Cardiovascular Surgery repair ASD

Atrial Septal Defect Closure (ASD)

Objective

•   To open chest

•   To close a defect (hole) in the atrial septum.

Position

•   Left semilateral/supine.

Anesthesia

General, endotracheal.

Procedure

   1.  Catheterization: Cleaning and draping.

   2.  Skin incision with No. 4 BP handle with No. 20 blade.

   3.  Saw and cable for sternotomy.

   4.  Pericardiotomy: Stay suture 2/0 At. silk.

   5.  Loop the SVC and IVC.

   6.  Keep ready for venous tubing, aortic tubing and cardio­plegia tubing.

   7.  Aortic purse string 3.0 T3 single arm suture (2) cannulated.

   8.  IVC purse string and cannulation.

   9.  SVC purse string and cannulation.

10.  Aortic cannulation No. 11 knife for hole in the aorta. Insert cannula, silk tie. Connect the venous and arterial line in SVC and IVC.

11.  Cardioplegia stitch 4.0 T3 single arm, arterial line, scissors, snugger medium snap, cardioplegia cannula, silk tie.

12.  Scissors for opening the RA.

13.  Direct closure 4.0 T3 stitch or Dacron patch 4/0 Surgilene.

14.  RA closure 5/0 Prolene.

15.  Decannulation, Pacing wire.

16.  Drainage tube.

17.  Sponge and instruments count.

18.  Sternum closure—muscle and subcutaneous.

Instruments

•   Cleaning tray

•   Catheterization set

•   Cardiac set

•   Open heart vascular set

•   Open heart special set

•           Open heart water seal.

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Cardiovascular Surgery Sternotomy procedure instruments

Sternotomy

Objective

To open the chest and to expose the heart and mediastinum.

Position

Supine.

Anesthesia

General, endotracheal.

Procedure

1.  Incision from suprasternal notch to xiphoid process.

2.  Deepen incision to periosteum.

3.  Retract skin at the upper end with Rake retractor with scissors and a right angled clamp clear the upper sternal edge.

4.  Divide interclavicular ligament.

5.  Use sternal saw to cut along the line from above downwards.

6.  Pericardium is incised.

Instruments

•   Cleaning tray

•   Sternotomy set.

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Cardio-vascular Surgery Pericardectomy

Pericardiectomy

Objective

•   To open chest

•   To excise pericardium

•   To relieve constriction of the heart.

Anesthesia

General, endotracheal.

Position

•   Supine or right semilateral

Procedure

   1.  Cleaning and draping.

   2.  Incision midsternotomy or thoracotomy.

   3.  Skin incision with knife, sponge and cutting cautery.

   4.  Separation of the pericardium with Rt. angle and cautery (cutting) and gauze piece.

   5.  Excise the pericardium.

   6.  Chest drainage tube.

   7.  Pericostal closure sponge and instruments count.

   8.  Muscle closure with 1-0 Vicryl or Dexron.

            9.         Subcutaneous 2-0 Vicryl or Dexron.

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THORACIC SURGERY Thoracoplasty

Thoracoplasty (Removal of Rib)

Objective

In cases of extensive TB of the lungs:

•   To cause a collapse of the lungs by removal of rib.

Position

Left or Right lateral position.

Anesthesia

General intubation.

Procedure

   1.  Cleaning of the patient with Savlon and painting with Tincture Iodine and draping.

   2.  Incision with No. 20 blade and No. 3 BP handle.

   3.  Cauterization with cutting cautery.

   4.  Elevation of the periosteum of the rib with periosteum elevator.

   5.  Cutting of the rib with rib cutter.

   6.  Sponge and instruments count.

   7.  Drainage: Under water seal drainage.

   8.  Muscle closure with No. 1-0 Vicryl.

   9.  Skin closure with 2-0 Vicryl.

10.  Dressing with Betadine ointment and gauze.

11.  Shifting of the patient.

Linen

Chest sheet 1 pkt, Gown 1 pkt, Chest drape 1 pkt, OPT 1 pkt.

Set

General set, water seal set, Rib resection set, Cleaning set.

Major procedure tray

•   Retractor Davidson scapula                        1

•   Duvals lung holding forceps                     2

•   Sinus rib holding forceps                          1

•   Dorham’s aneurysm needle                       2

•   Retractor Allisoi’s (Lung retractor )           1

•   Periosteum elevator notch type                 2

•   Bronchus clamp                                          2

•   Dissector W/S                                             1

•           Stinskey clamp

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Thoracic Surgery Thymectomy

Thymectomy

Objective

In cases of Myasthenia or tumors of thymus:

•   Removal of the thymus gland.

Position

Supine.

Anesthesia

General.

Procedure

1.  A sternal splitting incision.

2.  Mediastinal fat pad is incised and the thymus gland dissected from it and the underlying pericardium.

3.  Vascular attachments are ligated.

4.  To avoid the great vessels and the parathyroid glands.

5.  Hemostasis is achieved.

6.  If either pleural space has been entered a chest tube(s) and sealed drainage unit may be necessary.

Instruments

•   Thoracotomy procedure set 

•   Vascular procedures set 

•   Minor procedures set 

•   Tracheostomy tray 

•   Lebsche sternal knife 

•   Mallet 

•   Sternal saw 

•   Rake retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 adult, (2) No. 15 children 

•   Bone wax 

•   Drain 

•   Umbilical tape 

•   Dissectors 

•   Chest tube(s) connector, and sealed drainage unit.

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