SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: ANGIE NATALIA BAUTISTA BAUTISTA CODE: 01200022008 PRACTICE LEVEL: III

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

SPECIALTY: CX SURGEON: DATE: 16/11/2023

CARDIOVASCULAR Dr. Giraldo

NAME OF PATIENT MEDICAL HISTORY NUMBER: PATIENT AGE:

FELIPE MUÑOZ 19892876 22 años
SURGICAL PROCEDURE TO PERFORM: RE-INTERVENTION IN CONGENITAL HEART DISEASE PULMONARY STENOSIS

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1 Surgical Objective: (Make description)

Pulmonary valve replacement to improve blood flow and reduce symptoms of heart valve disease.
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1.2 Anatomy and physiology: (Make graph and description)

PULMONARY VALVE

The pulmonary valve is located superior

to the conus arteriosus of the pulmonary
artery [infundibulum], in a superior,
posterior and right direction, separating
the right ventricle from the pulmonary
artery; It measures approximately 2.5
centimeters in diameter.
It has three sigmoid or semilunar valves:
anterior (attached to the aorta), right
lateral and left lateral (both opposite to
the aorta). The leaflets insert into the
ventricular septum or the free walls of the
right ventricle and project into the lumen
of the pulmonary trunk. He
their free edge is reinforced by the
nodules of the semilunar valves

TRAINING SURGICAL PLANNING
1.3. Check list
MEDICAL EQUIPMENT / DEVICES
INSTRUMENTAL
• Extracorporeal equipment
• Sternal Separator
• Thread Grommet Clip
• Volkman Separator
• Accessory Equipment
• Oscillating Saw
• Ligaclip Forceps
• Biological Pulmonary Valve #27
Avalus
• Pulmonary Valve Gauges
SURGICAL INSTRUMENTATION PROGRAM
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SUTURES AND NEEDLES DRUGS AND
SOLUTIONS
• Valve Basket • Hemostasis of the sternum bone:
• clothing package Bone Wax • Warm
• HB #15-#11 Saline
• Pleur-Evac • Separation of the pericardium: Solution
• Semi rigid vacuum cleaner Seda 0 with SH. • Heparin
• Three-cavity • For the union of the cannulas: Silk
• Vent vacuum cleaner 1 precut.
• Antegrade cardioplegia cannula • Fixing the blake drains: Ti-cron
• Arterial cannula 20 Fr 2/0 (4) with needle 1/2
• Venous cannula VCS: 24 VCI: 28 • For the turnstile purses: 4/0
• Syringe 20cc polypropylene with RB1.
• Iovan • Purse the cardioplegia cannula
• 3/8 and 1/2 connectors and suture the pericardium patch:
• Qosine Connector Polypropylene 4/0 con RB1
• Yankawer cannula • Repair any injury: Polypropylene
5/0 c-1.
• Suction rubber
• To repair the vent wall and Art
• Electrosurgical
Pulm: Polypropilene 4/0 Cv-23.
• Dermabond
• For the vena cava purse:
• Tegaderms
Polypropylene 5/0 with RB1T.
• Lukomed
• Temporary electrical stimulation
• Radiopaque gauze
and atrial or ventricular
• Compresses detection: Pacemaker wire 2/0.
• Accesory field
• Closure of pericardial fascia:
• Blake drain Poliglactina 910 0-2/0 con CT1.
• Cardioplegia line • Leather closure: Monocryl 3/0
• Robe Accessory with cutting 3/8 needle.
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2. ETAPA DE ORGANIZACIÓN:

a. May table arrangements and reservation

 SURGICAL INSTRUMENTATION PROGRAM

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2.2 Patient Position (Name and Graphic):

2.3. Location of the Surgical Team (make chart):

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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 and thoracic incisión

Incision in left leg

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

1. A double incision is made and hemostasis is 1. Scalpel handle #7 Scalpel blade #15
performed andElectroscalpel.
2. The entire scar is removed. 2. Electroscalpel and Dissecting forceps with
claw.
3. The wire is removed from the sternum. 3. Farabeuf separators.
4. Hemostasis of the sternum is performed. 4. Electroscalpel.
5. The sternum and skin are separated. 5. Rake separator.
6. The cut of the sternum is made. 6. Oscillating saw.
7. Separation of adhesions is carried out. 7. Electroscalpel.
8. The separation of the sternum is performed 8. Sternal Separator.
withself-aesthetic fixation.

