SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: CODE:0120022011 PRACTICE

ANA MARIA BOTHIA AVILA LEVEL: III

TEACHER'S NAME: PRACTICE SCENARIO: NOTA:

IQ. GLENDA INSTITUTO CARDIOVASCULAR

SPECIALTY: SURGEON: DATE:

CX CARDIOVASCULAR DR. GIRALDO 15/NOVIEMBRE/2023

NAME OF PATIENT: CLINICAL HISTORY NUMBER: PX AGE:

JAIRO REDONDO URIBE 13847986 65 AÑOS
SURGICAL PROCEDURE TO BE PERFORMED:
MYOCARDIAL REVASCULARIZATION.

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description).

It is a surgical procedure performed to restore blood flow to the heart muscle (myocardium) that may be compromised
due to blockages in the coronary arteries.

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

Anatomy of the Coronary Arteries

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Left Coronary Artery (LCA):

Left Main Coronary Artery (LMCA): It is the first part of the LCA, originating from the ascending aorta and bifurcating
into two main branches.

Left Anterior Descending (LAD) Artery: Extends to the front of the heart and supplies blood to the majority of the
interventricular septum and the anterior and lateral portions of the left myocardium.

Right Coronary Artery (RCA):

Right Coronary Artery (RCA): Another major branch of the ascending aorta, supplying blood mainly to the right side of
the heart.

Right Marginal Artery: A branch originating from the RCA, supplying blood to the right lateral side of the heart.

Circumflex Artery:
Circumflex Artery: A branch of the left coronary artery, coursing around the back of the heart.

Obtuse Marginal Artery: A branch of the circumflex artery supplying blood to the inferior part of the left ventricle.

Posterior Descending Artery (PDA):

Posterior Descending Artery (PDA): A branch arising either from the right coronary artery or the circumflex artery,
supplying blood to the inferior part of the heart.

Anterior descending artery (ADA):

The LAD descends along the front of the heart, providing blood supply to a significant portion of the interventricular
septum, as well as the anterior and lateral regions of the left myocardium. Due to its location and the extent of its
coverage, the LAD is considered one of the most important coronary arteries.
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Anatomy of the Saphenous Vein

The great saphenous vein (or internal saphenous vein) and the small saphenous vein (or external saphenous vein) are
two of the most important superficial veins in the leg's venous system.

Great Saphenous Vein (Internal Saphenous):

• Originates on the medial (inner) side of the foot and ascends along the inner part of the leg and thigh.

• As it approaches the groin, it connects with the femoral vein, one of the major veins in the deep venous system.

Small Saphenous Vein (External Saphenous):

• Originates on the lateral (outer) side of the foot and follows a similar path to the great saphenous vein but along
the outer part of the leg.

• As it ascends towards the thigh, it connects with the popliteal vein, another important deep vein.
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1.2. Lista de chequeo:

INSTRUMENTAL MEDICAL EQUIPMENT / SUTURES AND DRUGS AND
DEVICES NEEDLES SOLUTIONS
• Valve Basket • Hemostasis of the
• Extracorporeal • clothing package sternum bone: Bone • Saline
equipment • HB #15 (3)-#11 Wax solution
• Pleur-Evac • Bupivacaina al
• Sternal • rigid vacuum • Separation of the 2% con
Separator cleaner pericardium: Seda 0 Epinefrina.
• Antegrade con SH.
• Breast Separator cardioplegia • For the cannulas
cannula purse: Ti-cron 2/0 (4)
• Arterial cannula Con aguja de 1/2
• Coronary 20 Fr • To make the
accessory • Venous cannula tourniquet: Seda 1
equipment Only: 34/36 precortada.
• Cannula for • Adjust the graft to the
arteriotomy arteriotomy cannula:
• Accessory
• Iovan Seda 4/0 precortada.
Equipment
• 3/8 and 1/2 • Purse the cardioplegia
cannula and suture the
• Fine Instrument connectors
• Qosine pericardium patch:
Equipment
Connector Polipropileno 4/0 con
• Yankawer RB1
• Suture the graft
• Reciprocating cannula
• Suction rubber distally: Polipropileno
saw.
6/0 c-1.
• Electrosurgical
• Dermabond • Suture the graft
proximally:
• Ligaclip forceps. • Tegaderms
Polipropileno 7/0 c-1.
• Lukomed
• Temporary electrical
• Radiopaque
stimulation and atrial
gauze
or ventricular
• Compresses detection: Hilo de
• chest tube 32-34 marcapasos 2/0.
• Syringe 20cc
• Closure of pericardial
• Accessory field fascia and
• Robe accessory subcutaneous cellular
• Aortic punch tissue saphenous vein
closure: Poliglactina
910 0-2/0 con CT1
• Leather closure:
Monocryl 3/0 (2) aguja
de 3/8 cortante.
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2. ETAPA DE ORGANIZACIÓN:

