SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NA CODE: 01200021015 PRACTICE

ME: CLARA JIMENEZ LEVEL: III

TEACHER'S NAME: LIDY HIGUERA PRACTICE STAGE: ICB NOTE:

SPECIALTY: CX SURGEON: DATE: 24/05/2023

CARDIOVASCULAR DR GIRALDO Y DR
OCAMPO
NAME OF PATIENT: CARLOS SUAREZ MEDICAL HISTORY NUMBER: PATIENT AGE: 82
26789654

SURGICAL PROCEDURE TO PERFORM

AORTIC VALVE REPLACEMENT AND MYOCARDIAL REVASCULARIZATION

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. SURGICAL OBJECTIVE: (MAKE DESCRIPTION)

THE OBJETIVE OF THIS SURGERY IS TO CHANGE THE AORTIC VALVE AND

REVASCULARIZE THE CORONARY ARTERIES IN THIS ALMOST THE LEFT ANTERIOR
DESCENDING ARTERY THAT IS OBSTRUCTED
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1.2. ANATOMY AND PHYSIOLOGY: (MAKE GRAPH AND DESCRIPTION).

The irrigation of the heart is given mainly by two branches coming from the ascending
aorta, called right and left coronary arteries; These branches are the ones that make
blood flow to the myocardium and epicardium.
The right coronary artery is derived from the coronary sinus and directed through the
atrioventricular septal defect that divides into the right posterior descending artery and
the marginal artery. And the left coronary artery arises from the coronary sinus and
emerges from this very
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 INTERNAL MAMMARY ARTERY (IMA), IS A

DESCENDING COLLATERAL BRANCH OF THE PRE-
SCALENIC PORTION OF THE SUBCLAVIAN ARTERY
(AS). ITS ORIGIN IS MEDIAL TO THE PHRENIC NERVE
(NF) AND POSTERIOR TO THE BRACHIOCEPHALIC
VENOUS TRUNK.

To reach this vein, a surgical cut will be made on the inside of the leg, between the
ankle and the groin. One end of the graft will be sutured to the coronary artery. The
other will be sutured to an opening made in the aorta.
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1.2. CHECK LIST:

MEDICAL
DRUGS AND
EQUIPMENT/ SUTURES AND
INSTRUMENTAL SOLUTIONS
DEVICES NEEDLES
-
EXTRACORPOR CLOTHING  PACEMAKE -HEPARIN
EAL BASKET PACKAGE R WIRE -SOLUTION
-CORONARY -ELECTROBISTURI  VASCULAR SALINE
EQUIPMENT -RUBBER SUCCIN POLYPROPY -BUPIVACAINE
(VASCULAR -BISTURI BLADE 15 LENE 4/0 TO 0,5%
BASKET) (3) CLOSE THE
-SEPARATOR -BBISTURI BLADE 11 AORTA,
MAMMARY (1) VENT
-STERNAL -COOPER TUBE POCKET
SEPARATOR -ASEPTOJERINGE AND
(FINOCHETO) -VENIPUNCTURE CARDIOPLE
- -RADIOPAQUE GAZE GIA
EXTRACORPOR -TUBE OF THORAX  SILK 0
EAL 34 (PERICARDI
EQUIPMENT -ANTEROGRADE UM REPAIR)
(MCE) CARDIOPLEGIA  POLYGLACT
-RECIPROCATIN CANNULA IN 910 0
SAW -NELATON PROBE 8  POLYESTER
FR 2/0
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- HANCOCK -IOBAN (ARTERIAL

BIOLOGICAL -INTRA-AORTIC AND
VALVE 23 PUNCH VENOUS
-CO2 GUIDA AND AORTA
TUBE POCKET)
-TORUNDAS  SILK 4/0
-COMPRESSES (REPAIR OF
-CLIPS LT 100 AND THE AORTA)
200  BONE WAX
-GLOVES  SILK 1 (TIE
BONE WAX THE
-CAIMAN CABLES CANNULAS)
PACEMAKER  POLYPROPY
-COKES AND WAIST LENE 6/0
BAGS (PROXIMAL
-ARTERIAL ANASTOMO
CANNULA SIS) AND 7/0
-VENOUS CANNULA (DISTAL
-SURGICEL ANASTOMO
POWDER SIS)
 MONOCRYL
3/0 (SKIN)
 WIRE #6
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2. ORGANIZATION STAGE:

a. ARRANGEMENT OF MAY TABLES AND RESERVATION (MAKE SCHEME).

