SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: Natalia Mendoza CODE: 01190021001 PRACTICE

LEVEL: lll

TEACHER'S NAME: PRACTICE STAGE: Fosunab NOTE:

SPECIALTY: SURGEON: DATE:

Surgery cardiovascular

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:

SURGICAL PROCEDURE TO PERFORM:

Implantation of bicameral pacemaker

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description)

Surgical intervention consisting of implanting two pacemakers, one in the right ventricle and the other in the right atrium,
and a catheter through the left innominate vein.

Bicameral pacemaker: this system uses 2 electrodes, one located in the atrium and the other in the ventricle, in this
way any of the cardiac chambers can be stimulated and thus coordinate the contraction of the atria with that of the
ventricles for a better efficiency of the pacemaker. heart.

Indications:
Bradycardia: It is a decrease in the normal heart rate.
Sinus node disease: A group of heart rhythm problems due to problems with the sinus node.

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

The heart

The heart pumps blood throughout the body and provides oxygen to the organs, tissues, and cells.

From a functional point of view, the heart forms a hollow chamber with muscular walls, which is
divided into 4 (two atria and two ventricles) and its function is to pump blood. If necessary you can multiply your
pumping capacity, for example, during physical work.

Essentially, two circuits supply blood to the entire body: the minor or pulmonary circulation and the pulmonary circulation.
major or systemic, which exerts greater pressure on the blood vessels than the pulmonary circulation. both circuits
They work together and run parallel to each other.

layers of the heart

From the outside the heart is bounded by the pericardial sac (pericardium), which protects the heart and separates it
from
 SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

IQX-FT-003-BUC
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other organs. The interior of the pericardium is lined with smooth tissue.

Inward, the smooth, fine-textured outermost layer of the heart (epicardium) joins the pericardium. The friction between
pericardium and the outer layer of the heart is reduced by the layered structure of both and a lubricating fluid called
pericardial fluid. Internal to the epicardium is a tube-shaped muscular layer (myocardium).
the diameter of the
heart muscle depends on the force required of it and the amount of blood it has to hold and pump.

BIBLIOGRAPHY: https://www.onmeda.es/anatomia/anatomia_corazon.html
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1.3. Check list:

MEDICAL EQUIPMENT/ DRUGS AND

SUTURES AND
INSTRUMENTAL DEVICES SOLUTIONS
NEEDLES

PACEMAKERBASKET CLOTHING KITSILK 0 WITHOUT SALINE SOLUTION

PACKAGING CUTTING NEEDLE: LIDOCAINEWITHOUT
ELECTROSURGERY TO FIX ELECTRODES EPINEPHRINE:TO
COMPRESSES AND GENERATOR INFILTRATE
10 CC SYRINGES
IODIZED FIELD PROLENE 3/0WITH
GLOVES CUTTING NEEDLE:
SCALPEL BLADE15 FOR SKIN.
ANGIOGRAM COVERS
PACEMAKER

2. ORGANIZATION STAGE:

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

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1. Pacemaker basket.
2. Cardio clothing package. 11 1
3. MB#15
4.T. Metzembaum
9
5. T mayonnaise
6. Curved midge 3 4 5 6 7 12 2
7. P. kelly curve
8
8. Adson dissection with and without claw.
9. compress, suture, needle holder, syringe
10. farabeuf separators. 10
11. coke.
12. 10 CC SYRINGES, IODIZED FIELD
GLOVES.

2.2. Patient position (Name and graphic):

POSITION: Supine position.

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

surgeon

reservation
table. anesthesiologist

Surgical assistant.
I.Q
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3.EXECUTION STAGE:
a) Anesthesia (write the type of anesthesia):

• Local anesthesia

b) Incision (write the type of approach and the name of the incision):
• below the left clavicle.

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

SURGICAL PROCEDURE.
Initially, the area to be operated on is infiltrated twice: with a 10 cc syringe and lidocaine without epinephrine.
The vein is punctured to introduce a guidewire and is secured with a curved Kelly clamp.
The position of the guide is verified through the angiographer.
An incision is made under the clavicle in order to create a pocket: scalpel handle 3 blade 15, then it isextended with the
electrocautery up to the TCS.
The electrode that will remain permanently in the right atrium is introduced through the guidewire andfixed with a curved Kelly
clamp.
The same steps are performed for the electrode that will remain in the right ventricle.
The electrodes are fixed to the muscle with silk or with a needle.
The position of the electrodes is verified with the angiographer
The generator is passed to the table and placed in the pocket that was created under the clavicle, theelectrodes are fixed by
means of a screwdriver that comes with the pacemaker kit.
The generator is fixed in the pocket with silk or with a needle, hemostasis is performed with theelectrosurgical unit.
TCS closure with vicryl 2/0 and skin closure with prolene 3/0

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