Iqx-Ft-003 Format For Surgical Planning February 21 2024
Iqx-Ft-003 Format For Surgical Planning February 21 2024
Iqx-Ft-003 Format For Surgical Planning February 21 2024
STUDENT NAME: ISIS DANIELA ROJAS GELVES CODE: 01210021006 PRACTICE LEVEL: III SEVENTH SEMESTER
1. PLANNING STAGE:
1.1. SURGICAL OBJECTIVE: Improve the symptoms that the patient has, slow the progression of the disease, preventing it from affecting other
organs and, consequently, increase the patient's life expectancy.
1.2. ANATOMY AND PHYSIOLOGY: The aortic valve is made up of three semilunar-shaped fragments of tissue (veils) that are attached to the
wall of the aorta.
Aortic sinuses
Right Coronary Sinus: it is located anteriorly and rests on the muscular septum, from which the right coronary artery arises.
Left Coronary Sinus: it is located towards the left posterior and from it, the Left Coronary Artery arises. It rests on one of its halves on the
muscular septum, and on the other on the left fibrous trigone and the intervalvular trigone.
Non-Coronary Sinus: it is located towards the right posterior and, as its name indicates, it does not
gives rise to no coronary artery. It rests on the intervalvular trigone and the membranous septum
SURGICAL INSTRUMENTATION PROGRAM
REFERENCES. RA: right atrium; PA: pulmonary artery; RSC: right coronary sinus; RV: right ventricle; ncs:
non-coronary sinus.
SURGICAL INSTRUMENTATION PROGRAM
1.3 CHECKLIST
INSTRUMENTS MEDICAL DEVICES/EQUIPMENT SUTURES AND NEEDLES DRUGS AND SOLUTIONS
Extracorporeal Basket Disposable Cardio Clothing Pack ACIFLEX Wire Suture #6 Warm saline solution
Accessory equipment Gauze container VICRYL Plus 0 CT-1 36.4 mm for subcutaneous tissue
Dr. Giraldo sternal retractor Sharps container bone wax for sternum hemostasis
Reciprocating saw with battery Handlebars PROLENE 4-0 2 RB-1 17 mm for making tobacco
MOSAIC valve meters Accessory fields for the skin pouches and suturing the aorta
Biological valve #27 sterile gloves MONOCRYL 3-0 PS-2 19 mm 3/8 circle for skin suture
electrosurgical pencil SILK 0 SH 26 mm to repair the pericardium
Dr. Giraldo's Restoration Clamp SILK 1 pre-cut for fixing the cannulas
Gauze (10) SILK 4-0 RB-1 17 mm to repair the aorta
Compresses (20) Suture or thread for pacemaker TEMPOWIRE 2-0 SH
suction rubber 26 mm
IOBAN surgical field Ti-Cron 2-0 Y-31 polyester suture 16 mm 16 needles
Tegaderm dressing with PTFE felt for aortic valve suture
Yankawer cannula Ti-Cron 2-0 polyester suture 25 mm 1/2 round circle
Sample bottle for arterial and venous cannulation
20 cc syringe Bupivacaine 0.5% increases to 100%
sterile micropore Fibrillar-Gelita-Cel
Pericardial aspiration cannula
Arterial cannula + guide 20 Fr EOPA
Single venous cannula of 34 - 46 Fr
Vein aspirator: for the right upper pulmonary vein
Qosina Connector
#32 and #34 Valve Ring Gauges
(2) Chest tube #34
Nelaton 14 Fr probe (To repair clamps)
#14 suction tube to aspirate chest tubes
Aseptosyringe
Accessory gown
Alligators for pacemakers
connectors for cannulas
Scalpel blades No. 11 and No. 15
Cardioplegia line
Hypodermic needle #18
Sternal protection tubes
three-way wrench
Tourniquet Kit
Polyester dressing for healing
SURGICAL INSTRUMENTATION PROGRAM
DERMABOND
2. Organizational stage
1. Surgeon
2. Surgical instrumentation
3. Surgical assistant
4. Anesthesiologist
5. Extracorporeal circulation machine
SURGICAL INSTRUMENTATION PROGRAM
3. Execution stage
a. Type of anesthesia: General
b. Approach: anterior-Incision: sternotomy
c. Steps and instruments used in the surgical technique:
INITIAL COUNT OF COMPRESSES, GAUZE...
