Case

Clinical
"Off-Pump Myocardial Revascularization"
By: Juan Sebastian Rincon Martinez
Patient Information
Name: Antonia Cespedes
ID: 12228900
Weight: 70kg
Height: 1.68cm
Blood Type: O -
Results: HIV (-), Hepatitis B (-) COVID - 19
Age: 72years old
FE: 49%.
EPS:
Diagnosis:
Coronary artery disease
involving right coronary artery.

Procedure:
"Off-Pump Myocardial
Revascularization"
Definition of the Procedure
This procedure consists of bridging using autologous grafts to provide
blood flow to ischemic cardiac tissue. These grafts are anastomosed at
one end to the aorta; and at the other end are anastomosed to the distal
portion of the stenotic coronary artery. They can be free grafts of
saphenous vein, gastroepiploic, radial, etc. or pedicled grafts such as the
internal mammary artery without extracorporeal circulation.
Anatomy of the procedure
The process begins... (Before anesthetic induction)
The review of the clinical history is evidenced.
The patient interview is evidenced (Introducing ourselves, communicating
the procedure to be performed, consulting the pre-surgical bath and the
antiseptic used, informing the state in which the wound will come out
after surgery and giving the necessary recommendations to take into
account after surgery, buy a soap and towel for specific use for the
wound, avoid scratching the wound).
The respective cleaning and disinfection of surfaces is evidenced.
Before Incision...
Patient's body surface area is evident: 1,7
Flow rate evident: 4,25
Heparin dose is evidenced: 4,9
It is evidenced that the perfusion devices are correct.
The sterility of the equipment is confirmed
It is evidenced that the pre-surgical asepsis used was alcohol and
isopropyl alcohol.
It is evidenced that the washing was total and the plaque is located.
Adequate positioning of the patient is evidenced
Surgical Process
Verify that the sternal retractor is appropriate for off-pump
revascularization.
For repair of the posterior pericardium, pass to the surgeon
polyester suture with pledget, supported by tourniquet and / or
thread passer.
Pass to the surgeon healing elements such as compresses and
gauze in order to improve exposure.
Pass to the surgeon the special restraint and stabilization
devices, in order to position the heart and achieve exposure of
the arteries to revascularize (support of the assistant surgeon).
Connect the suction to the systems in order to achieve the
necessary pressure for the operation of the coronary positioner
and stabilizer.
Pass to the surgeon instruments of dieresis (scalpel with blade
15), and vascular apprehension, to dissect the epicardial fat and
locate the coronary to revascularize.
Pass the elastic band (silastic stitch with round needle) to
perform the preconditioning of the coronary artery and repair it
with protected hemostatic clamp.
Pass to the surgeon instruments of diaeresis, elastic micro
vascular apprehension to perform the coronary arteriotomy
(scalpel handle blade 15) and for the prolongation of the incision
pass microvascular scissors type potts anterograde and / or
retrograde depending on the cut.
To measure the diameter of the vessels pass the coronary
dilators.
Pass to the surgeon the coronary shunts (1.0,1.5,2.0,2.5) supported
by a fine elastic grasping forceps in order to maintain the
coronary flow.
Perform the closing time steps
Perform the ending time steps
Post-Surgical Time
It is recorded on the instrumentation checklist whether or not the medical device count was verbally
confirmed.

Before leaving the

operating room....
Confirm and record whether or not there are problems to be resolved with instruments and/or
equipment.
Confirm and record the same confirmation of samples and labeling
Central Sterilization
The baskets used in surgery are verified, ensuring that they are in correct condition and quantity,
reorganizing and arranging them, with their respective indicators.
Clinical Case finished
Elaborated by: Juan Sebastian Rincon Martinez
University of Santander
Surgical Instrumentation Seventh Semester
Practice III