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2.2. PATIENT POSITION (NAME AND GRAPHIC):

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2.3. LOCATION OF THE SURGICAL TEAM (MAKE A GRAPH):

ANESTHESIOLOGI
ST PERFUSIONIS
T
SURGEON PATIENT ASSISTAN
T
IQ
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3. EXECUTION STAGE:

a) ANESTHESIA (WRITE THE TYPE OF ANESTHESIA):

GENERAL ANESTHESIA

b) INCISION (WRITE THE TYPE OF APPROACH AND THE NAME OF THE INCISION):

MEDIAN STERNOTOMY INCISION

c) SURGICAL PROCESS (DESCRIBE THE MAIN STEPS OF THE SURGICAL MEDICAL

TECHNIQUE WITH THE INSTRUMENTS TO BE USED).

 Incise with scalpel 11 place wilander separator

 To remove the saphenous graft
 take out the graft
 Fascia is closed with 2/0 vicryl and 3/0 monocryl skin
 Incision with scalpel 15
 It continues to affect with electro
 Incise the sternum with a reciprocating saw and gradually hemostasize the bone.
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 Place bone wax on the bone

 Place mammary separator
 Then dissect the mammary, place the clips and cut
 They administer the heparin
 The mammary separator is removed and the morse sternal is placed.
 An incision is made to break the pericardial layer with the electro and the
pericardium is repaired with silk 0
 2/0 polyester is passed to the surgeon for the aortic pursestring
 The purse string is made for right atrial venous cannulation (single cannulation)
 performing arterial cannulation and it is attached to the tube of the
extracorporeal circulation machine then single cannulation in the right atrium
and it is attached to the tube
 The vent is located in the right upper pulmonary vein.
 then anesthesiologist ventilates the patient then the custodiol is placed
(cardioplegia) and the pump is entered
 Incise the aorta to give direct antegrade cardioplegia in the coronary ostium and
remove the valve
 Incise the posterior descending artery and place the saphenous graft with 7/0
prolene
 Then they do the test to see if it passes with a solution
 then they pass the meters # 23 and 25 biological to know the size of the valve
and they chose # 25
 4 capos are placed so that the threads at the time of suturing the valve are not
lost and it is fixed with 2/0 polyester
 fields are removed
 then the aorta is closed with prolene 4/0
 Then he bridges the proximal graft that goes to the aorta
 Repair the mammary, place a bulldog clamp and proceed to place the graft
 The bulldog clamp is removed
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 They place pace marking thread

 They place the alligators before leaving the bomb
 it comes out of bomb
 Decannula remove separator and perform hemostasis
 The separator is placed again and hemostasis is performed.
 Tubes are placed in the right pleura and mediastinum
 The separator is removed and the sternum is sutured in 6/0 stainless steel.
 Fascia is closed with vicryl 0
 Leather with monocryl 3/0

BIBLIOGRAPHY

 https://www.google.com/search?q=ANATOMIA+DE+LA+ARTERIA+MAMARIA&rlz=1C1
CHBD_esCO1014CO1014&hl=es-
419&sxsrf=APwXEdcUzYOvqqAspgFvX4WCb7fuQ9gMcQ:1684604757159&source=lnm
s&tbm=isch&sa=X&ved=2ahUKEwjSiIzhuYT_AhX3mWoFHVGtCJIQ_AUoAXoECAEQA
w&biw=1366&bih=592&dpr=1#imgrc=_AyuJau5zMk0WM&imgdii=8vWGaEzFks6rlM
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

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

STUDENT SIGNATURE: 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
superior.
Coordinadora de prácticas

01 Eliminación pie de página por 03/08/2022

modificación en procedimiento control
de documentos y registro.