The surgeon begins by performing a sternotomy #7 scalpel handle with #15 blade
Incision of the subcutaneous cellular tissue and hemostasis are made. Electroscalpel, compress, Farabeuf separators
The surgeon makes cut of the sternum and opening of the thoracic cavity Reciprocating saw, compresses
Hemostasis of the sternum and cavity Electroscalpel, bone wax
Protection is placed on the sternum and the thoracic cavity is opened. Plastic probes, sternal separator
Dissection and elevation of the epicardium is done to expose the heart Fine dissecting forceps, electroscalpel
Repair stitches are made to the epicardium to expose the heart Silk 0 SH, 26 mm needle ½ round circle, May scissors, dissecting forceps and
Needle Holder
Repair points are made in the aorta artery for the respective arterial Silk 4-0 RB-1 17 mm, May scissors, dissecting forceps, Needle Holder
cannulation
A repair stitch is made in the right atrium Silk 4-0 RB-1 17 mm, May scissors, dissecting forceps, Needle Holder
A repair stitch is performed on the right superior pulmonary vein Silk 4-0 RB-1 17 mm, May scissors, dissecting forceps, Needle Holder
An incision is made in the ascending aorta artery, a cannula is inserted, and #7 Scalpel Handle with #11 Blade, 20 Fr Aortic Arterial Cannula,
the purse string is adjusted. tourniquets, tourniquet guide, 1 pre-cut silk to adjust the cannula
Cardioplegia is passed through the left coronary artery and then through the Coronary perfusion cannula, 1000 cc cardioplegia bolus
right coronary artery.
Repair stitches are made to the aorta SILK 4-0 RB-1 17 mm, vascular dissection forceps, needle holder, long mayo
scissors, straight Kelly forceps for suture repair
The patient's Pump time begins and the heart becomes asystole, and total Bakey Clamp
clamping of the aorta is performed in the middle of the two cannulas.
Surgeon finds traces of endocarditis in aortic and mitral valve Vascular Dissection Hook and Forceps
The semilunar valves of the aorta that are damaged are cut, a perforated one Long mayo scissors, long dissection forceps, bottle to take the sample
was observed and it is delivered for laboratory culture of the same.
The aortic valve is measured to determine its respective replacement valve. Mosaic Aortic Valve Gauges #25 and #27
Placement of clean accessory fields around the surgical wound skin fields
Soak and prepare the aortic valve for 60 seconds Clean coke, saline solution and valve holder
Aortic valve #27 is passed to surgeon to be sutured Ti-Cron 2-0 Y-31 polyester suture 16 mm, long needle holder, May scissors
The right side is sutured first and then the left.
Culture is delivered to the nursing assistant
All the sutures of the aortic valve are finished Aseptosyringe, needle holder, long May scissors and Ti-Cron 2-0 Y-31
polyester suture 16 mm
The valve is lowered and located at the root of the aorta and each suture Aseptosyringe, May scissors
begins to be tied.
SURGICAL INSTRUMENTATION PROGRAM
It is decided to place the #34 valve ring, starting by suturing from the edges Needle holder, Ti-Cron polyester suture 2-0 Y-5 26 mm
The base of the implanted valve is checked to see that there are no leaks, Needle holder, Ti-Cron 2-0 polyester suture 25 mm, long scissors,
adjustment points are placed. Aseptosyringe
Valve protector removed, It is checked that it is in good condition, #7 scalpel handle with #11 blade
hemostasis is checked
The aorta artery is sutured with internal and external suture PROLENE 4-0 2 RB-1 17 mm, Needle holder, long scissors, syringe asepto
The patient is placed in the Trendelenburg position and cardiac massage is
performed.
The aorta is unclipped
Pacemaker wire is placed in the left ventricle Suture or thread for pacemaker TEMPOWIRE 2-0 SH 26 mm
The black color is connected to the pacemaker suture needle and the red
color to the hypodermic needle that is placed on the patient's skin.
SURGICAL INSTRUMENTATION PROGRAM
After a while the heart does not recover its rhythm so another pacemaker
thread is placed on the right side.
The patient is removed from the pump
A venous cannula is removed from the pulmonary vein and said structure is PROLENE 4-0 2 RB-1 17 mm, Needle holder, vascular dissection forceps
sutured.
They remove the arterial cannula from the aorta and suture said structure PROLENE 4-0 2 RB-1 17 mm, Needle holder, vascular dissection forceps
Administer protamine to the patient to reverse the effect of heparin
Hemostasis is checked
The epicardium repair stitches are removed, hemostasis is checked. Mayo scissors, Yankawer cannula and dissecting forceps
The heart is checked to beat again, the patient's vital signs are checked
The tube is passed to the chest in the mediastinum, an incision is made in the #34 chest tube, Kocher clamp, #7 scalpel handle with #15 blade, compress
xiphoid process.
A second tube is passed to the chest but located in the right pleura.
Sternal separator is removed, final count is done before closing the sternum Aciflex #6, Wire needle holder, wire cutter
Closure is done: first suture the sternum and then the subcutaneous cellular Curved Rochester forceps, #6 wire suture, wire cutter, wire needle holder
tissue, the patient's tissue is infiltrated Syringe with 0.5% bupivacaine taken to 100%
Fine Needle Holder, VICRYL Plus 0 CT-1 36.4mm, Clawless Dissecting
Forceps, Short May Scissor, Compress
skin suture Fine needle holder, MONOCRYL 3-0 PS-2 26 mm,
dissecting forceps with claw
SURGICAL INSTRUMENTATION PROGRAM
Cleaning the surgical wound, placing a dressing, cleaning the patient, Compress, saline solution, DERMABOND, gauze, dressing and transparent
removing the surgical field IOBAM fixomull
Removal of fields and arrangement of instruments
SURGICAL INSTRUMENTATION PROGRAM