a. Arreglos de mesas de mayo y reserva (realizar esquema).

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2.2. Posición del paciente (Nombre y gráfico):

SUPINE POSITION

2.3. Ubicación del Equipo Quirúrgico (realizar gráfico):

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3. ETAPA DE EJECUCION:

a) Anestesia (escribir el tipo de anestesia):

RTA: General anesthesia

b) Incisión (escribir el tipo de abordaje y el nombre de la incisión):

RTA: Sternotomy

c) Proceso Quirúrgico (Describir los pasos principales de la técnica médico quirúrgica con el instrumental a usar).

STERNAL OPENING TIME

SURGICAL PROCEDURE INSTRUMENTAL
1. Incision and hemostasis are made in the skin. 1. Scalpel handle #7 Scalpel blade #15
2. The opening of the sternum is made. 2. Reciprocating saw.
3. We carry out manual separation. 3. Farabeuf separators.
4. Perform hemostasis to the sternum and sternal 4. Electroscalpel and bone wax.
periosteum.
5. We pass sternum protectors and we pass self- 5. Venous tubing and sternal separator.
static separators.
6. We open the pericardium. 6. Electroscalpel.
7. We separate the pericardium. 7. Silk 0 with SH.

MAMMARY ARTERY DISSECTION TIME

SURGICAL PROCEDURE
1. We protect the sternum and separate the
mammary gland.
2. We perform the cutting, hemostasis and separation
of the mammary artery.
3. We clip the mammary artery and at the same time
we separate it to cut the graft..
4. We perform vasodilation of the mammary artery.
INSTRUMENTAL
1. Breast separators.
2. Electrosurgery and vascular instruments.
3. Garter Clip, Clips and Metzembaum Scissors.
4. Gauze and substance nitroglycerin.
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SAPHENOUS VEIN DISSECTION

SURGICAL PROCEDURE

Instrumental pass of Dieresis Scalpel handle #3 Scalpel blade #15 for the surgeon to make the incision of the
tissues.
Pass to the surgeon instruments of elastic apprehension and electrocoagulation elements in 40 for the
incision of deep tissues (subcutaneous cellular tissue and muscle).
For manual separation, pass the Farabeuf and Senn type separators to the surgeon.
Go to the surgeon with vascular-type elastic apprehension instruments, umlaut instruments for dissection of
the saphenous vein and its tributaries.
For ligation and hemostasis, use ligature clip forceps and the corresponding clip cartridge according to the
caliber of the vessel.
To extract the venasafena, pass cystic type hemostasis instruments, scissors-type umlaut instruments,
Adson Kelly clamp, and pre-cut silk 1.
Prepare umlaut instruments, ligation clips, and baby and mosquito-type hemostatic forceps to dilate the distal
end of the saphenous vein.
Prepare arteriotomy cannula and 10ml syringe to cannulate and dilate the saphenous vein with heparinized
solution and prepare hemo clip according to the caliber of the vessel for ligation of loose tributaries.

