SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: CODE: PRACTICE

LEVEL: IV
Anguie Tatiana Herrera Hernandez 01200021060

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

SPECIALTY: CX SURGEON: DATE: 22/11/23

CARDIOVASCULAR Dr. Fabian Giraldo

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:

SURGICAL PROCEDURE TO PERFORM:

Aortic Valve Replacement

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description)

Replace the aortic valve through a sternotomy with extracorporeal circulation to replace the damaged valve with
a valve implant

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

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The aortic valve is located in the initial portion of the aorta, which is called the aortic root. This is the continuation of
the left ventricular outflow tract. The aortic root is related in 2/3 of its circumference with the interventricular septum
and in the remaining 1/3 with the anterior leaflet of the mitral valve. There are 3 aortic leaflets (right, left, and
noncoronary or posterior) that determine 3 sinuses of Valsalva. When the leaflets give way to the arterial portion, we
do not find a border area between the valvular portion and the tubular portion called the sinotubular junction. The 2
coronary arteries arise from this area.

When the heart compresses (contracts), the aortic valve opens, allowing blood to flow from the left ventricle into the
aorta. When the heart relaxes, the aortic valve closes, preventing blood from flowing backward.

You may need aortic valve surgery to replace the valve in your heart if:

The aortic valve does not close completely, so blood leaks back toward the heart. This is called aortic regurgitation.

The aortic valve does not open fully, so blood flow out of the heart is reduced. This is called aortic stenosis.

1.3. Check list:

MEDICAL EQUIPMENT/ DRUGS AND

DEVICES SUTURES AND SOLUTIONS
INSTRUMENTAL
NEEDLES

-Eq. extracorporeal -Pack of Heart R. PERICARDIUM: -Saline solution

-Eq. Accessory -Compresses -(2) Silk 0 needle ½ - infiltration

C.R. 26 mm de 75 cm
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-Valve Gauges -Gauze ARTERIAL AND

VENOUS TOBACCO
-Reciprocating Saw -Fields for two BAGS:
-Sternal Retractor -Handlebars -Polyester 2/0 needle ½
-Defibrillator paddles -Accessory Robes C.R. 25cm

- Clamp dr. giraldo -Gloves TOBACCO VENT

BAGS, CARDIOPLEGIA
-Gauze container AND AORTIC
CLOSURE:
-Sharps container
-Polypropylene 4/0
-Electro scalpel
needle ½ C.R. 17cm
-Alligators
FIXATION OF
-Rubber Suction CANNULAS:

-Yankawer cannula -Silk 1 Precut

-Aseptosyringe AORTA REPAIRS:

-Tourniquets -Silk 4/0 vascular

-20 and 10 ml syringe VALVE SETTING:

-Arterial cannula -Valve Kit

-Venous Cannula -Pacemaker wire

-tube to chest STERNAL:

-Nelaton probe #8 and 14 -Surgical Wire 5

-Rigid pericardium MUSCLE AND T.C.S. :

aspirator
-(2) Poliglactin 910 0
-Vent aspirator needle ½ C.R. 36.4mm
de 90cm
-Ioban
SKIN:
-Antegrade and ostium
cardioplegia cannula -Poliglecaprone 3/0
needle 3/8 C.C. de
-Three-way tap 19mm de 70 cm
(cardioplegia)
CHEST TUBE
-Connectors FIXATION:
-pink needle # 18 -Polyester 2/0 whit
plush
-Aortic valve
PACEMAKER WIRE
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-Pathology Flask FIXATION:

-Silk 2/0 SH

HEMOSTATICS:

-Bone Wax

-Bioglue

-1 Scalpel Blades 11

-1 Scalpel Blades 15

2. ORGANIZATION STAGE:

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

13 14
15 9. M.B. # 7 Con H.B.# 15 1. P. Tubo
10. M.B. #7 Con H.B.# 11 2. Rec. Cortopunzantes
7 11. M.B. #3 Con H.B.# 15 3. P. Campo
12 12. Tijera Metzenbaum 4. Gasas
11 13. Tijera de Mayo 5. Seda 2/0 Precortada
10 6
14. Sep. Farabeuf 6. Disección con garra y sin
9 5 17 18
8 4 15. P. Mosquito protegidas garra
3 16. P. Kelly recta 7. Disecciones 2 en 1
2 17. P. Kelly curva 8. Pledgets
1 19 18. P. Kelly Adson
19. P. Rochester
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2.2. Patient position (Name and graphic):

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

Anestesiologist

Nurse

Perfusionist
Surgeon

Assistant
S.I.

