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STUDENT NA CODE: 01200021024 PRACTICE

ME: DAVID ALBERTO JONES PARDO LEVEL: III

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

SPECIALTY: CX SURGEON: DATE:17/03/2023

CARDIOVASCULAR FABIAN GIRALDO

NAME OF PATIENT:WILLVER HERIBERTO MEDICAL HISTORY NUMBER: PATIENT AGE:39

SANTAMARIA 91521590
SURGICAL PROCEDURE TO PERFORM:
MYOCARDICAL REVASCULARIZATION

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description)

THE PURPOSE OF THE SURGERY IS TO PERFORM A REVASCULARIZATION OF THE CORONARY ARTERIES

WHICH ARE BLOCKED OR OBSTRUCTED WHICH IS GENERATING AN ISCHEMIA AND A LOW EFFICIENCY IN THE
HEART, THIS MAY BE GENERATED BY ATHEROSCLEROSIS OR ANOTHER RISK FACTOR, BECAUSE WHAT IS OF
VITAL IMPORTANCE TO RECOVER SAID CARDIAC FUNCTION
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1.2. Anatomy and physiology: (Make graph and description).

TAKEN FROM: https://i0.wp.com/post.medicalnewstoday.com/wp-content/uploads/sites/3/2022/04/1797975-

branches-of-the-right-coronary-artery_1296x900-body-1024x711.png?w=1155&h=1890

THE IRRIGATION OF THE HEART IS MAINLY IRRIGATED BY TWO BRANCHES OF THE ASCENDING
AORTA, THEY ARE CALLED THE RIGHT AND LEFT CORONARY ARTERIES, THESE TWO BRANCHES
IRRIGATE THE MYOCARDIUM AND THE EPICARDIUM

RIGHT CORONARY ARTERY, ARISES FROM THE CORONARY SINUS AND DIRECTED THROUGH THE
ATRIOVENTRICULAR GROUCH, IS DIVIDED INTO THE RIGHT POSTERIOR DESCENDING ARTERY AND
MARGINAL ARTERY
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LEFT CORONARY ARTERY, THIS BRANCH ARISES FROM THE CORONARY SINUS AND EMERGES
BETWEEN THE AORTA ARTERY AND THE PULMONARY TRUNK, THE BRANCHES OF THIS ARTERY ARE
THE LEFT ANTERIOR DESCENDING ARTERY AND THE LEFT CIRCUMFLEX ARTERY

TAKEN FROM: https://fmed.uba.ar/sites/default/files/2019-

04/Irrigaci%C3%B3n%20Arterial%20y%20Drenaje%20Venoso%20del%20Coraz%C3%B3n.pdf

ANATOMY OF THE GRAFTS USED

SAPHENOUS

THE GREAT SAPHENON VEIN IS LOCATED MEDIALLY IN THE LOWER LIMB AND THE SAPHENA PARVA
LATERALLY IN THE LEG, THE DEEP VEINS HAVE THE SAME NAMES AS THE ARTERIES, THERE ARE TWO
FIBULAR VEINS, TWO ANTERIOR TIBIAL AND TWO POSTERIOR TIBIAL, THESE OUTLET OF THE POPLITEA

MAMMARY ARTERY
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The internal thoracic artery (ITA), also called the internal mammary artery (IMA), is a descending collateral
branch of the prescalenic portion of the subclavian artery (AS).

PATHOLOGY

- The cause is usually the buildup of plaque,

which causes the coronary arteries to narrow and
limit the blood supply to the heart.
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1.3. Check list:

