SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: KAREN DANIELA BAUTISTA ESQUIVIA CODE: 01210021064 PRACTICE LEVEL: III

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

SPECIALTY: CX SURGEON: DATE: 22/02/2024

CARDIOVASCULAR Dr. Giraldo

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE: 79 Años

Maria Alcira Carvajal 28355704
SURGICAL PROCEDURE TO PERFORM

MYOCARDIAL REVASCULARIZATION
SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

SURGICAL OBJECTIVE: Perform bridging using autologous grafts to provide blood flow to ischemic heart tissue

ANATOMY:
The heart is the main organ of the circulatory system, it is located in the thoracic
cavity, in the middle and retro-sternal mediastinum. This organ is muscular and
conical, it works like a pump because it drives blood throughout the body.
The heart is supplied by the right and left coronary arteries. They are called
coronary because they surround the base of the ventricle forming a crown; they
originate in the root of the aorta, in the right and left coronary ostium. The
coronary circulation is formed by a network of vessels that conduct and provide
blood flow to the epicardium and myocardium.
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CORONARY ARTERIES OF THE HEART:

Left coronary artery: It arises in the left coronary ostium and bifurcates into
two: Anterior Descending Artery, Circumflex Artery. (which gives off the left
marginal artery)

Right coronary artery: It arises from the right coronary ostium and its main
bifurcations are: Posterior descending artery, Right marginal branch

SAPHENOUS VEIN
The saphenous vein has the typical three-layer wall structure of the
tunica adventitia, tunica media, and tunica interna (intima).
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2. CHECK LIST
Instrumental Supplies Sutures Solutions
• Adult extracorporeal • Cardiovascular • Precut silk 4/0 • Warm saline solution
disposable clothing • Polyglactin 910 0
basket #3
package Needle 1/2 round circle
• Accessory coronary • Gauze container • Poliglactin 910 3/0 -
• Sharps container round needle 1/2 round
basket. • Handlebars circle
• Sternal separator • Accessory skin fields • Monocryl 3/0 Needle
• Sterile gloves 3/8 sharp (2)
Mamary separator • Electroscalpel • Silk 0 needle 1/2 round
• Reciprocating saw with • Gauze (10) circle
• Compresses (20) • Precut silk 1
battery. • Suction rubber • Polyester 2/0 needle
• Fine instrumental Dr • Ioban 1/2 round circle
• Sterile dressing
giraldo • Polypropylene 6/0 -
• Ligaclip forceps • Tegaderm
round double needle
• Yankawer cannula
1/2 circle 17 (2)
• Pathology bottle
• Silk 4/0 - round needle
• 20 cc syringe
1/2 round circle
• 10 cc syringe
• Flexible pericardial • Ti-cron suture
aspiration cannula. (Polyester) 2/0 - needle
• Scalpel blades No. 11 1/2 circle double
and No. 15 needle
• Chest tube #34 • Polypropylene 7/0 -
round double needle
1/2 cutting circle
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• Nelaton 8Fr probe (clamp • 4/0 polypropylene -

repair) round double needle
• Nelaton 18Fr probe 1/2 cutting circle
(suction tubes) • pacemaker wire
• Asepto syringe • #6 wire suture
• CO2 rubber
• Fibrillary surgery
• And connector (vcs and
vci)
• Cardioplegia with
antegrade cannula
• 3-way stopcock
• Hypodermic needle #18
• Dermabond
• Alligators
• Cardiovascular tourniquet
kit
• Clips lt 100 and 200-
gloves
• Crocodile-pacemaker
cables
• Coca and fanny packs
• Venous cannula
• Arterial cannula
•Sternal protector
• Intra-aortic punch
• 3/8 3/8 connector
• Accessory gown
• EOPA cannula
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3. TABLE ARRANGEMENT

1. MB# 3 HB# 15
MAY TABLE 2. MB#7 HB# 15
3. MB#7 HB# 11
4. Metzembaum scissors (2)
5. May scissors (2)
6. Farabeuf separators (2 pairs)
7. Mosquito Forceps curved
8. Protected Mosquito Forceps
9. Straight Kelly Forceps
10. Curved Kelly Forceps
11. Adson Kelly Forceps
12. Cystic forceps .
13. Rochester Forceps
14. Tube clamp
15. Vascular dissection forceps
16. Adson dissecting forceps with clamp
17. Coca for sharps + field fórceps
18. Diethrich scissors
19. Castroviejo needle holder
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RESERVATION TABLE
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1. Disposable clothing package 18. Claw dissection 35.Compresses

