SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

Versión: 1
IQX-FT-003-BUC

STUDENT NAME: CODE:0120022011 PRACTICE

ANA MARIA BOTHIA AVILA LEVEL: III

TEACHER'S NAME: PRACTICE SCENARIO: NOTA:

IQ. GLENDA INSTITUTO CARDIOVASCULAR

SPECIALTY: SURGEON: DATE:

CX CARDIOVASCULAR DR. DONIS 16/NOVIEMBRE/2023

NAME OF PATIENT: CLINICAL HISTORY NUMBER: PX AGE:

JUAN EDUARDO BARRERA PADILLA 1005281637 22 AÑOS
SURGICAL PROCEDURE TO BE PERFORMED:
REINTERVENTION IN CONGENITAL HEART DISEASE DUE TO PULMONARY STENOSIS + TRICUSPID
VALVULOPLASTY.
SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description).

It is a surgical procedure performed to restore blood flow to the heart muscle (myocardium) that may be compromised
due to blockages in the coronary arteries.

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

Anatomy of the Coronary Arteries

 SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

Versión: 1
IQX-FT-003-BUC

What is the pulmonary valve?

The pulmonary valve is one of the four valves of the human heart and is located at the outlet of the right ventricle, which
is the lower right chamber of the heart. Its main function is to allow blood pumped by the right ventricle to flow into the
pulmonary artery, carrying deoxygenated blood from the heart to the lungs to pick up oxygen and remove carbon
dioxide.

Pulmonary valve anatomy.

The anatomy of the pulmonary valve includes three semilunar cusps or leaflets that form a structure similar to the shape
of a crescent. These leaflets are also called semilunar valves because of their shape. The cusps are formed by
connective tissue and lined internally by endocardium.

Function of the pulmonary valve.

When the right ventricle contracts during the ejection phase, the pressure inside the ventricle increases and the cusps of
the pulmonary valve open, allowing blood to flow into the pulmonary artery. After the blood has been expelled, the cusps
close to prevent retrograde flow of blood into the right ventricle during relaxation of the heart.

Function of the tricuspid valve.

The tricuspid valve is another of the four valves that make up the human heart. It is located between the right atrium and
the right ventricle and is composed of three leaflets or cusps. The main function of the tricuspid valve is to regulate blood
flow between the right atrium and right ventricle.

Cusps or Valves:
The tricuspid valve consists of three cusps or valves, which are membranous extensions covered by endothelial and
connective tissue. These cusps are known as the anterior cusp, septal cusp, and posterior cusp.

Chords Tendineae and Papillary Muscles:

Inside the right ventricle, the cusps of the tricuspid valve are attached to chordae tendineae, which in turn are connected
to papillary muscles. These muscles help stabilize the cusps and prevent them from inverting toward the atrium during
contraction of the ventricle.
 SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

Versión: 1
IQX-FT-003-BUC

1.2. Lista de chequeo:

INSTRUMENTAL MEDICAL EQUIPMENT / SUTURES AND DRUGS AND
DEVICES NEEDLES SOLUTIONS
• Valve Basket • Hemostasis of the
• Extracorporeal • clothing package sternum bone: Bone • Warm Saline
equipment. • HB #15 -#11 Wax Solution.
• Pleur-Evac • Heparin.
• Semi-rigid • Separation of the
• Sternal Vacuum Cleaner pericardium: Seda 0
Separator. • Three-cavity con SH.
vacuum cleaner. • For the union of the
• Accessory • Vent vacuum cannulas: Silk 1
Equipment. cleaner precut.
• Antegrade • Fixing the blake drains:
cardioplegia Ti-cron 2/0 (4)
• Thread Grommet cannula Con aguja de 1/2
Clip. • Arterial cannula • For the turnstile
20 Fr purses: 4/0
• Venous cannula Polypropylene with
• Volkman VCS: 24 VCI: 28 RB1 (One with pledget
separator. • Iovan and one without
• 3/8 and 1/2 pledget).
connectors • Purse the cardioplegia
• Oscillating saw. • Qosine cannula and suture the
Connector pericardium patch:
• Yankawer Polipropileno 4/0 con
• Ligaclip forceps. cannula RB1
• Suction rubber • Repair any injury:
Polypropylene 5/0 C-1.
• Electrosurgical
• Biological • To repair the vent wall.
• Dermabond
pulmonary valve and Art. Pulm:
• Tegaderms
#27 Avalus. Polypropylene 4/0 Cv-
• Lukomed 23.
• Radiopaque • For the vena cava
gauze
• Pulmonary valve purse: Polypropylene
• Compresses 5/0 with RB1T
gauges.
• Syringe 20cc • Temporary electrical
• Accessory field stimulation and atrial
• Robe accessory or ventricular
• Blake drain. detection: Hilo de
• Cardioplegia marcapasos 2/0.
Line. • Closure of pericardial
fascia: Poliglactina 910
0-2/0 con CT1
• Leather closure:
Monocryl 3/0 (2) aguja
de 3/8 cortante.
 SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

Versión: 1
IQX-FT-003-BUC

2. ETAPA DE ORGANIZACIÓN:

a. Arreglos de mesas de mayo y reserva (realizar esquema).

-MB #7 (2) -Vascular dissections (6)

- Metzembaum scissors -Kelly protected (2)

- May Scissors -Field clamp (8)
- Straight Kelly clamp (6) -Farabeuf separator
- Curved kelly clamp (10)

- Mosquito clamp (2)

- Kelly Adson clamp (2)

-Allix clamp (2)

-Rochester clamp (6)

-Pipe clamp (2)

-Cardioplegia cannula.

