SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: CODE: PRACTICE LEVEL: III

LAURA DANIELA MENDOZA RIOS 01200021041

TEACHER'S NAME: PRACTICE STAGE: NOTE:

GLENDA FOSUNAB

SPECIALTY: SURGEON: DATE:

CARDIO DR OCAMPO 15/02/2023

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:

ESTEBAN MIRALDA 1095421252 26
SURGICAL PROCEDURE TO PERFORM:
PERICARDIECTOMIA

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description)

This is a procedure done on the sac that surrounds the heart. A surgeon cuts and removes this sac or a large part of it. This allows
the heart to move freely.
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1.2. Anatomy and physiology: (Make graph and description).

The pericardium is formed by a double membrane that acts as a sac surrounding the heart.
acts as a sac enveloping the heart. Of these two membranes, one is in direct contact with
the heart and is called the visceral pericardium; the other, the outermost layer, is known as
the parietal pericardium. Between the two layers a virtual space is created that may contain
a small amount of fluid that functions as a lubricant.

Functions of the pericardium. Taken from:

Effects on cardiac cavities: https://www.fbbva.es/microsites/salud_car
- Limits short-term cardiac distension. dio/mult/fbbva_libroCorazon_cap54.pdf
- Facilitates coupling and interaction between cardiac chambers.
- Maintains the pressure/volume ratio and cardiac output of the cardiac cavities.
cardiac cavities.
- Maintains left ventricular geometry.

Effects on the whole heart:

- Lubrication.
- Balances gravitational and hydrostatic forces.
- Immunological.
- Fibrinolytic.
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Vascularization: The visceral serous pericardium

receives branches from the coronary arteries (1). The
parietal fibrous and serous pericardium is supplied by
the pericardic phrenic (2), internal mammary and
pericardial (3), bronchial and esophageal arteries.
The veins drain to the brachiocephalic venous trunks,
superior vena cava, azygos vein, and the right atrium.
The lymphatics go to the tracheobronchial nodes.

Innervation: Sensory fibers from the X-vagus nerves (1)

and phrenic nerves (2) and Sensory and vasomotor fibers Taken from:
from the thoracic sympathetics (3). https://es.slideshare.net/oskrdjoker/enferme
dades-del-pericardio-28384121
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1.3. Check list:

MEDICAL EQUIPMENT/ DRUGS AND

SUTURES AND
INSTRUMENTAL DEVICES SOLUTIONS
NEEDLES

-Extracorporeal basket -Pack of clothes -Monocyl 3/0- PS-2 -Warm saline solution
-Pads -Vicryl 0, CT-1
-Reciprocating saw -Gloves -Polypropylene5-0,
-Scalpel blade #15 Vascular
-Sternal Separator -Suction rubber -Polyester 2-0, Vascular
-Electrobisturi -Aciflex 5
-Asepto-syringe -Prolene 4/0, curved
-20cc syringe cutting needle
-Handles -Pacemaker wire
-Pathology bottles
-Nelaton probe
-Ioban
-Bone Wax
-Dressings
-Yankawer cannula
-Pleurovac
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2. ORGANIZATION STAGE:

a. Arrangement of May tables and reservation (make scheme).

1. Scalpel handle #7 with scalpel blade #15

2. Mayo scissors
3. metzembaum scissors
9 4. Adson dissecting forceps without claw and with claw
10 5. Vascular dissection forceps
8
6. Curved kellu forceps
7 4 5 7. Kelly adson forceps
3
6 8. Rochester clamp
2
9. Allix clamp
1 10. Farabeuf separators

1 3
4 6
5 12
10 9 11
2 1. Instrument basket
7. Bone wax
2. Clothes package
7 8 8. Bottle of pathology
3. Folded compress with sutures and
needle holder 9. Wire cutter
4. Cokes 10. Finochietto separator
5. Aseptojeringa 11. Wire holder
6. 20cc syringe 12. Yankawer cannula
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2.2. Patient position (Name and graphic):

Supine decubitus

2.3. Location of the Surgical Team (make a graph):

Anesthesiologist
P Surgeon
A Assistant
C
Surgical
I Instrumentator
E May table
N Reserve table
T
E
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3. EXECUTION STAGE:

a) Anesthesia (write the type of anesthesia):

General anesthesia

b) Incision (write the type of approach and the name of the incision):

Sternotomy, sternal approach

c) Surgical Process (Describe the main steps of the surgical medical technique with the instruments to be used).

-Asepsis and antisepsis of the operative area and placement of the Ioban.

-Sternal approach, skin incision, subcutaneous cellular tissue, sternotomy (#7 scalpel handle with #15 scalpel blade, electrosurgical scalpel,
procussive saw).

-A retractor is placed so that the entire anterior and lateral sides of the pericardium can be well visualized (finochietto retractor).

-A plane is formed between the myocardial muscle and the deep surface of the fibrous pericardium.

-A medial incision is made and dissection is started on the anterior aspect, over the left ventricle and left atrium, until the phrenic nerve is
reached.

-Continue through the diaphragmatic pericardium and continue to the tip of the heart. The right side of the pericardium is resected up to one
centimeter in front of the left phrenic nerve.
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-This phrenic to phrenic dissection is sufficient to free the heart in cases of constrictive pericarditis, or to minimize fluid production (Allix clamp,
Electribusturi).

-Hemostasis is performed and the tubes are positioned to pleurovac thorax (Electrobisturi, sera osea).

-Compress and gauze count

-Sternal suture, subcutaneous cellular tissue and skin (Aciflex 5, Vicryl 0 and polypropylene 4/0, wire cutter, wire holder, needle holder, May
scissors).

-Finally, cleaning and healing of the wound is performed.

WEEKLY REPORT FORMAT OF TRAINING PRACTICE

SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES

STUDENT SIGNATURE: TEACHING SIGNATURE: __________________________

CONTROL DE CAMBIOS

FECHA DE
VERSIÓN DESCRIPCIÓN DEL CAMBIO RESPONSABLE
APROBACIÓN

Lizeth Guiza
00 Versión de Prueba Coordinadora de Prácticas 25/11/2015
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Elimina del encabezado la fecha de la

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disposición de la alta dirección consejo Coordinadora de prácticas
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01 Eliminación pie de página por 03/08/2022
modificación en procedimiento control de
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