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: 24//11/2023

CARDIOVASCULAR Dr. Giraldo

NAME OF PATIENT MEDICAL HISTORY NUMBER: PATIENT AGE:

PATRICIA RODRIGUEZ 17645454 74
SURGICAL PROCEDURE TO PERFORM: MYOCARDIAL REVASCULARIZATION WITHOUT EXTRACORPOREAL CIRCULATION

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1 Surgical Objective: (Make description)

Perform a bridge in the affected coronary arteries using a graft from the same patient to recover the blood flow
necessary for the heart muscle not to die.
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1.2 Anatomy and physiology: (Make graph and description)

MYOCARDIUM
Muscular layer of the heart. They are striated muscle fibers, with some
peculiar histological characteristics, of involuntary contraction.
Depending on the force with which they have to pump the blood, the
thickness of the myocardial layer is very different in the different
cardiac chambers: the thickest wall corresponds to the left ventricle,
then the right ventricle and the thinnest wall corresponds to the atria.
The myocardium is covered, superficially, by the visceral pericardium
or epicardium and, internally, by the endocardium.

CORONARY ARTERIES
The coronary arteries are
small tubes (with an average diameter of only 2-3 mm) that, from
the aorta artery, extend around the heart, penetrate the heart
muscle and divide into multiple branches to irrigate it and deliver
oxygenated blood. (which is known as arterial blood).
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INTERNAL SAPHENA VEIN

The internal saphenous vein (also called the great
saphenous vein or great saphenous vein) originates on the
dorsum of the foot and progresses to the groin along the inside
of the leg until it empties into the common femoral vein.
This superficial vein is of great importance in the venous
circulation of the legs and feet, since its function is to transport
deoxygenated blood from the skin, subcutaneous tissues and
the superficial structures of the leg to the heart.

INTERNAL MAMMARY ARTERY

It is a descending collateral branch of the pre-scalene portion of the
subclavian artery. At its origin it is located medial with respect to the
phrenic nerve and posterior with respect to the brachiocephalic venous
trunk.
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1.3. Check list

MEDICAL EQUIPMENT / DEVICES SUTURES AND NEEDLES DRUGS AND
INSTRUMENTAL SOLUTIONS
• Valve Basket • Bone wax: hemostasis of the
• Extracorporeal equipment • Clothing Package sternum bone • Saline
• HB #15 (3)- #11 Solution
• Sternal separator • Pleur-evac • SEDA 0 SH: Separation of • Bupivac
• Rigid vacuum cleaner thepericardium. aine
• Cannula for Arteriotomy • TI-CRON 2/0 172 CIRCLE:To
• Breast Separator • 3/8 and 1/2 connectors hold chest tubes.
• Iovan • SEDA 1 PRE-CUT: To ligate
• Qosine Connector the saphenous vein
• Accessory equipment • Yanwaker cannula • SEDA 4/0 PRE- CUT: To ligate
• Suction rubber the mammary artery.
• Electrosurgical • POLYPROYLENE 6/0 C-1
• Coronary Accessory Suture the graftdistally:
Equipment • Dermabond
• Tegaderms • POLYPROPYLENE 7/0
• lukomed suture graftproximally.
• • PACEMARK WIRE 2/0:
• Fine Instrument Equipment Pathology bottle
Temporary
• Syringe of 20cc
electricalstimulation and
• Alligators
atrialor ventriculardetection
• Reciprocating Saw • Nelaton 8 probe
• POLIGLACTIN 910 0 Y 2/0:
• chest tube 32-34 Closure of pericardialfascia
• Radiopaque gauze and subcutaneous
• LIgaclip forceps • Compresses cellulartissue saphenous
• Accessory field veinclosure:
• Robe accessory • MONOCRYL 3/0: Leather
closure
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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

Leg incision

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

STERNAL OPENING TIME

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 homeostasis to the sternum and sternal 4. Electroscalpel and bone wax.
periosteum.
5. We pass sternum protectors and we pass 5. Venous tubing and sternal separator.
self-static separators.
6. We open the pericardium. 6. Electroscalpel.
7. We separate the pericardium. 7. Silk 0 with SH

MAMARY ARTERY DISSECTION TIME

8. We protect the sternum and separate the 8. Breast separators.
mammary gland.
9. We perform the cutting, homeostasis and 9. Electrosurgery and vascular instruments.
separation of the mammary artery.
10. We clip the mammary artery and at the 10. Garter clip, clips and metzembaum scissors.
same time we separate it to cut the graft
11. We perform vasodilation of the mammary 11. Gauze and substance nitroglycerin.
artery.
SAFHENOUS VEIN DISSECTION

12. The surgeon makes an incision in the left leg 12. Scalpel handle #3 Scalpel blade #15 and
#24 cannula.
13. The surgeon performs the dissection of the 13. Electrosurgical
subcutaneous cellular tissue
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14. They carry out manual separation 14. farabeuf separator

15. dissection of the saphenous vein and its 15. vascular dissection
tributaries
16. Ligation is performed with clips 16. clips of 100 and 200 depending on the
caliber of the glass
17. Extraction of the saphenous vein is 17. kelly adson clamp precut silk 1 metzenbaum
performed scissors
18. dilate the distal end of the saphenous vein. 18. umlaut instruments, ligation clips and baby
mosquito hemostatic forceps
19. Prepare arteriotomy cannula and 10ml syringe 19. arteriotomy cannula 10ml syringe hemoclip
to cannulate and dilate the saphenous vein with
heparinizedsolution and prepare hemo clip according
to the caliber of the vessel for ligation of loose
tributaries
CORRECTION TIME
20. Go to the instrumental surgeon with umlaut, microvascular elastic apprehension to perform the
coronaryarteriotomy and its prolongation.
21. Prepare the 7/0 and/or 8/0 gauge polypropylene synthesis and suturing instruments for the
surgeon toperform distal anastomoses of the vein graft to the coronary artery.
22. For better exposure of the surgical field at the anastomosis site, prepare CO2 aeration with a
suction line andcannula
23. To test the effectiveness of vasocoronary, prepare a syringe with saline solution.
24. If it is necessary to reinforce the suture, prepare microvascular synthesis instruments,
microvasculardissection forceps and suture.
25. Prepare umlaut instruments, elastic vascular apprehension instruments and bulldog clamp, to
cut the freesaphenous graft and prepare the vessel for the proximal anastomosis
26. 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
CLOSING TIME
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27. Pass synthesis instruments, elastic grip, and pacemaker wire so that the surgeon can position
them as he/she deems appropriate in the atrium and ventricle respectively.
28. -Instrumental passage of umlaut, elastic apprehension, suture and synthesis and tubes to the
chest 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.
29. Assist the surgeon in general hemostasis of the surgical area by providing suture material,
healing elements (gauze, compresses), hemostasis elements (bone wax, solid hemostats, liquid
hemostats), warm saline solution), electrocoagulation device.
30. -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.) for the surgeon to deal with tissues
31. Heal the patient by cleaning and covering the wound with dressings and/or adhesive tapes.
WEEKLY REPORT FORMAT OF TRAINING PRAC SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE
IQX-FT-024-UDES

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