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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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procedures

Procedures

Intermediate Format:

Pericardiectomy/Pericardial Window

objectives
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.
objectives3
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
Terms and Definitions
  • Pericardium
  • Decortication
  • Pericardial effusion
  • Cardiac tamponade
definition purpose of procedure
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
Pathophysiology
  • Chronic pericarditis
    • Tubular
    • Rheumatic
    • Viral
    • Neoplastic
    • Constrictive
pathophysiology7
Pathophysiology
  • Signs & Symptoms
    • Chest pain
    • Fever
    • Cough
    • Dyspnea
    • Palpitations
    • Friction Rub
surgical intervention special considerations
Surgical Intervention:Special Considerations
  • Patient Factors
    • anxiety
  • Room Set-up
    • For heart surgery
  • Possibly cardiac bypass on standby
surgical intervention positioning
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
Surgical Intervention: Special Considerations/Incision
  • Special considerations
  • State/Describe incision
    • Median sternotomy
    • # 10, # 15 blades
surgical intervention supplies
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
Surgical Intervention: Instruments
  • General: Chest and Heart sets
  • Specific
    • Have all cardiac bypass instrumentation available if needed
surgical intervention equipment
Surgical Intervention: Equipment
  • General
  • Specific
    • Cardiac defibrillator on standby with internal and external paddles
    • Cardiac bypass on standby
surgical intervention procedure steps
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 steps15
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
Counts
  • Initial: Sponges, Sharps, instruments
  • First closing
  • Final closing
    • Sponges
    • Sharps
    • Instruments
specimen care
Specimen & Care
  • Identified as pericardium
  • Handled: routine
resources
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
slide19

The surgical incision most likely for open heart surgery is:

  • Anterolateral thoracotomy
  • Posterolateral thoracotomy
  • Median sternotomy
  • supraclavicular
slide20

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

  • Epinephrine
  • Protamine sulfate
  • Papavarine
  • Heparin
slide21

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)
slide22

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
slide23

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
slide24

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
slide25

Which of the following bypass grafts would require preclotting?

  • Knitted polyester (Dacron)
  • Saphenous vein
  • Human umbilical cord graft
  • Polytetrafluoroethylene (PTFE)
slide26

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
slide27

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
slide28

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

  • Aorta
  • Carotid artery
  • Pulmonary artery
  • Coronary artery
slide29

Common artery bypass procedures include all of the following except:

  • axillo-popliteal
  • Femoro-femorol
  • Axillo-femoral
  • Femoro-popliteal
slide30

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
slide32

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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