1 / 32

Procedures

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.

lycoris
Download Presentation

Procedures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Procedures Intermediate Format: Pericardiectomy/Pericardial Window

  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.

  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

  4. Terms and Definitions • Pericardium • Decortication • Pericardial effusion • Cardiac tamponade

  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

  6. Pathophysiology • Chronic pericarditis • Tubular • Rheumatic • Viral • Neoplastic • Constrictive

  7. Pathophysiology • Signs & Symptoms • Chest pain • Fever • Cough • Dyspnea • Palpitations • Friction Rub

  8. Surgical Intervention:Special Considerations • Patient Factors • anxiety • Room Set-up • For heart surgery • Possibly cardiac bypass on standby

  9. Surgical Intervention: Positioning • Position during procedure • Supine, arms on armboards at 90 degrees • Supplies and equipment • Special considerations: high risk areas

  10. Surgical Intervention: Special Considerations/Incision • Special considerations • State/Describe incision • Median sternotomy • # 10, # 15 blades

  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

  12. Surgical Intervention: Instruments • General: Chest and Heart sets • Specific • Have all cardiac bypass instrumentation available if needed

  13. Surgical Intervention: Equipment • General • Specific • Cardiac defibrillator on standby with internal and external paddles • Cardiac bypass on standby

  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

  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”

  16. Counts • Initial: Sponges, Sharps, instruments • First closing • Final closing • Sponges • Sharps • Instruments

  17. Specimen & Care • Identified as pericardium • Handled: routine

  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

  19. The surgical incision most likely for open heart surgery is: • Anterolateral thoracotomy • Posterolateral thoracotomy • Median sternotomy • supraclavicular

  20. Which medication is commonly given IV about 3-5 min prior to cross-clamping the artery during Arteriotomy? • Epinephrine • Protamine sulfate • Papavarine • Heparin

  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)

  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

  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

  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

  25. Which of the following bypass grafts would require preclotting? • Knitted polyester (Dacron) • Saphenous vein • Human umbilical cord graft • Polytetrafluoroethylene (PTFE)

  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

  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

  28. The artery that carries deoxygenated blood in the adult is the: • Aorta • Carotid artery • Pulmonary artery • Coronary artery

  29. Common artery bypass procedures include all of the following except: • axillo-popliteal • Femoro-femorol • Axillo-femoral • Femoro-popliteal

  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

  31. Suture material used to place vascular grafts would include: • PDS • Vicryl/Dexon • Prolene • Stainless steel

  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

More Related