Planeamiento 4

SURGICAL INSTRUMENTATION PROGRAM
TRAINING SURGICAL PLANNING

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IQX-FT-003-BUC
STUDENT NAME: CODE: PRACTICE

LEVEL: III /IV
ANDREA VALENTINA VILLAMIZAR BLANCO 01200021056
TEACHER'S NAME: Lidy Higuera PRACTICE STAGE: ICB NOTE:
SPECIALTY: CX SURGEON: DATE:
CARDIOVASCULAR DR GIRALDO 30 AUGUST 2023
NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:
GALIA XIOMARA LOPEZ 63553418 38 YEARS OLD
SURGICAL PROCEDURE TO PERFORM:
MITRAL VALVE REPLACEMENT
SURGICAL INSTRUMENTATION PROCESS
1. PLANNING STAGE:
1.1. Surgical Objective: (Make description)
SURGICALLY REPLACE THE MITRAL VALVE WITH A MECHANICAL ONE


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1.2. Anatomy and physiology: (Make graph and description).
The mitral valve has two leaflets called anterior and posterior, with a similar surface and thickness ( ∼1 mm), separated by
their respective commissures (called by some the 4 leaflets) and anchored at their bases to the annulus and at their free
edges to the subvalvular apparatus. through the chordae tendineae.
The mitral valve is one of the four valves in the heart that keep blood flowing in the right direction. Each valve
has leaflets (leaflets) that open and close once during each heartbeat.
1.3. Check list:


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MEDICAL EQUIPMENT/ DRUGS AND

DEVICES SUTURES AND SOLUTIONS
INSTRUMENTAL
NEEDLES
EXTRACORPORE -Compresses-Gauze- pacemaker leadvicryl 0 Saline solution

ALEQUIPMENTRE Aseptosyringe- MONOCRYL3/0PROLE
Electrosurgical- NE 4/0ETHIBOND infiltrationbupivacaine
CIPROCATINGSA
WSTERNALRETR Pathology bottle- 2/0BONE WAXTI-CRON
COLOREDTOURNIQUET 2/0 Y-5 ACIFLEX 5
S-Gloves-Handlebars-
nelaton probe-Scalpel
ACTORVALVE blade 11-15RIGID
TESTERS PERICARDIAL
ASPIRATORVENOUS
CANNULA ARTERIAL
CANNULATUBE TO
THORAX OF
32CONNECTOR 3/8 3/8
3/8Y-CONNECTOR10 CC
SYRINGE
2. ORGANIZATION STAGE:

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Arrangement of May tables and reservation (make scheme).
2.2. Patient position (Name and graphic):


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


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3. EXECUTION STAGE:

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a) Anesthesia (write the type of anesthesia):
GENERAL
b) Incision (write the type of approach and the name of the incision):
STERNOTHOMY
c) Surgical Process (Describe the main steps of the surgical medical technique with the instruments to be used).
◦ Incision mb # 7 hb# 15
◦ Enlargement of incision with electro
◦ Reciprocating saw sternotomy
◦ Hemostasis with bone wax(2) and electro(in 60)
◦ Sternal retractor with shields


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◦ Opening of the pericardium with electro and dissection
◦ Pericardium repair with silk 0(2)
◦ Tobacco bags in aorta with ethibon 2/0 (2)
◦ Colored tourniquets are placed
◦ Repair of the upper cava is made with pre-cut silk 1 and thread pass pliers
◦ Superior vena cava tobacco pouch with Ti-cron 2/0 Y5
◦ Colored tourniquets are placed
◦ Inferior vena cava repair with precut silk 1 and thread-passing forceps
◦ Cena cava inferior tobacco bag with Ti-cron 2/0 Y5
◦ Colored turnstiles
◦ Tobacco pouch of cardioplegia in the root of the aorta with Ti-cron 2/0 Y5
◦ Colored turnstiles
◦ Cannulation begins (first arterial and then venous)
◦ The tourniquets are fixed to the cannulas with precut silk 1


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◦ The cannulas are connected to the lines
◦ Cardioplegia cannula
◦ Purge lines
◦ The pulmonary vein is dissected to separate it from the aorta
◦ Wait a few minutes for the cardioplegia to take effect
◦ After the estimated waiting time, the cardioplegia does not take effect and more doses of heparin are given
◦ The pump is entered with a low ct (600) to avoid coagulation
◦ The aorta is clamped with debakey clamp

◦ The left atrium and septum are opened with mb# 7 hb # 11, Metzembaum scissors
◦ The left atrium is repaired with ti-cron 2/0 Y5
◦ The mitral valve is observed to replace the damaged leaflets
◦ The valve is opened with hb#11
◦ A wide incision is made with Metzembaum scissors.
◦ The leaflet is cut into two parts with metzembaum scissors to allow it to hang and fulfill the function of the broken chordae

