SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: CODE: 0120021008 PRACTICE

Catalina Jaimes Paredes LEVEL: III

TEACHER'S NAME: PRACTICE STAGE: NOTE:

Lidy Higuera ICB

SPECIALTY: CX SURGEON: DATE:

CARDIOVASCULAR DR GIRALDO AND DR 26/04/2023
OCAMPO
NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:
CRISTOBAL JAIMES 3912248 71
SURGICAL PROCEDURE TO PERFORM:
MIOCARDICAL REVASCULARIZATION

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description)

It is a medical procedure to improve the irrigation of the heart by performing a reanastomosis of the so-called coronary arteries
with grafts so that there is better irrigation to the tissue since these have a narrowing or obstruction.
mainly by calcifications of atheromatous plaques

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

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The coronary artery system begins

with two main arteries that arise from
the aortic sinuses at the root of the
aorta.

The right coronary artery: wraps

around the right side of the heart,
traveling in the
coronary/atrioventricular groove. This
artery gives rise to three groups of
branches (anterior, marginal, and
posterior - also known as inferior),
which vascularize most of the
structures located on the right side of
the heart.

The left coronary artery: travels into

the anterior interventricular groove,
where it bifurcates to form its two
terminal branches: the anterior
interventricular artery and the
circumflex artery of the heart.

https://www.kenhub.com/es/library/anatomia-es/corazon
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MAMMARY ARTERY:
The internal thoracic artery (ITA), also called the internal
mammary artery (IMA), is a descending collateral branch of
the subclavian artery (AS). Its origin is medial to the phrenic
nerve (NF) and posterior to the brachiocephalic venous trunk.

SAPHENON VEIN:
The great saphenon vein is situated medially in the lower
extremity and the saphenan vein is paravalaterally 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 leave from the poplitea.
https://revista-anatomia.com.ar/archivos-parciales/2012-3-revista-argentina-de-anatomia-online-e.pdf
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1.3. Check list:

MEDICAL EQUIPMENT/ SUTURES AND DRUGS AND

INSTRUMENTAL DEVICES NEEDLES SOLUTIONS

-Prolene 7/0 of
• Coronary • Clothing package 3/8 • Heparin
Equipment • Electrobisturí circle vascular • solution
(Vascular (X2) distal saline
basket) • Yankawer anastomosis • Bupivacaine
cannula 0,5%
• Separator • Suction rubber -Prolene 6/0 of • Custodiol
Mammary • Bisturi blade 15 3/8
(3) circle vascular
• Fine • Bisturi blade 11 13
instrumental (1) mm
Dr Giraldo • 10 syringe and aortic
20 syringe anastomosis
• Sternal • Aseptosyringe
separator • Handlebars -Silk 0 of ½ of
(fianchetto) • Pathology bottle circle 26 mm
pericardium
• Microbisturi
• Extracorporeal • Aseptojeringe
-Prolene 4/0 of
• 3-WAY VALVE ½
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equipment circle round

(mce) • Arteriotomy rb-1 17 mm
• Reciprocatin cannula with
saw olive (graft) -Polyester 2/0
• Radiopaque gaze of ½
• Tube of thorax circle vascular
• Pleuroevac 32 25mm
AND 34
• Y conector -Pre-cut silk 1
• Set of torniquets
and thread paser -Pre-cut silk
• -Nelaton probe 4/0
#8 Fr (
FORCEPS) -Monocryl 3/0
#14 of 3/8
19mm tapper
• ioban
cutting (skin)
• intra-aortic punch
• Co2 guide and -Poliglactin
• tube 910 0
• Torundas(4) of ½ circle
• Compresses 36mm
• Clips LT 100 (fascia sct)
internal
mammary -Poligalctin
YELLOW and 910 2/0
200 of ½ circle 36
saphenectomy mm
BLUE
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-Aciflex 6
• Gloves breastbone
• bone wax -Pacemaker
• Fibrilar surgicel wire 0
• Caiman cables
pacemaker
• Cokes and waist
Bags

• Arterial cannula
eopa (18) Tube
conector 3/8
• Unic venous
cannula (30-32)
Tube conector
1/2
• Anterograde
cardioplegia
cannula (aortic
root)
• semi-rigid
pericardial
aspirator
• Bandage 6*5
• Dermabond
• Gauzes
• Dressing with
pad
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• Dressing without
pad

