PERICARDIOTOMY

Margy P. Paredes
Caballero

01180021022

Práctica III
 DATA
Date Thursday 08 April 2021 Patient Humberto Rojas Tarazona
Institution Chicamocha Clinic CC 5616735
Surgeon Carlos Ocampo F. Birth
Surgical inst Glenda Pabón Weight 62 kg
Size 174 cm
RH O+
VIH -
Hep B -
COVID 19 -
 ANATOMY

It is made up of a double membrane that acts like a sac surrounding the heart. Of these two membranes,
one is in direct contact with the heart and is called the visceral pericardium; the other, the outermost layer, is
known as the parietal pericardium. Between both layers a virtual space is created that can contain a small
amount of liquid that works as a lubricant.
The pericardium transmits pressures from the thoracic cavity to the heart, which it isolates from neighboring
structures, especially during contraction of the heart muscle; likewise, it limits the sudden dilation of the heart
that can be generated in some situations. However, the absence of a pericardium, known as agenesis of the
pericardium, is consistent with normal heart function.
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 PATOLOGY
PERICARDIUM SPILL.
The space between the two sheets of the
pericardium normally contains 15-50 ml of fluid.
Pericardial effusion is understood as the presence of
a greater amount of fluid. As with inflammation of the
pericardium, pericardial effusion can be due to
multiple causes: infectious, inflammatory and of
another nature. The presence of fluid can raise
intrapericardial pressure and thereby increase the
pressure in the cardiac chambers.

https://www.cirujanosdelcorazon.es/es/enfermedades-tecnicas-diagnosticas/enfermedades/enfermedades-pericardio/derrame-pericardico-taponamiento-
cardiaco.ficheros/443078-EP1.%20Saco%20peric%C3%A1rdico.jpg?width=460&height=300&aspectRatio=true
 INDICATIONS
There are many conditions that can cause extra fluid to build up around
the heart. Sometimes this can be treated with medicine. In other cases, the
extra liquid is dangerous, and needs to be flushed out right away.
One way to remove this fluid from around the heart is to make a pericardial
window. Can:
Letting go of the extra fluid that surrounds the heart
Preventing too much fluid from building up in the future
Allow the healthcare provider to take a sample of the tissue from the sac
(biopsy) and diagnose the cause of the extra fluid

https://cardiopatiascongenitas.net/wp-content/uploads/2017/12/1.8.-derrame-pericardico.png
 SURGICAL OBJECTIVE

It is a procedure that is done in the sac

that surrounds the heart. Surgical
removal of a small part of the sac
allows excess fluid to drain from the
sac.

https://interconsulta.online/wp-content/uploads/2019/07/S%C3%ADndrome-post-pericardiotom%C3%ADa.jpg
 CHECK LIST
General clothing package. Yankawer cannula.
Coronary reintervention team. Asepto syringe.
Small, medium and large malleable valve. Handlebars.
Wide Deaver divider. Sterile gloves.
Richardson separator. Scalpel blade # 15.
Sterile compresses and gauze. Chest drainage tube # 32.
Incisional field. Nelaton probe # 16.
Pathology bottle. Thoracic drainage
Suction rubber. 20cc syringe.
Electrosurgical unit. Healing dressings.
 SUTURES

Fixation of the tube to the thorax; 2/0 polyester needle ½ round circle 25mm.
Subcutaneous cell tissue; polygllantine 910 2/0 (CT1) needle ½ round circle 36mm.
Skin; Poligrecaprone 3/0 (PS2) 3/8 circle 19mm sharp reverse.
 TÉCNICA QUIRÚRGICA
General anesthetic induction.
Dressed and table setting.
Washing of the surgical area.
Dressed by the patient.
Dressed as the surgeon.
Initial count of compresses and gauze.
Location of surgical equipment and surgical tables.
Incision on the xiphoid appendix 5 to 10 cm parallel to the ribs (scalpel #
3, blade # 15 - electrosurgical unit - Farabeuf retractors).

https://image.slidesharecdn.com/enfermedadesdelpericardio-131118151512-phpapp02/95/enfermedades-del-pericardio-59-638.jpg?cb=1384787805
 TÉCNICA QUIRÚRGICA
Separation and dissection of the xiphoid process from the fibers
of the anterior rectus muscle (electrosurgical unit - dissection
forceps)
Incision of the xiphoid appendix (Metzembaum scissors).
Diaphragm release (electrosurgical knife - dissection forceps).
Separation of the pleurae; parietal and visceral; and pericardial
fat (blunt dissection).
Access to the pericardium.Traction of the pericardium (Allix
clamp).
Pericardial incision (scalpel handle # 3 blade # 15 - long
dissecting forceps without claw).

https://image.slidesharecdn.com/enfermedadesdelpericardio-131118151512-phpapp02/95/enfermedades-del-pericardio-60-638.jpg?cb=1384787805
 TÉCNICA QUIRÚRGICA
 Aspiration of the content (Yankawer cannula -
suction rubber).
 Incision for the exit of the tube to the thorax
(scalpel handle # 3 blade # 15 -
electrosurgical knife).
 Count of compresses and gauze.
 Chest tube placement (# 32 chest drainage
tube - curved Rochester forceps).
 Fixation of the tube to the thorax (polyester
2/0 needle ½ round circle 25mm) (Hegar
needle holder - dissection without claw - mayo
scissors).

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 TÉCNICA QUIRÚRGICA
Subcutaneous cellular tissue suture (polyglantine 910 2/0 (CT1)
needle ½ round circle 36mm) (Hegar needle holder - clawless
dissection - mayo scissors).
Skin suture (Poligrecaprone 3/0 (PS2) 3/8 circle 19mm sharp
reverse) (fine needle holder - mayo scissors - short claw
dissection).
Connection to drainage system (chest drain - nelaton tube # 14)
Removal of cables and rubbers.
Cleaning and healing;
Incisional field removal (liquid suture) (wet compresses - saline
solution - dry compresses - dressings - sterile gauze)Surgical
clothing removal.

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 REFERENCES

Capítulo 54: El pericardio. Cecilia Corros Vicente.

https://www.fbbva.es/microsites/salud_cardio/mult/fbbva_libroCorazon_cap54.pdf
Enfermedades del pericardio. https://es.slideshare.net/oskrdjoker/enfermedades-del-pericardio-28384121
Ventana pericárdica. The StayWell Company.
https://carefirst.staywellsolutionsonline.com/spanish/Encyclopedia/135,359es#
Ventana pericárdica. Duke homeCare & Hospice. https://dhch.kramesonline.com/Spanish/3,S,90467es