3. EXECUTION STAGE:

a) Anesthesia (write the type of anesthesia):

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General

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

Esternotomy

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

- May table arrangement and reservation

- Patient's dress
- Count of compresses and gauze
- Fixing pipes and lines with straight kellys
- Dress of the surgeon and assistant

STERNAL OPENING TIME:

- To make an incision, go to the surgeon MB# 7 and HB# 15

- Pass to surgeon dissection and electrocautery for deep tissue incision.
- For sternotomy pass to surgeon reciprocanting saw equipment
- For manual separation of the sternum, go to the Farabeuf separator surgeon.
- Pass bone wax, electrocautery in 60 for hemostasis of the sternal periosteum and bone marrow.
- Pass to the surgeon the sternal protectors and the self-retaining retractor for the fixed retraction of the sternum.
- Pass to the surgeon vascular type dissection and electrocautery device in 40 for the opening of the pericardium.
- Pass needle holder with 0 silk suture to repair the pericardium.

VASCULAR TIME:

- Pass vascular dissection, T. Mayo and 2/0 polyester suture for the surgeon to make the tobacco pouches in:
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o Ascending Aorta
o right atrium
- Prepare 4/0 polypropylene for the surgeon to make the tobacco pouches in:
o Right Upper Pulmonary Vein (Vent Aspirator)
- Prepare pass threads (tourniquet) and Kelly to refer the tobacco bags made by the surgeon.
- Prepare the appropriate cannula for the patient's infusion as appropriate.
- Go to the surgeon MB# 7 HB# 11 to perform the arteriotomy to perform the corresponding cannulation.
- Prepare pre-cut silk 1 for fixing the placed cannulas by passing them through the surgeon's hand.
- Prepare tube clamp and gauze for purging the arterial cannula.
- Go to surgeon MB#7 HB#11 to make the incision in the right atrium.
Pass the long Metzembaum scissors to the surgeon to widen the incision and perform the corresponding cannulation.
- Prepare pre-cut silk 1 for fixing the placed cannulas by passing them through the surgeon's hand.
- Prepare suitable connectors for the connection of the cannula to the extracorporeal circuit.
- Go to surgeon MB#7 HB#11 to make the incision in the right upper pulmonary vein.
- Go to the surgeon P. Kelly Adson to widen the incision and perform the corresponding cannulation.
- Prepare total occlusion vascular clamp for the surgeon to perform aortic clamping.

CORRECTION TIME:

- Pass to the surgeon MB#3 HB# 11), and vascular dissection to incise the aorta, then pass long tissue scissors.

- Pass the suction cannula of the machine, to collect the blood.

- Pass coronary perfusion cannula, for direct antegrade cardioplegia in coronary ostium.

- Silk pass 4-0 to repair the walls of the aorta.

Pass vascular grasping forceps and scissors for dissection and removal of the aortic valve.

- Keep in mind that when the valve is calcified, the surgeon removes the valve using allix forceps, scissors and vascular
grasping forceps.

- It is washed with saline solution, remember to place an extension to the aseptosyringe

- The valve is measured with the gauge approved by the surgeon and confirmed.

- The nursing assistant is asked for the valve device to be implanted, confirmed aloud.

- If the valve to be implanted is biological, wash it according to the valve device washing protocol.

- Pass the valve to the assistant surgeon.

- Support the surgeon in the passage of the sutures in the valve annulus.

- The surgeon is passed a 2-0 vascular polyester suture in each of the posts and the respective repair, then the following
sutures are passed, taking special care not to repeat the color of the thread.

- After implantation of the medical device, pass a closing suture (prolene 4-0 16mm round needle with pledget).

- Ready root suction.

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- 4/0 polypropylene pass for aortic root purse string, tourniquet and antegrade cardioplegia cannula for deaeration.

CLOSING TIME:

- Prepare warm saline solution, to speed up patient warming.

- Prepare for aortic unclamping and removal of the patient from extracorporeal circulation.
- Pass Mayo scissors, vascular dissection and assist the surgeon at the time of removal of the cardiovascular cannulas,
anticipating partial occlusion clamp and reinforcing sutures with and without supportfrom pledget.
- Pass pacemaker wire so that the surgeon can position them ashe sees fit in the atrium and ventricle.
- Pass HS#3 SB#15, vascular dissection, suture and Long Metzenbaum Scissors and chest tubes so that the surgeon can
position them as he sees fit in the pleurae and mediastinum respectively.
- Nelaton 14 probe is inserted for chest tube aspiration
- Assist the surgeon in general hemostasis with electrocautery of the surgical area, providing suture material, gauze,
compresses and hemostasis elements.
- Verification of counts
- Prepare number 5 surgical wire, Rochester, needle holder, and wire cutters for the surgeon to face the sternum.
- Prepare 2/0 or 3/0 polypropylene to face the muscles and subcutaneous tissue with needle holder, claw dissection, and
Mayo scissors.
- Prepare poliglecaprone to face the skin with needle puller, adson dissection with claw and mayo scissors.
- Make the patient heal by cleaning and covering the wound with dressings and/or adhesive tapes.

WEEKLY REPORT FORMAT OF TRAINING PRACTICE

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

STUDENT SIGNATURE: TEACHING SIGNATURE: __________________________