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tendineae.
◦ Valve gauges are passed
◦ Mechanical carbomedics mitral valve #29
◦ The valve is passed through with the threaded adapter
◦ Valve ring points are made with ti-cron 2/0 Y5
◦ Sutures are tied to secure the valve
◦ The valve is tested with the tester
◦ The interatrial septum is closed with prolene 4/0
◦ Closure of the auricle with prolene 4/0 needle 22 left repair
◦ We left bomb
◦ We remove the clamp
◦ Obstacles are removed for the closure of the atrium
◦ Pacemaker lead is passed
◦ Cardioplegia is reversed

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◦ The cannulation is withdrawn (first coming then arterial) and the purse strings or tobacco bags are closed
◦ An incision is made for the passage of the drainage tube
◦ The sternal retractor and shields are removed
◦ Hemostasis of bleeding vessels
◦ The separator is placed with compresses
◦ The drainage tube is passed and fixed
◦ Nelaton probe is passed through the tube and connected to the suction
◦ The separator is removed with the compresses

◦ Gauze and compress count
◦ The bony periosteum is cauterized
◦ Sternal closure with aciflex 5 steel suture
◦ Infiltration with bupivacaine
◦ Closure of TCS with Poliglactin 910 0 (2)
◦ Skin closure with 3/0 monocryl


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◦ Healing is performed with dermabon and leukomed dressing
◦ The pleurovac is connected


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WEEKLY REPORT FORMAT OF TRAINING PRACTICE
SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES
STUDENT SIGNATURE: TEACHING SIGNATURE: __________________________

Planeamiento 4

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SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

STUDENT NAME: CODE: PRACTICE

TEACHER'S NAME: Lidy Higuera PRACTICE STAGE: ICB NOTE:

SPECIALTY: CX SURGEON: DATE:

CARDIOVASCULAR DR GIRALDO 30 AUGUST 2023

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:

GALIA XIOMARA LOPEZ 63553418 38 YEARS OLD

SURGICAL PROCEDURE TO PERFORM:

MITRAL VALVE REPLACEMENT

SURGICAL INSTRUMENTATION PROCESS

1.1. Surgical Objective: (Make description)

SURGICALLY REPLACE THE MITRAL VALVE WITH A MECHANICAL ONE

TRAINING SURGICAL PLANNING

1.2. Anatomy and physiology: (Make graph and description).

1.3. Check list:

TRAINING SURGICAL PLANNING

MEDICAL EQUIPMENT/ DRUGS AND

EXTRACORPORE -Compresses-Gauze- pacemaker leadvicryl 0 Saline solution

TRAINING SURGICAL PLANNING

Arrangement of May tables and reservation (make scheme).

2.2. Patient position (Name and graphic):

TRAINING SURGICAL PLANNING

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

TRAINING SURGICAL PLANNING

TRAINING SURGICAL PLANNING

a) Anesthesia (write the type of anesthesia):

◦ Enlargement of incision with electro

◦ Reciprocating saw sternotomy

◦ Hemostasis with bone wax(2) and electro(in 60)

◦ Sternal retractor with shields

TRAINING SURGICAL PLANNING

◦ Opening of the pericardium with electro and dissection

◦ Pericardium repair with silk 0(2)

◦ Tobacco bags in aorta with ethibon 2/0 (2)

◦ Colored tourniquets are placed

◦ Superior vena cava tobacco pouch with Ti-cron 2/0 Y5

◦ Colored tourniquets are placed

◦ Cena cava inferior tobacco bag with Ti-cron 2/0 Y5

◦ Cannulation begins (first arterial and then venous)

◦ The tourniquets are fixed to the cannulas with precut silk 1

TRAINING SURGICAL PLANNING

◦ The cannulas are connected to the lines

◦ The pulmonary vein is dissected to separate it from the aorta

◦ Wait a few minutes for the cardioplegia to take effect

◦ The pump is entered with a low ct (600) to avoid coagulation

◦ The aorta is clamped with debakey clamp

◦ The left atrium is repaired with ti-cron 2/0 Y5

◦ The mitral valve is observed to replace the damaged leaflets

◦ The valve is opened with hb#11

◦ A wide incision is made with Metzembaum scissors.

TRAINING SURGICAL PLANNING

◦ Valve gauges are passed

◦ Mechanical carbomedics mitral valve #29

◦ The valve is passed through with the threaded adapter

◦ Valve ring points are made with ti-cron 2/0 Y5

◦ Sutures are tied to secure the valve

◦ The valve is tested with the tester

◦ The interatrial septum is closed with prolene 4/0

◦ Closure of the auricle with prolene 4/0 needle 22 left repair

◦ We remove the clamp

◦ Obstacles are removed for the closure of the atrium