Case

Clinical
"Myocardial Revascularization"
By: Juan Sebastian Rincon Martinez
Patient Information
Name: Orlando Diaz
ID: 37825279
Weight: 67kg
Height: 1.60cm
Blood Type: O+
Results: HIV (-), Hepatitis B (-)
Age: 66 years old
FE: 54%.
EPS: Nueva EPS
Diagnosis:
Coronary artery disease
involving anterior desc.,
circumflex and right coronary
artery.

Procedure:
Myocardial revascularization
The process begins... (Before anesthetic induction)
The review of the clinical history is evidenced.
The patient interview is evidenced (Introducing ourselves, communicating
the procedure to be performed, consulting the pre-surgical bath and the
antiseptic used, informing the state in which the wound will come out
after surgery and giving the necessary recommendations to take into
account after surgery, buy a soap and towel for specific use for the
wound, avoid scratching the wound).
The respective cleaning and disinfection of surfaces is evidenced.
Before Incision...
Patient's body surface area is evident: 1,75
Flow rate evident: 4.3
Heparin dose is evidenced: 4.69
Z value not applicable
Effective orifice area value not applicable.
It is evidenced that the perfusion devices are correct.
The sterility of the equipment is confirmed
It is evidenced that the pre-surgical asepsis used was alcohol and
isopropyl alcohol.
It is evidenced that the washing was total and the plaque is located.
Adequate positioning of the patient is evidenced
Surgical Process
First step
The steps of the opening time (skin incision,
tcs, saphenous vein extraction as free graft,
internal mammary artery extraction as
pedicled graft, graft permeabilization,
sternotomy, incision and pericardium repair)
are performed.
This will be done
with...
MB 3 Sheet 15( (Left Leg) Electrosurgical
scalpel, weitlander retractor, Farabeuf
retractors, compresses, dissecting forceps,
metzembaun scissors, ligaclip forceps and
ligaclips 100 and 200, silk4/0, 10 cc syringe,
arterial cannula, heparinized solution, 1 cc
syringe, nitropusside solution, Vycril 2/0,
monocryl 3/0, MB 7 Sheet 15 (Thorax)
Electrobisturi, mammary retractor, sternal
retractor, vascular dissection forceps, 0 silk,
reciprocating saw.
Second step
The vascular timing steps are performed
(Tobacco Bags, Aortic Cannulation, Clamping
right atrium, starting pump and clamping
aorta).
This will be done
with...
2/0 polyester, thread passer, metzembaun
scissors, MB 7 Sheet 11, EOPA 40 cannula, tube
clamp, silk 1, partial occlusion clamp,
metzembaum scissors, vascular dissection,
32/40 single venous cannula, anterograde
root cardioplegia cannula, curved Kellys,
stracorporeal circulation lines, connectors,
rigid pericardial suction.
Third step This will be done
An incision is made in the right coronary
artery to perform the respective with...
anastomosis to the saphenous vein as a MB 7 blade 15, fine microcoronary scissors,
free graft. vascular dissection forceps, Dennis
dissection.
Fourth Step
Proximal anastomosis of the free graft from
the saphenous vein to the right coronary
artery is performed.
This will be done
with...
Prolene 8/0, vascular needle holder,
dissection, May scissors, Dennis dissection.
Fifth step This will be done
with...
Elevation of the apex of the heart is
performed to perform the second
anastomosis sequentially to the circumflex
artery continuing with the saphenous vein Starfished
graft.
Sixth Step
Incision is made in the circumflex and in the
graft to perform the respective anastomosis
to the saphenous vein as a free graft
sequentially.
This will be done
with...
MB 7 blade 15, fine microcoronary scissors,
vascular dissection forceps, Dennis dissection
Seventh Step This will be done
Sequential anastomosis of the free graft
from the saphenous vein to the circumflex
artery is performed, and the starfished is
with...
Prolene 8/0, vascular needle holder,
removed
dissection, May scissors, Dennis dissection.
Eighth Step
Separation of the epicardium is performed
and an incision is made in the anterior
descending artery to perform the respective
anastomosis to the internal mammary
artery as a pedicled graft, preparing the
mammary graft.
This will be done
with...
Epicardial retractor, MB 7 blade 15, fine
microcoronary scissors, vascular dissection
forceps, Dennis dissection, 1cc syringe with
nitropusside.
Ninth Step
Distal anastomosis of the pedicled graft from
the internal mammary artery to the anterior
descending artery is performed.
This will be done
with...
Prolene 7/0, vascular needle holder,
dissection, Mayo scissors, Dennis dissection.
Tenth Step This will be done
Unclamp (removing Satinsky) and clamp the
aorta again and make a small hole for the
with...
third and final anastomosis of the free
Clamp of partial occlusion, Punch
sequential saphenous vein graft.
Eleventh Step
Anastomosis is performed proximal to the
aorta of the last portion of the sequential
free graft.
This will be done
with...
Prolene 6/0, vascular needle holder,
dissection, May scissors, Dennis dissection.
Twelfth Step This will be done
The closing time steps are performed (Pump
out, unclamp (partial occlusion clamp),
with...
Pacing wire 0, Polyester 2/0, Tube to Thorax,
unclamp and knot tourniquet sutures,
pleuroback, compresses, vascular dissection,
pacemaker thread position, chest tube
steel 5, Vycril 0, Monocryl 3/0).
position with pleuroback, compress count,
sternal suture, tcs and skin suture).
Eleventh Step This will be done
with...
The steps of the finishing time (Cleaning and
Healing) are performed.
Wet and dry compresses, silver dressing,
gauze and transparent dressing without pad
and polyester with pad, Dermabond.
Post-Surgical Time
It is recorded on the instrumentation checklist whether or not the medical device count was verbally
confirmed.

Before leaving the

operating room....
Confirm and record whether or not there are problems to be resolved with instruments and/or
equipment.
Confirm and record the same confirmation of samples and labeling
Immediate Postoperative
We proceed to fill out the expense sheet in the system, recording all the supplies spent during the
surgery, without leaving empty spaces, and printing the final record and filling out the checklist that
this was indeed done.
The instrumentation planning record is made and recorded in the system
It is recorded that the health care event report does not apply
The SAP system (international foscal) is registered and evidenced
It is recorded that the registration of sterilization invoices does not apply
It is recorded that the shift delivery record does not apply
It is recorded that the verification of high-cost devices does not apply
The record of instrumented procedures is filled out and it is recorded in the checklist that this was
done
It is recorded that the verification of the sterile instruments was made
In observations, it is recorded that the closure of the wounds by planes was carried out without
complications, clean wounds covered with the used dressings and that the sterility indicators were
good.
The baskets used in surgery are verified, ensuring that they are in correct condition and quantity,
reorganizing and arranging them, with their respective indicators.
Clinical Case finished
Elaborated by: Juan Sebastian Rincon Martinez
University of Santander
Surgical Instrumentation Seventh Semester
Practice III