-Thread feeder clamp.

-Cystic Forceps.

-Satinky Clan

-Total Occlusion Clan.

-Vein separator.

-Clawless dissecting forceps.

-Dissecting forceps with claw.

-Short needle holder. -Pipe scissors.
-Adson dissection forceps with claw.
-Fine needle holders. -Wire cutter.
- Rake separator.
-Wire holder.
-Turnstiles.
 SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

Versión: 1
IQX-FT-003-BUC

2.2. Posición del paciente (Nombre y gráfico):

SUPINE POSITION

2.3. Ubicación del Equipo Quirúrgico (realizar gráfico):

 SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

Versión: 1
IQX-FT-003-BUC

3. ETAPA DE EJECUCION:

a) Anestesia (escribir el tipo de anestesia):

RTA: General anesthesia

b) Incisión (escribir el tipo de abordaje y el nombre de la incisión):

RTA: Sternotomy

c) Proceso Quirúrgico (Describir los pasos principales de la técnica médico quirúrgica con el instrumental a usar).

SURGICAL PROCEDURE INSTRUMENTAL

1.A double incision is made and hemostasis is 1. Scalpel handle #7 Scalpel blade #15 and
performed. Electroscalpel.
2.The entire scar is removed. 2. Electroscalpel and Dissecting forceps with claw.
3. The wire is removed from the sternum. 3. Farabeuf separators.
4. Hemostasis of the sternum is performed. 4. Electroscalpel.
5. The sternum and skin are separated. 5. Rake separator.
6. The cut of the sternum is made. 6. Oscillating saw.
7. Separation of adhesions is carried out. 7. Electroscalpel.
8. The separation of the sternum is performed with 8. Sternal Separator.
self-aesthetic fixation.
9.The correction of the injury caused by the saw to 9. Polipropileno 5/0 C-T1.
the heart is performed.
10. Continue separating the adhesions. 10. Electroscalpel and Metzenbaum scissors.
11. Perform pericardium separation. 11. Silk 0 con SH.
12. Repair of damage to the heart. 12. Poliglactina 910 0 con CT1.
13. We perform the placement of heparin. 13. 23,000 units of Heparin.
14. We make the arepas for cinnamon are arterial 14. Polipropileno 4/0 con pledget RB1and tourniquet.
and tourniquet.
15. We make the fins of the inferior vena cava. 15. Polipropileno 5/0 con RB1.
16. Tourniquet placement in the inferior vena cava 16. Tourniquet and Venous cannula #28..
and perform annulment of the inferior vena cava..
17. We perform the placement of the arterial meat. 17. EOPA cannula #20.
18. We transfer the pericardial patch to the table and 18. Saline solution.
let it rest.
19. We perform the earrings in the Superior vena 19. Polipropileno 5/0 con RB1.
cava.
20. We perform the tourniquet in the Superior vena 20. Malleable venous cannula #24.
cava and cancel it.
21. We make the purse for the cardiology cannula. 21. Polipropileno 4/0 con RB1.
22. We introduce the cardioplegia cannula into the 22. Cardioplegia cannula.
root of the aorta.
 SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

Versión: 1
IQX-FT-003-BUC

23. We perform total occlusion between the
cardioplegia cannula and the arterial cannula.
24. We make the cut in the pulmonary artery and
introduce the free cavity aspirator.
25. We place two repairs in the pulmonary artery.
26. We expanded the pulmonary artery incision.
27. Introducing the pulmonary valve gauge.
28. We ask the nurse for the Biological pulmonary
valve.
29. Placement of the pulmonary biological valve.
30. We fix the valve.
31. We place the pericardium in the pulmonary artery.
32. We place the pacemaker wire in the epicardium.
33. We place the Blake drain, one in each pleura and
the other in the mediastinum.
34. We repair injuries to the heart.
35. We open a contracture to remove Blake's drains.
36. Close up of cardioplegia cannula puncture in the
atrium.
37. We remove the venous cannulas and arterial
cannulas.
38. The separation points in the pericardium are
removed.
39. Hemostasis of the sternum and revision of the
cavity are performed.
40. Closure of the sternum is performed.
41. Closure of sternal fascia subcutaneous cellular
tissue.
42. Leather closure.
43. We perform healing.
23. Total arterial clan.
24. Scalpel handle #7 Scalpel blade #11 and cavity
aspirator.
25. Polipropileno 5/0 con RB1.
26. Scalpel handle #7 Scalpel blade #11.
27. Valve gauge #27.
28. Biological pulmonary valve Avalus #27.
29. Biological pulmonary valve Avalus #27.
30. Polipropileno 4/0 RB1.
31. Polipropileno 4/0 RB1.
32. Pacemaker wire 2/0.
33. Blake drain.
34. Polipropileno 5/0 RB1.
35. Scalpel handle #7 Scalpel blade #11.
36. Polipropileno 4/0 con Rb1.
37. Venous cannulas and arterial cannula.
38. Metzenbaum scissors.
39. Electrobisturi.
40. Surgical wire 6.
41. Poliglactina 910 0 con ct-1.
42. Monocryl 3/0 With needle 3/8.
43. Gauze, Tegaderm. Dermabon and leukomed.

FORMATO DE INFORME SEMANAL DE LA PRACTICA FORMATIVA

FORMATO RECORD DE ASISTENCIA A CIRUGIA - PRACTICA FORMATIVA
IQX-FT-024-UDES

FIRMA DOCENTE: __________________________

FIRMA ESTUDIANTE: ________________________