protected

  • The pericardium is incised

  • Decortication begins with the left ventricle

    • To prevent development of pulmonary edema and Rt Side Heart Failure, which could happen if one starts w/right ventricle

  • A plane is developed between parietal & visceral pericardium

    • Caution must be taken to prevent calcified portions of the parietal pericardium from penetrating the heart’s chambers, esp the atria.

  • The outer, thickened pericardium is removed as indicated

    • Have cartilage scissors ready

Slide 15

Surgical Intervention: Procedure Steps

  • Fibrous portions adhering to the atria and ventricles are carefully dissected w/dry dissectors and scissors

    • Extreme caution used to prevent perforation of atria and right ventricle—small areas of adherent pericardium may be retained

    • STSR is prepared with loaded 4-0 or 5-0 pledgeted Prolene sutures.

  • Dissection is continued; large blood vessels are exposed and freed as needed; the Atria, Ventricles, and both Cavae are freed

  • Drainage catheters are placed near the heart or through the pleural spaces

    • STSR has chest tubes ready with closed drainage system

  • Sternum is closed w/ stainless steel wire, and remainder of wound closed “usual manner”

Slide 16

Counts

  • Initial: Sponges, Sharps, instruments

  • First closing

  • Final closing

    • Sponges

    • Sharps

    • Instruments

Slide 17

Specimen & Care

  • Identified as pericardium

  • Handled: routine

Slide 18

Resources

  • STST Ch 22 pp. 918, 919

  • Taber’s Cyclopedic Medical Dictionary

  • Alexanders Ch 27, p. 1143, 1156-1157

  • Lemone and Burke pp. 895-897

Slide 19

  • The surgical incision most likely for open heart surgery is:

  • Anterolateral thoracotomy

  • Posterolateral thoracotomy

  • Median sternotomy

  • supraclavicular

Slide 20

  • Which medication is commonly given IV about 3-5 min prior to cross-clamping the artery during Arteriotomy?

  • Epinephrine

  • Protamine sulfate

  • Papavarine

  • Heparin

Slide 21

  • All of the following are sutures used in CV surgery to suture vessels or vascular grafts except:

  • Polytetrafluoroethylene (PTFE or Gore-Tex)

  • Polyporpylene (Prolene)

  • Polyester (Dacron)

  • Surgical gut (chromic)

Slide 22

  • Which of the following procedures would commonly require the use of extracorporeal circulation (heart-lung bypass)?

  • Abdominal Aortic Aneurysmectomy with Graft

  • Pneumonectomy

  • Coronary Artery Bypass Graft

  • Vena Cava Umbrella insertion

Slide 23

  • The vessel used to increase the overall blood supply to the heart following CABG is the :

  • Saphenous artery

  • Brachial artery

  • Carotid artery

  • Internal mammary artery

Slide 24

  • The creation of a commuication between an artery and a vein for hemodialysis access is called a(n)

  • Bypass Graft

  • Aneurysmectomy

  • Vena Cava Umbrella Filter Placement

  • Arteriovenous Fistula Formation

Slide 25

  • Which of the following bypass grafts would require preclotting?

  • Knitted polyester (Dacron)

  • Saphenous vein

  • Human umbilical cord graft

  • Polytetrafluoroethylene (PTFE)

Slide 26

  • The procedure in which a Fogerty Catheter is used to remove blockage of a vessel is referred to as:

  • Arteriovenous shunt

  • Endarterectomy

  • Embolectomy

  • Ligation and stripping

Slide 27

  • The autogenous graft which is left in place after destruction of the internal valves and then sutured into the arterial system is:

  • In-situ saphenous vein graft

  • Human umbilical cord graft

  • PTFE graft

  • ligation and stripping of the saphenous vein

Slide 28

  • The artery that carries deoxygenated blood in the adult is the:

  • Aorta

  • Carotid artery

  • Pulmonary artery

  • Coronary artery

Slide 29

  • Common artery bypass procedures include all of the following except:

  • axillo-popliteal

  • Femoro-femorol

  • Axillo-femoral

  • Femoro-popliteal

Slide 30

  • Specific equipment used during surgery on a pt with a pacemaker in place should include:

  • A magnet

  • Mono-polar ESU with its patient return electrode applied to the patient

  • Mono-polar ESU without its patient return electrode applied to the patient

  • Bi-polar ESU with its patient return electrode applied to the patient

Slide 31

  • Suture material used to place vascular grafts would include:

  • PDS

  • Vicryl/Dexon

  • Prolene

  • Stainless steel

Slide 32

  • A Femoro-popliteal Bypass is scheduled. Which self-retaining retractor would be used to facilitate exploration of the femoral artery?

  • Harken

  • Debakey

  • Weitlaner

  • Gelpi


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