CLINICAL

CASE
"Off-Pump Myocardial
Revascularization"

JULIANA ISAZA MANRIQUE

PATIENT INFORMATION

Name: F.R
ID: 99225500
Weight: 70kg
Height: 1.74cm
Blood Type: O - Results: HIV (-),
Hepatitis B (-) COVID - 19
Age: 80 years old
EF: 56%.
EPS:

DIAGNOSIS: PROCESS

Coronary heart disease. Myocardial revascularization

without extracorporeal
circulation.

PROCEDURE DEFINITION
This procedure involves bridging using autologous grafts to provide blood
flow to ischemic heart tissue. These grafts are anastomosed at one end
to the aorta; and at the other end they are anastomosed to the distal
portion of the stenotic coronary artery. They can be free grafts of the
saphenous, gastroepiploic, radial vein, etc. or pedunculated grafts such
as internal mammary without extracorporeal circulation.

PROCESS
The review of the clinical history is evidenced.
The interview of the patient is evidenced (Introducing ourselves,
communicating the procedure to be performed, consulting the
pre-surgical bathroom and the antiseptic used, informing the
state in which the wound will remain after surgery and giving the
necessary recommendations to be taken into account after
surgery, buy a soap and a towel for specific use for the wound,
avoid scratching the wound).
 BEFORE THE INCISION
The body surface area of ​the patient is
evident: 1.79
Evident Flow: 4.47
Heparin dose is evidenced: 4.9
It is evident that the perfusion devices are
correct.
The sterility of the equipment is confirmed.
It is evident that the preoperative asepsis
used was alcohol and isopropyl alcohol.
It is evident that the washing was complete
and the plaque is located.
Proper positioning of the patient is evidenced

SURGICAL PROCESS
Verify that the sternal retractor is appropriate for off-pump
revascularization.
For posterior pericardial repair, pass polyester suture with a
compress, held by tourniquet and/or thread passer, to the surgeon.
Pass healing elements such as compresses and gauze to the surgeon
in order to improve exposure.
Pass the special containment and stabilization devices to the
surgeon, in order to position the heart and achieve exposure of the
arteries to be revascularized (assisting surgeon support).
Connect the suction to the systems to achieve the necessary pressure
for the operation of the coronary positioner and stabilizer.
Pass the surgeon diaeresis instruments (scalpel with 15 blade), and
vascular apprehension, to dissect the epicardial fat and locate the
coronary artery to be revascularized.
Pass the elastic band (silastic point with a round needle) to
precondition the coronary artery and repair it with a protected
hemostatic clamp.
Pass the surgeon umlaut instruments, elastic microvascular
apprehension to perform the coronary arteriotomy (scalpel handle
blade 15) and to extend the incision pass anterograde and/or
retrograde microvascular pots-type scissors depending on the cut
To measure the diameter of the vessels pass the coronary dilators.
Pass the coronary leads (1.0, 1.5, 2.0, 2.5) to the surgeon supported
by fine elastic grasping forceps to maintain coronary flow.
Perform the closing time steps
Perform the completion time steps
 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
solved with instruments and/or equipment.
Confirm and record the same confirmation of samples and
labeling

STERILIZATION CENTRAL

The baskets used in surgery are verified, making sure that they
are in correct condition and quantity, reorganizing and
accommodating them, with their respective indicators.
 PRODUCED BY :
Juliana Isaza Manrique
University of Santander
Surgical instrumentation seventh
semester
Practice III