procedures intermediate format: pericardiectomy/pericardial window
TRANSCRIPT
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Procedures
Intermediate Format:
Pericardiectomy/Pericardial Window
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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.
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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
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Terms and Definitions
• Pericardium
• Decortication
• Pericardial effusion
• Cardiac tamponade
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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
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Pathophysiology
• Chronic pericarditis– Tubular– Rheumatic– Viral– Neoplastic– Constrictive
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Pathophysiology
• Signs & Symptoms– Chest pain– Fever– Cough– Dyspnea– Palpitations– Friction Rub
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Surgical Intervention:Special Considerations
• Patient Factors– anxiety
• Room Set-up– For heart surgery
• Possibly cardiac bypass on standby
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Surgical Intervention: Positioning
• Position during procedure– Supine, arms on armboards at 90 degrees
• Supplies and equipment
• Special considerations: high risk areas
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Surgical Intervention: Special Considerations/Incision
• Special considerations
• State/Describe incision– Median sternotomy– # 10, # 15 blades
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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
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Surgical Intervention: Instruments
• General: Chest and Heart sets
• Specific– Have all cardiac bypass instrumentation
available if needed
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Surgical Intervention: Equipment
• General
• Specific– Cardiac defibrillator on standby with internal
and external paddles– Cardiac bypass on standby
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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
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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”
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Counts
• Initial: Sponges, Sharps, instruments
• First closing
• Final closing– Sponges– Sharps– Instruments
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Specimen & Care
• Identified as pericardium
• Handled: routine
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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
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The surgical incision most likely for open heart surgery is:
a. Anterolateral thoracotomy
b. Posterolateral thoracotomy
c. Median sternotomy
d. supraclavicular
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Which medication is commonly given IV about 3-5 min prior to cross-clamping the artery during Arteriotomy?
a. Epinephrine
b. Protamine sulfate
c. Papavarine
d. Heparin
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All of the following are sutures used in CV surgery to suture vessels or vascular grafts except:
a. Polytetrafluoroethylene (PTFE or Gore-Tex)
b. Polyporpylene (Prolene)
c. Polyester (Dacron)
d. Surgical gut (chromic)
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Which of the following procedures would commonly require the use of extracorporeal circulation (heart-lung bypass)?
A. Abdominal Aortic Aneurysmectomy with Graft
B. Pneumonectomy
C. Coronary Artery Bypass Graft
D. Vena Cava Umbrella insertion
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The vessel used to increase the overall blood supply to the heart following CABG is the :
a. Saphenous artery
b. Brachial artery
c. Carotid artery
d. Internal mammary artery
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The creation of a commuication between an artery and a vein for hemodialysis access is called a(n)
a. Bypass Graft
b. Aneurysmectomy
c. Vena Cava Umbrella Filter Placement
d. Arteriovenous Fistula Formation
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Which of the following bypass grafts would require preclotting?
A. Knitted polyester (Dacron)
B. Saphenous vein
C. Human umbilical cord graft
D. Polytetrafluoroethylene (PTFE)
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The procedure in which a Fogerty Catheter is used to remove blockage of a vessel is referred to as:
a. Arteriovenous shunt
b. Endarterectomy
c. Embolectomy
d. Ligation and stripping
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The autogenous graft which is left in place after destruction of the internal valves and then sutured into the arterial system is:
a. In-situ saphenous vein graft
b. Human umbilical cord graft
c. PTFE graft
d. ligation and stripping of the saphenous vein
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The artery that carries deoxygenated blood in the adult is the:
a. Aorta
b. Carotid artery
c. Pulmonary artery
d. Coronary artery
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Common artery bypass procedures include all of the following except:
a. axillo-popliteal
b. Femoro-femorol
c. Axillo-femoral
d. Femoro-popliteal
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Specific equipment used during surgery on a pt with a pacemaker in place should include:
a. A magnet
b. Mono-polar ESU with its patient return electrode applied to the patient
c. Mono-polar ESU without its patient return electrode applied to the patient
d. Bi-polar ESU with its patient return electrode applied to the patient
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Suture material used to place vascular grafts would include:
a. PDS
b. Vicryl/Dexon
c. Prolene
d. Stainless steel
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A Femoro-popliteal Bypass is scheduled. Which self-retaining retractor would be used to facilitate exploration of the femoral artery?
a. Harken
b. Debakey
c. Weitlaner
d. Gelpi