2. Extracorporeal basket adult #3 19. Allix clamp 36. Gauze container

3. Reciprocating saw 20.Punuch 37.Suture container
4. Accessory coronary instrumentation 21.Dilator 38.Gauze
5. Instrumental doctor Giraldo 22.Old castro needle holder 39. Ioban
6. Pacemaker cable 23. Debakey clamp 40. Clips 100-200
7. Electroscalpel 24. Sutures
8. Suction rubber 25.Pathology Flask
9. Sternal separator 26. Coca with saline solution
10. Breast separator 27. Asepto syringe
11. Gloves 28.Nelaton probe #8
12. CO2 line 29. Nelaton probe
13. Pin holder 30. EOPA cannula
14. Short pin 31. Arterial cannula
15. Stayler Scissors 32. Antegrade cardioplegia cannula
16. Vascular needle holder 33. Tourniquet Kit
17. Normal needle holder 34.Connectors
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4. PATIENT POSITIONING AND TYPE OF

ANESTHESIA

Decubitus Supine
And
General
anesthesia
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POSITIONING OF THE SURGICAL TEAM

6
1. Surgeon
1 2. Surgical assistant
3 4 3. Surgical instrument
4. Surgical instrumentation
student
5. Perfusionist nurse
6. Anesthesiologist
7. Nursing assistant

5
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TYPE OF INCISION: MEDIAL INCISION IN THE LEFT LEG FOR REMOVAL OF THE SAPHENOUS VEIN AND
STERNOTOMY
5. SURGICAL TECHNIQUE

PROCESS INSTRUMENTAL

Once the patient is anesthetized and dressed, the Ioban

surgical field is placed in the incision area.

We use MB 3 blade 15, electro scalpel, weithlander

Skin incision and TCS are performed on the left leg
The saphenous vein is located and its respective
extraction is performed.
The previous step is repeated until the saphenous vein
is completely removed.
separator, farabeuf separator
We use Electro scalpel, Weithlander separator, ligature
clips and 200 clips, cystic forceps, Metzembaum
scissors, Adson Kelly forceps with pre-cut silk 1, May
scissors
We use Electro scalpel, Weithlander separator, ligature
clips and 200 clips, cystic forceps, Metzembaum
scissors, Adson Kelly forceps with pre-cut silk 1, May
scissors

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Once the saphenous vein has been removed, its
permeabilization is carried out, binding any possible
leaks.
The incisions are closed to extract the saphenous vein
and the wounds are covered.
A sternotomy incision is made in the skin and TCS in
the chest until reaching the sternum.
Sternotomy is performed
Hemostasis of the sternum is performed
Stemal separation is performed to look for the internal
mammary artery
The search, extraction and preparation of the internal
mammary artery is carried out, making it permeable.
The mammary separator is changed to the sternal
separator, incision and elevation of the pericardium is
performed.
The purse string is performed in the aorta artery
The purse-string is performed in the right atrium
The position of the aortic cannula is made and it is
connected to the arterial perfusion line.
SURGICAL INSTRUMENTATION PROGRAM
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Bulldog clamp, arteriotomy cannula, 4/0 precut silk, May
scissors, baby mosquito clamp, 10cc syringe with
heparinized solution, blue fanny pack
We use saline solution, wet compress, dry compress,
vicryl 2/0, mayo scissors, monocryl 3/0, elastic bandage
For this we use MB 7 blade 15, electro scalpel, farabeuf
separator, suction with yankawer cannula
With reciprocating saw
We use electroscalpel, suction with a Yankee cannula,
bone wax
We use sternum protector and breast separator
Electro scalpel, ligalip clamp 100, clips 100 (2 in a row),
Metzembaum scissors, clips 200 at the end,
Metzembaum scissors, wet gauze, clip 100 at the end of
the mammary artery, fine vascular dissections,
antegrade Potts microvascular scissors
We use two sternal protectors, sternal separator, electro
scalpel, dissecting forceps, suction with a Yankee
cannula, silk or normal needle holder, May scissors
With 2/0 polyester without plush, tomiquettes, mayo
scissors, curved Kelly tweezers, metzembaum scissors
With 2/0 polyester without plush, tomiquete, May
scissors, curved Kelly clamp
We use MB 7 blade 11, EOPA 20 cannula, tube clamp,
dd tourniquet kit, pre-cut silk 1, May scissors, rigid
pericardial suction, arterial perfusion line

