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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.
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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. 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 Terms and Definitions Pericardium Decortication Pericardial effusion Cardiac tamponade 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 Pathophysiology Chronic pericarditis Tubular Rheumatic Viral Neoplastic Constrictive Pathophysiology Signs & Symptoms Chest pain Fever Cough Dyspnea Palpitations Friction Rub Surgical Intervention:Special Considerations Patient Factors Room Set-up Possibly cardiac bypass on standby Surgical Intervention: Positioning Position during procedure Supine, arms on armboards at 90 degrees Supplies and equipment Special considerations: high risk areas Surgical Intervention: Special Considerations/Incision Special considerations State/Describe incision Median sternotomy # 10, # 15 blades 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 Surgical Intervention: Instruments General: Chest and Heart sets Specific Have all cardiac bypass instrumentation available if needed Surgical Intervention: Equipment General Specific Cardiac defibrillator on standby with internal and external paddles Cardiac bypass on standby 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 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” Counts Initial: Sponges, Sharps, instruments First closing Final closing Sponges Sharps Instruments Specimen & Care Identified as pericardium Handled: routine 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 The surgical incision most likely for open heart surgery is: Anterolateral thoracotomy Posterolateral thoracotomy Median sternotomy supraclavicular Which medication is commonly given IV about 3-5 min prior to cross-clamping the artery during Arteriotomy? Epinephrine Protamine sulfate Papavarine Heparin 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) 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 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 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 Which of the following bypass grafts would require preclotting? Knitted polyester (Dacron) Saphenous vein Human umbilical cord graft Polytetrafluoroethylene (PTFE) 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 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 The artery that carries deoxygenated blood in the adult is the: Aorta Carotid artery Pulmonary artery Coronary artery Common artery bypass procedures include all of the following except: axillo-popliteal Femoro-femorol Axillo-femoral Femoro-popliteal 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 Suture material used to place vascular grafts would include: PDS Vicryl/Dexon Prolene Stainless steel A Femoro-popliteal Bypass is scheduled. Which self-retaining retractor would be used to facilitate exploration of the femoral artery? Harken Debakey Weitlaner Gelpi