MEDICAL EQUIPMENT/ DRUGS AND

SUTURES AND
INSTRUMENTAL DEVICES SOLUTIONS
NEEDLES
-CLOTHING PACKAGE -PROLENE 7/0 OF 3/8
-CORONARY -ELECTROBISTURI CIRCLE VASCULAR
EQUIPMENT -RUBBER SUCCIN -PROLENE 6/0 OF 3/8 HEPARIN
(VASCULAR BASKET) -BISTURI BLADE 15 (3) CIRCLE VASCULAR 13
-SEPARATOR -BBISTURI BLADE 11 MM SOLUTION SALINE
MAMMARY (1) -SILK 0 OF ½ OF
-FINE INSTRUMENTAL -COOPER TUBE CIRCLE 26 MM INFILTRATION
DR GIRALDO -ASEPTOJERINGE -PROLENE 4/0 OF ½ BUPIVACAINE 0,5%
-STERNAL - VENIPUNCTURE CIRCLE ROUND RB-1
SEPARATOR -RADIOPAQUE GAZE 17 MM
(FINOCHETO) -TUBE OF THORAX 34 -POLYESTER 2/0 OF ½
-EXTRACORPOREAL -ANTEROGRADE CIRCLE VASCULAR 25
EQUIPMENT (MCE) CARDIOPLEGIA MM
-RECIPROCATIN SAW CANNULA - PRE-CUT SILK 1
-SET OF TORNIQUETS - PRE-CUT SILK 4/0
AND THREAD PASER -MONOCRYL 3/0 OF 3/8
-NELATON PROBE 8 19MM TAPPER
FR CUTTING
-IOBAN -POLIGLACTIN 910 0
-INTRA-AORTIC OF ½ CIRCLE 36MM
PUNCH -POLIGALCTIN 910 2/0
-CO2 GUIDA AND OF ½ CIRCLE 36 MM
TUBE -ACIFLEX 5
-TORUNDAS -PACEMAKER WIRE 0
-COMPRESSES
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-CLIPS LT 100 AND 200

-GLOVES
BONE WAX
- CAIMAN CABLES
PACEMAKER
- COKES AND WAIST
BAGS
-ARTERIAL CANNULA
-VENOUS CANNULA
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2. ORGANIZATION STAGE:

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

-SCALPEL HADLE #7 AND SCALPEL HADLE #3

-MAYO SCISSORS FINE

-METZEMBAUM SCISSORS (NORMAL AND FINE)

-VASCULAR DISSECTION FORCEPS

-ADSON DISSECTION WITH AND WITHOUT CLAW

-CURVED MOSQUITO FORCEPS WITH PROTECTOR

-CURVED KELLY FORCEPS

-ROCHESTER FORCEPS

- FIELD CLAMPS

-KOCHER FORCEPS

-FARABEUF SEPARATOR (2)

- CASTROVIEJO NEEDLE HOLDER

- RETROGRADE AND ANTERORETROGRADE SCISSORS

-GAZE
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-COCA WITH SOLUTION AND ASEPTOJERINGE -WIRE HOLDER

-CLIPS LT 100 AND 200 -WIRE CUTTER
-VENOPUNCTION -EXTRACORPOREAL BASKET
-JERINGE OF 20 CC -CLOTHING PACKAGE
-CORONARY EQUIPMENT - RECIPROCATING SAW
-SUTURES - MICRO SCALPEL
-COMPRESESS - CORONARY PUNCH
-VASCULAR DISSECTION - LIGACLIP LT 100 AND 200 PLIERS
-ELECTIRC SCALPEL -CAIMAN
-SPENCER CANNULA FOR CARDIOPLEJIA -KIDNEY BAG
-CLOSING WIRE -HADLES , GLOVES
-STERNAL (FINOCHETO) AND MAMARY RETRACTOR -PATHOLOGY JAR
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2.2. Patient position (Name and graphic): supine position

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

1. SURGEON
2. INSTRUMENTATOR
3. ASSISTANT SURGEON
4. EXTRACORPOREAL CIRCULATION MACHINE
5.PERFUSIONIST
6. ANESTHESIOLOGIST
7. CIRCULATING NURSE
8. MAY TABLE
9. RESERVATION TABLE
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3. EXECUTION STAGE:

a) Anesthesia (write the type of anesthesia):

GENERAL

b) Incision (write the type of approach and the name of the incision):

