CASO CLINICO

OFF-PUMP MYOCARDIAL
REVASCULARIZATION
JULIANA ISAZA MANRIQUE

INFORMATION OF THE PATIENTE:

Name: Jose Raul Arenas Pinilla

ID: 5745006
Weight: 70kl
Height: 1.74 cm
Blood Type: O+
Results: VIH - Hepatitis -
Age: 80 years old
FE: 49%.
EPS:

DIagnosis:
Coronary artery diseaseinvolving

right coronary artery.

Procedure:
"Off-Pump MyocardialRevascularization"

Procedure:
This procedure consists of bridging using autologous
grafts to provideblood flow to ischemic cardiac tissue.
These grafts are anastomosed atone end to the aorta;
and at the other end are anastomosed to the
distalportion of the stenotic coronary artery. They can be
free grafts ofsaphenous vein, gastroepiploic, radial, etc.
or pedicled grafts such as theinternal mammary artery
without extracorporeal circulation.

Anatomy of the procedure

 Procedure:
Patient's body surface area is
evident: 1,7
Flow rate evident: 4,25
Heparin dose is evidenced: 4,9
It is evidenced that the perfusion
devices are correct.
The sterility of the equipment is
confirmedIt is evidenced that the
pre-surgical asepsis used was alcohol
andisopropyl alcohol.
It is evidenced that the washing was
total and the plaque is located.
Adequate positioning of the patient
is evidenced

SURGICAL PROCESS
Verify that the sternal retractor is appropriate for
off-pumprevascularization.
For repair of the posterior pericardium, pass to the
surgeonpolyester suture with pledget, supported
by tourniquet and / or thread passer.
Pass to the surgeon healing elements such as
compresses andgauze in order to improve
exposure.
Pass to the surgeon the special restraint and
stabilizationdevices, in order to position the heart
and achieve exposure of the arteries to
revascularize (support of the assistant surgeon).
Connect the suction to the systems in order to
achieve thenecessary pressure for the operation of
the coronary positionerand stabilizer.
Pass to the surgeon instruments of dieresis (scalpel
with blade15), and vascular apprehension, to
dissect the epicardial fat andlocate the coronary
to revascularize.
Pass the elastic band (silastic stitch with round
needle) toperform the preconditioning of the
coronary artery and repair itwith protected
hemostatic clamp.
Pass to the surgeon instruments of diaeresis,
elastic microvascular apprehension to perform the
coronary arteriotomy(scalpel handle blade 15) and
for the prolongation of the incisionpass
microvascular scissors type potts anterograde and
/ orretrograde depending on the cut.
To measure the diameter of the vessels pass the
coronarydilators.
Pass to the surgeon the coronary shunts
(1.0,1.5,2.0,2.5) supportedby a fine elastic grasping
forceps in order to maintain thecoronary flow.
Perform the closing time steps
Perform the ending time steps
 Post-Surgical Time
It is recorded on the instrumentation
checklist whether or not the medical
device count was verballyconfirmed

Before leaving theoperating

room
Confirm and record whether or not there are
problems to be resolved with instruments
and/orequipment.
Confirm and record the same confirmation of
samples and labeling

Central Sterilization
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

University of Santander
Surgical Instrumentation Seventh Semester
Practice III