2. ORGANIZATION STAGE:

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

• SCALPEL HADLE #7(2) AND SCALPEL HADLE #3

• MAYO SCISSORS FINE
• METZEMBAUM SCISSORS (NORMAL AND FINE)
• VASCULAR DISSECTION FORCEPS
• ADSON DISSECTION WITH AND WITHOUT CLAW
• RETROGRADE AND ANTERORETROGRADE SCISSORS
• CURVED MOSQUITO FORCEPS WITH PROTECTOR
• CURVED KELLY FORCEPS
• ROCHESTER FORCEPS-
• FIELD CLAMPS
• KOCHER FORCEPS
• FARABEUF SEPARATOR (2)-
• CASTROVIEJO NEEDLE HOLDER
• GAZE
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• SUTURES
• COCA WITH SOLUTION AND ASEPTOJERINGE • MICRO SCALPEL
• WIRE HOLDER • COMPRESESS
• CONECTORS • CORONARY PUNCH
• TORNIQUETS • VASCULAR DISSECTION
• ARTERIAL CANNULA EOPA (18) TUBE CONECTOR 3/8 • ELECTIRC SCALPEL
• CAIMAN
• UNIC VENOUS CANNULA (30-32) TUBE CONECTOR ½
• ANTEROGRADE CANNULA FOR CARDIOPLEJIA
• ASEPTO SYRINGE
• SEMI-RIGID VACUUM CLEANER
• YANKAUER CANNULA • HANDLES, GLOVES-STERNAL (FINOCHETO) AND
• NELATON PROBE MAMARY RETRACTOR
• CLIPS LT 100 AND 200 LIGACLIP LT 100 AND 200 PLIERS • PATHOLOGY JAR
• WIRE CUTTER • IOVAN
• VENOPUNCTION • AORTIC CLAMP
• EXTRACORPOREAL BASKET • 20 CC, 10 CC AND 5 CC SYRINGE
• JERINGE OF 20 CC • CASTROVIEJO NEEDLE HOLDER
• EPICARDIAL RETRACTOR
• CLOTHING PACKAGE
• LISTER'S SCISSOR
• CORONARY EQUIPMENT • WIRE HOLDER
• RECIPROCATING SAW
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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):

NURSE
ANESTHESIOLOGIST

SURGEON PERFUSIONIST
SURGEON
ASSISTANT

SURGICAL SURGEON MCE

INSTRUMENTATOR ASSISTANT

May table

Reservation
table
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3. EXECUTION STAGE:

• Anesthesia (write the type of anesthesia):

GENERAL ANESTHESIA
a)

b) Incision (write the type of approach and the name of the incision):
MIDDLE STERNOTOMY AND FEMORAL

c) Surgical Process (Describe the main steps of the surgical medical technique with the instruments to be used).
1. preparation of the patient dressed as a patient, dressed in tables and arrangement.

2. Extraction of the graft from the great saphenous vein of the left leg, guaranteeing its patency, closure by planes
Garter clip forceps Scalpel handle retractor 3 scalpel blade 15 Pre-cut silk 4-0 Poliglactin 910 Monocryl Fine
vascular dissections Kelly Adson Kelly T metzembaum Separators farabeuf Bandage 6*5 T may
Electrosurgical Weitlaner separator 20cc syringe, bulldog clamp, arteriotomy cannula.

3. Sternotomy incision is made to the media, hemostasis, hemostasis of the external bone, and the graft extraction of
the internal mammary artery is performed: Scalpel handle 7 scalpel blade 15, Electrosurgical scalpel, Farabeuf
retractors, Reciprocating saw, Self-static retractor of internal mammary gland, ligaclip forceps and LT 100
clips (yellow), plasty scissors, 20cc syringe, arteriotomy cannula with olive, yankawer cannula, bone wax.

4. The pericardium is incised, hemostasis and fixation of the pericardium is performed visualizing the heart and the
placement of the Finochietto separator is performed, Fine dissections, Silk 0 with a needle, May scissors,
Electrobistury
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5. CANNULATION:
Tourniquets and purse strings are performed for cannulation of the aorta with EOPA arterial cannula in the
ascending aorta, single venous cannulation in the right atrium and finally antegrade cardioplegia cannula in the
aortic root, finally the fixation of them:
polyester 2/0needle holder,vascular dissection, aortic clamp .may scissors, tourniquets, arterial cannula Eopa #
18, single venous cannula 34/36 and antegrade cardioplegia cannula.

6. the connection of the tubes and the cannulas of the extracorporeal circulation machine is made.
EXTRACORPOREAL CIRCULATION SYSTEM

when the heart enters the pump, the saphenous graft is placed. in this case anastomosing it with the circumflex
artery and repairing the anterior descending artery with the mammary artery, de anastomosis is verified and the
MCEC is removed.
saphenous vein and circumflex artery graft, scalpel handle #7 and scalpel blade 15 or microscalpel, fine
dissections and Dennis dissection, CO2 Frazier cannula, semi-rigid aspirator, castroviejo needle holder,
anterograde and retrograde Potts scissors, arteriotomy cannula and syringe 10cc, may scissors, metzembaum
scissors

INPUT OF MEDICAL SUPPLIES

7. incisions are made and placement of tubes in the chest, placement of pacemaker thread

scalpel handle#7 scalpel blade #15, chest tubes 34 and 32, Y-connector, Kocher forceps, needle holder, Mayo
scissors, pacemaker wire, pleurovac

8. The sternal is sutured, hemostasis is checked and the respective plans tcs and skin are sutured
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#6 steel, wire cutter, rochester forceps, monocryl 3/0, polyglactin 910 0, needle holder, mayo scissors

9. cleansing and healing

May scissors, dressings without pad, gauze, dermabond, compresses
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

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

STUDENT SIGNATURE: CATALINA JAIMES PAREDES TEACHING SIGNATURE: __________________________

CONTROL DE CAMBIOS

FECHA DE
VERSIÓN DESCRIPCIÓN DEL CAMBIO RESPONSABLE
APROBACIÓN

Lizeth Guiza
Coordinadora de Prácticas
00 Versión de Prueba 25/11/2015

Elimina del encabezado la fecha de la

implementación del formato, según Erika Grandas Ardila
disposición de la alta dirección consejo
Coordinadora de prácticas
superior.
01 Eliminación pie de página por
03/08/2022
modificación en procedimiento control
de documentos y registro.