STERNOTOMY AND FEMORAL

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

PROCESS INSTRUMENTAL
THE BEGINNING IS GIVEN BY PERFORMING THE SCALPEL HANDLE #3 HB #15
EXTRACTION OF THE GRAFT FROM THE EXTERNAL METZEMBAUM'S SCISSORS
SAPHENON VEIN OF THE LEFT LEG AND CLOSURE OF SENT MILLER SPACER
BLOOD LEAKS AND PERMEABILITY IS PERFORMED PRE-CUT SILK 4/0
CLIPS LT 100 AND 200
POLYGLATIN 910 2/0
MONOCRYL 3/0
THE STERNOTOMY IS BEGINNING ALWAYS PRESERVING SCALPEL HANDLE #3 HB #15
HEMOSTASIS THE STERNAL MEDULLA IS COATED WITH ELECTRIC SCALPER
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BONE WAX TO PRESERVE THE HEMOSTASIS OF THE FARABEUF SEPARATOR

STERNAL AND IN TURN THE GRAFT OF THE MAMMARY RECIPROCATING SAW
ARTERY IS PREPARED BONE WAX
CLIPS LET 100
THE PERICARDIUM IS INCIDED, HEMOSTASIS AND CLAWLESS DISSECTION
FIXATION OF THE PERICARDIUM IS PERFORMED TO SILK 0 WITH NEEDLE
EXPOSE THE HEART ADEQUATELY AND THE FINOCCHETO NEEDLE HOLDER
OR THE BREAST RETRACTOR IS PLACED VASCULAR DISSECTION
MAY SCISSORS
FINOCHETO SEPARATOR
THE POINTS OF THE TOBACCO BAG OF THE AORTA ARE POLYESTER 2/0
MADE IN THE VENAS CAVA AND THE TOURNIQUETS ARE NEEDLE HOLDER
PLACED THROUGH THREADS AND LEAVE IT REPAIRED VASCULAR DISSECTION
AND AFTER THIS, AN ARTERIOTOMY AND VENOTOMY ARE KELLY CLAMP
PERFORMED TO PERFORM THE FIXATION OF THE MAY SCISSORS
CORRESPONDING CANNULAS AND FIX THEM THREAD GROUND
ANTERORETROGRADE SCISSORS
TOURNIQUETS
THE CONNECTION OF THE TUBES AND THE CANNULAS OF EXTRACORPOREAL CIRCULATION SYSTEM
THE EXTRACORPOREAL CIRCULATION MACHINE IS MADE
WHEN THE HEART ENTERS THE PUMP, THE SAPHENONAL POLESTEER 2/0
GRAFT IS PLACED. IN THIS CASE, REPAIR OF THE RIGHT POLYPROPYLENE 7/0
CORONARY ARTERY, THE POSTERIOR DESCENDING MAY SCISSORS
ARTERY, AND THE RIGHT CORONARY ARTERY CASTROVIEJO NEEDLE HOLDER
ANASTOMOSIS OF THE MAMMARY ARTERY IS MADE IN FRAZIER CANNULA WITH CO2
THE CIRCUMFLEX ARTERY FINE DISSECTION OR VASCULAR FORCEPS
PERMEABILITY AND ANASTOMOSIS ARE VERIFIED AND PACEMAKER WIRE
THE HEART OF THE PUMP IS REMOVED AND THE PLEUROVAC
EXTRACORPOREAL CIRCULATION CANNULAS ARE VASCULAR DISSECTION
REMOVED AND THE PACEMAKER WIRE AND CHEST TUBE WET COMPRESS
ARE PLACED PERICARDIAL CANNULA
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THE STERNAL IS SUTURED, HEMOSTASIS IS CHECKED AND SURGICAL WIRE 5

THE RESPECTIVE PLANS TCS AND SKIN ARE SUTURED ROCHESTER
POLYGLACTIN 910
MONOCRYL 3/0
NEEDLE HOLDER
CLAW DISSECTION
MAY SCISSORS
WIRE CUTTER
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

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

STUDENT SIGNATURE: DAVID JONES TEACHING SIGNATURE: __________________________

CONTROL DE CAMBIOS

FECHA DE
VERSIÓN DESCRIPCIÓN DEL CAMBIO RESPONSABLE
APROBACIÓN

Lizeth Guiza
00 Versión de Prueba Coordinadora de Prácticas 25/11/2015
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Elimina del encabezado la fecha de la

implementación del formato, según Erika Grandas Ardila
disposición de la alta dirección consejo
superior.
Coordinadora de prácticas

01 Eliminación pie de página por 03/08/2022

modificación en procedimiento control
de documentos y registro.