VASCULAR TIME
SURGICAL PROCEDURE

Prepare vascular-type elastic apprehension instruments, synthesis and 2/0 polyester suture material so that
the surgeon can make the tobacco pouches in:
-Ascending Aorta (purse of tobacco for arterial cannulation).
-Right atrium (tobacco bag for single venous cannulation).
-Prepare 4/0 polypropylene so that the surgeon can make the tobacco bags in:
-Aorta root (purse of tobacco forcannulation of antegrade cardioplegia by aorta root.
Prepare a tourniquet and/or thread guide to remove the tobacco pouches made by the surgeon, repairing
them with Kelly-type hemostatic instruments.
Prepare the appropriate cannulas for the patient's perfusion as appropriate.
-Go to the mb#7 hb#11 type umlaut instrument surgeon to perform the arteriotomy to perform the
corresponding cannulation.
-Prepare pre-cut silk 1 for fixation of the placed cannulas by passing them into the surgeon's hand.
- Prepare tube clamp and gauze for purging the arterial cannula.
-Go to the diaeresis instrument surgeon type mb#7 hb#11 to make the incision in the right atrium.
-Pass long demetzembaum scissors to the surgeon to expand the incision and perform the corresponding
cannulation.
-Prepare pre-cut silk 1 for fixation of the placed cannulas by passing them in the surgeon's hand.
Prepare suitable connectors for proper connection of the cannula to the extracorporeal circuit.
-Pass the antegrade cardioplegia cannula to the surgeon for its respective cannulation.
-Pass to the surgeon protected mosquito hemostasis instruments to purge the cannula
-Prepare total occlusion vascular clamp for the surgeon to perform aortic clamping
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CORRECTION TIME
SURGICAL PROCEDURE

Provide the surgeon with compresses and gauze in order to position the heart and expose the arteries to be
revascularized.
Go to the instrumental surgeon with umlaut, microvascular elastic apprehension to perform the coronary
arteriotomy and its prolongation.
Prepare the 7/0 and/or 8/0 gauge polypropylene synthesis and suturing instruments for the surgeon to
perform distal anastomoses of the vein graft to the coronary artery.
For better exposure of the surgical field at the anastomosis site, prepare CO2 aeration with a suction line and
cannula.
To test the effectiveness of vasocoronary, prepare a syringe with saline solution.
If it is necessary to reinforce the suture, prepare microvascular synthesis instruments, microvascular
dissection forceps and suture.
Prepare umlaut instruments, elastic vascular apprehension instruments and bulldog clamp, to cut the free
saphenous graft and prepare the vessel for the proximal anastomosis.
For proximal anastomoses, prepare umlaut instruments mb#7 hb#11 and intra-aortic punch to prepare the
aorta at the anastomosis site of the new coronary vessel.
Prepare the 6/0 gauge polypropylene synthesis and suturing instruments so that the surgeon can perform the
proximal anastomoses of the graft to the aorta.

CLOSING TIME
SURGICAL PROCEDURE

Prepare warm saline solution to accelerate warming of the patient.

Prepare to unclamp the aorta and remove the patient from extracorporeal circulation.
Instrumental passage of umlaut, vascular elastic apprehension and assist the surgeon at the time of removal
of the cardiovascular cannulas, foreseeing partial occlusion clamp and reinforcement sutures with and
without support of polytetrafluoroethylene pads to solve possible bleeding.
Pass synthesis instruments, elastic apprehension, pacemaker thread so that the surgeon can position them
as he sees fit in the atrium and ventricle respectively.
-Pass instrumental diaeresis, elastic apprehension, suture and synthesis and tubes to the thorax so that the
surgeon can position them as he sees fit in the pleura and mediastinum respectively.
-Nelaton 14 probe is introduced for chest tube aspiration.
Assist the surgeon in general hemostasis of the surgical area by providing suture material, healing elements
(gauze, compresses), hemostasis elements (bone wax, solid hemostatics, liquid hemostatics), warm saline
solution), electrocoagulation device.
-Verification of the counts of gauze pads, compresses, swabs, arteriotomy cannulas and bulldog clamps, etc.,
as appropriate.
-Prepare synthesis instruments, elastic apprehension and sutures (number 6 surgical wire, absorbable
suture, etc.) so that the surgeon can face the tissues.
Heal the patient by cleaning and covering the wound with dressings and/or adhesive tapes.
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FORMATO DE INFORME SEMANAL DE LA PRACTICA FORMATIVA

FORMATO RECORD DE ASISTENCIA A CIRUGIA - PRACTICA FORMATIVA
IQX-FT-024-UDES

FIRMA DOCENTE: __________________________

FIRMA ESTUDIANTE: ________________________