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The single venous cannula is positioned and connected
to the venous perfusion line.
It goes into bomb
Clamping of the aorta artery is performed
A bag of tobacco for cardioplegia is made, the
cardioplegia cannula is positioned and connected to the
perfusion line for cardioplegia.
Cardioplegia is applied
Correction time steps are performed
Retraction of the heart is performed to look for the right
coronary artery
An incision is made in the right coronary artery to
perform the respective anastomosis to the saphenous
vein as a free graft.
Proximal anastomosis of the free saphenous vein graft
to the right coronary artery is performed.
Before making an incision in the aorta, the vein graft is
cut to the necessary length
An incision is made in the aorta artery to perform the
distal anastomosis of the right coronary artery graft.
A distal anastomosis is performed of the graft previously
anastomosed to the right coronary artery and now in its
distal part to the aorta artery.
SURGICAL INSTRUMENTATION PROGRAM
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We use vascular dissection forceps, MB 7 blade 11,
single 34/46 venous cannula with 1/2-1/2 connector,
tomiquette presser, 1 pre-cut silk, May scissors, venous
perfusion line
With satinsky total occlusion clamp
For this we use 4/0 polypropylene, tomiquete, May
scissors, curved Kelly clamp, cannula for antegrade
cardioplegia, protected mosquito clamp, perfusion line
for cardioplegia with cousine connector and three-way
stopcock.
Perfusion line for cardioplegia
It is performed manually with radiopaque gauze.
We use MB 7 blade 15, pottsanterograda microvascular
scissors, saphenous graft in blue coca, vascular
dissection forceps, dennis dissection
Prolene 7/0, vascular needle holder, dennis dissection,
protected kelly clamp, mayo scissors, dennis dissection,
solution in 20cc syringe
We use breast dissection forceps, antegrade scissors
We use HB # 11, MB #7, punch, wet compress (twice)
We use Prolene 6/0, vascular needle holder, dissection,
protected kelly clamp, mayo scissors, demnis
dissection, solution in 20cc syringe

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Patency of the internal mammary artery is performed by
removing the clip placed at its end ateriorly and testing
patency, the anterior descending artery is located and
an incision is made to perform the respective
anastomosis to the internal mammary artery.
as pedicled graft
Distal anastomosis of the pedicled graft is performed,
from the internal mammary artery to the anterior
descending artery.
It comes out of the pump, it is unclamped and
decannulated, tying the tobacco bags.
Pacemaker wire position and chest tube incision are
made.
The sternal separator is removed and final hemostasis
of the sternum is performed.
The clean stemal separator is repositioned, the chest
tube is positioned, the pleuroback is prepared and the
compresses are performed and counted.
The separator is finally removed and the sternum is
sutured.
Washing and infiltration
TCS and skin are sutured
SURGICAL INSTRUMENTATION PROGRAM
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We use Demnis dissection forceps, antegrade Potts
scissors, syringe with solution, bulldog clamp, MB 7
blade 15, antegrade Potts scissors, vascular dissection
forceps, Dennis dissection
We used Prolene 7/0, vascular needle holder,
dissection, mayo scissors, dennis dissection, 20 cc
syringe with warm saline solution
Removal of total occlusion clamp, vascular dissection
clamp, saline mayo scissors
Pacemaker thread 2/0, piece of perfusion line, needle
holder, polyester 2/0, MB 7 blade 15, electro scalpel,
May scissors
Electroscalpel, bone wax, farabeuf separators
We use Kocher clamp, chest tube, polyester knot,
Nelaton 14 probe, suction rubber
Compress, surgical steel 5, wire holder, wire cutter,
Rochester forceps
Asepto Syringe, dry compress, 20cc syringe with
bupivacaine + hypodermic needle
Vicryl 0, monocryl 3/0, mayo scissors
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

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

STUDENT SIGNATURE: KAREN DANIELA BAUTISTA ESQUIVIA TEACHING SIGNATURE: LIDY HIGUERA