9. The correction of the injury caused by the 9. Polypropylene 5/0 C-T1.

saw tothe heart is performed.
10. Continue separating the adhesions. 10. Electroscalpel and Metzenbaum scissors.
11. Perform pericardium separation. 11. Silk 0 con SH.

12. Repair of damage to the heart. 12. polyglactin 910 0 con CT1.
13. We perform the placement of heparin. 13. 23,000 units of Heparin.

14. We make the arepas for cinnamon are 14. Polypropylene 4/0 con pledget RB1and
arterialand tourniquet. tourniquet.

15. We make the fins of the inferior vena cava. 15. Polypropylene 5/0 con RB1.
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16. Tourniquet placement in the inferior vena 16. Tourniquet and Venous cannula #28.
cavaand perform annulment of the inferior vena
cava.
17. We perform the placement of the arterial 17. EOPA cannula #20.
meat.
18. We transfer the pericardial patch to the table 18. Saline solution.
andlet it rest.
19. We perform the earrings in the Superior 19. Polypropylene 5/0 con RB1.
venacava.
20. We perform the tourniquet in the Superior 20. Malleable venous cannula #24
venacava and cancel it

21. We make the purse for the cardiology 21. Polypropylene 4/0 con RB1.
cannula

22. We introduce the cardioplegia cannula into 22. Cardioplegia cannula.

theroot of the aorta.

23. We perform total occlusion between 23. Total arterial clan.

thecardioplegia cannula and the arterial cannula.
24. We make the cut in the pulmonary artery
andintroduce the free cavity aspirator.
25. We place two repairs in the pulmonary
artery.
26. We expanded the pulmonary artery incision.
24. Scalpel handle #7 Scalpel blade #11 and
cavityaspirator.
25. Polipropileno 5/0 con RB1.
26. Scalpel handle #7 Scalpel blade #11.

27. Introducing the pulmonary valve gauge. 27. Valve gauge #27.
28. We ask the nurse for the 28. Biological pulmonary valve Avalus #27.
Biological pulmonaryvalve.
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29. Placement of the pulmonary biological 29. Biological pulmonary valve Avalus #27.
valve.
30. We fix the valve. 30. Polipropileno 4/0 RB1.

31. We place the pericardium in the pulmonary 31. Polipropileno 4/0 RB1.
artery.
32. We place the pacemaker wire in the 32. Pacemaker wire 2/0.
epicardium.
33. We place the Blake drain, one in each 33. Blake drain.
pleura andthe other in the mediastinum.

34. We repair injuries to the heart. 34. Polipropileno 5/0 RB1.

35. We open a contracture to remove Blake's 35. Scalpel handle #7 Scalpel blade #11.
drains.
36. Close up of cardioplegia cannula puncture 36. Polipropileno 4/0 con Rb1.
in theatrium.

37. We remove the venous cannulas and 37. Venous cannulas and arterial cannula.
arterialcannulas.
38. The separation points in the pericardium 38. Metzenbaum scissors.
areremoved.
39. Hemostasis of the sternum and revision of 39. Electrobisturi.
thecavity are performed.
40. Closure of the sternum is performed. 40. Surgical wire 6.

41. Closure of sternal fascia subcutaneous 41. Poliglactina 910 0 con ct-1.
cellulartissue.
42. Leather closure. 42. Monocryl 3/0 With needle 3/8.
43. We perform healing. 43. Gauze, Tegaderm. Dermabon and
leukomed.
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WEEKLY REPORT FORMAT OF TRAINING PRAC SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE
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