Cardiac and Vascular Surgery ppt RPN Student Copy. 2023.pdf

Cardiac Surgery  Learning Outcomes ▪ Describe the anatomy of the heart. ▪ Explain basic procedural considerations for cardiac surgery. ▪ Describe the cardiopulmonary bypass machine, the purpose and location of the three main units and their corresponding cannulas. Heart Anatomy ...

Cardiac Surgery  Learning Outcomes ▪ Describe the anatomy of the heart. ▪ Explain basic procedural considerations for cardiac surgery. ▪ Describe the cardiopulmonary bypass machine, the purpose and location of the three main units and their corresponding cannulas. Heart Anatomy  Heart Anatomy ▪ Delivers ___________blood to the pulmonary system ▪ Propels ___________ blood into circulatory system ▪ Covered by pericardial sac ▪ Four Chambers – Right/Left atrium – Right/Left ventricle ▪ Four Valves – Tricuspid Valve – Pulmonary Valve – Mitral valve – Endocardium  Heart Anatomy ▪ Cardiac wall – Epicardium – Myocardium – Endocardium  Perioperative Nursing Considerations ▪ Anesthesia ▪ Position ▪ Count ▪ Instrumentation ▪ Blood replacement ▪ Solutions ▪ Sutures Perioperative Nursing Considerations Instrumentation  Perioperative Nursing Considerations ▪ Chest Drainage System – Inserted before chest closure – Pericardial cavity and mediastinum – Evacuates post-op blood  Cardiopulmonary Bypass (CPB) ▪ Temporary substitution of the heat and lungs by diverting blood ▪ Provides oxygen for the heart and lungs ▪ Allows surgeon to stop the heart ▪ Allows for heart manipulation without causing ventricular fibrillation and reduced cardiac output  CPBM Consists of 2 main functional units 1.._______________ 2. ________________ These remove oxygen deprived blood from the patient’s body and replaces it with oxygenated blood through a cannulation system Heat exchanger – warm and cools patients Filter – removes micro emboli and debris CPBM  Cardiopulmonary Bypass (CPB) ▪ Arterial cannula inserted in aorta – Returns oxygenated blood to circulatory system ▪ Venous cannula inserted in right atrium – Drains from IVC – Removes deoxygenated blood away from patient’s body ▪ Cardioplegia catheter inserted into the aorta – Delivers cardioplegia containing potassium and buffering agents to counteract ischemic acidosis – Cause the heart to stop beating Cannulas Arterial cannula CBPM  Cardiopulmonary Bypass (CPB) ▪ Venous Reservoir – Blood collection – Removes CO2 – Oxygenates blood – Warms or cools as needed  Cardiopulmonary Bypass (CPB) ▪ Weaning the patient off – Heart rewarmed and re-started spontaneously – Cardioplegia delivery ended – Aorta unclamped – Defibrillation to re-start heart if rewarming and other measures not sufficient  Surgical Interventions ▪ Aortocoronary Bypass (Coronary Artery Bypass Grafts) – CABG ▪ Valve Replacement/Repair  Aortocoronary Bypass (Coronary Artery Bypass Grafts) ▪ CABG ▪ Gold Standard treatment for Coronary Artery Disease (CAD) ▪ Often occurs after myocardial infarction ▪ Relieve angina and prolongs life ▪ Grafts or conduit used to circumvent the scarred stenotic CA’s  Grafts 1. Internal Mammary Artery (IMA) - LIMA or RIMA - Excellent patency 2. Saphenous Vein - Ideal when multiple grafts are needed 3. Radial Artery  Grafts LIMA (Left Internal Mammary Artery) → Grafting the Left Anterior Descending Coronary Artery → Results in a patent Left Internal Thoracic Artery (LITA) RIMA (Right Internal Mammary Artery) → Grafting the Right Coronary Artery Advantages: - Already attached to the aorta - Only one end needs to be grafted to the diseased CA - More durable long term Saphenous Vein Harvest  Valve Replacement / Repair ▪ Required for valve stenosis, preventing blood flow and return into ventricle ▪ Tricuspid, Pulmonary, Mitral, Aortic ▪ Valves can be artificial (bioprosthesis) or mechanical ▪ Mechanical valve require permanent post op anticoagulant therapy Vascular Surgery  Learning Outcomes ▪ Describe the anatomy of the vascular system ▪ Explain basic procedural considerations for vascular surgery  Vascular Anatomy ▪ Artery Thick walled Elastic vessels Constrict and contract Carry blood away from the heart Contains three layers Tunica intima (innermost layer) Tunica media (muscular layer) Tunica adventitia (fibrous outer layer)  Vascular Anatomy ▪ Vein – Thin Walled – Less elastic – Fragile and difficult to control bleeding – Valves prevent blood backflow – Fewer nerve fibers – Carries blood towards the heart  Perioperative Nursing Considerations Vascular Prosthesis ▪ Used for by pass procedures and reconstruction to re-establish arterial blood circulation ▪ Prosthetic graft – Allograft – Bovine pericardial patch commonly used ▪ Autogenous – From the patient – Commonly used is saphenous vein Instrumentation Fogarty Clamps  Perioperative Nursing Considerations Medications and Solutions ▪ Heparinized Saline – Anti-coagulant – Decreases clotting ability of blood intra-op ▪ Papavarine – Vasodilator and antispasmodic – Relaxes the blood vessels ▪ Contrast Dye – Used to visualize vessels under fluoroscopy  Surgical Interventions ▪ Abdominal Aortic Aneurysm Resection and Repair ▪ Endovascular Abdominal Aortic Aneurysm Repair ▪ Emergency Aneurysm Repair ▪ Femoral Popliteal Bypass ▪ Pacemaker Insertion ▪ Implantable Cadioverter Defibrillator (ICD) Insertion  Aneurysm ▪ Abnormal stretching/weakening of the wall of an artery caused by trauma, disease (arthrosclerosis), or birth abnormality  Abdominal Aortic Aneurysm (AAA) Resection and Repair ▪ Open repair ▪ Dissect and isolate aorta ▪ Clamp aorta proximal and distal ▪ Open aortic sac & clean out ▪ Tie off Lumbar arteries ▪ Size and sew in graft ▪ Close aortic sac around graft  Grafts Straight & bifurcated vascular grafts for aortic aneurysm repair  Endovascular Abdominal Aortic Aneurysm Repair (EVAR) ▪ Done under Xray/Image Intensifier ▪ Critically ill patients unable to undergo open repair ▪ Stent graft is delivered through the femoral/Iliac artery into the abdominal aorta and deployed ▪ Stents are self-expanding or balloon expanding once in the aorta Surgical Interventions  Emergency Aneurysm Repair ▪ Clamp the aorta as soon as possible ▪ Count may not be done ▪ Prepping and draping may occur while the patient is still awake ▪ Scrub nurse to have items ready: – 20 blade, loaded – Aortic Cross Clamp - Fogarty – Sponges – Suction  Aortic Cross Clamps ▪ Debakey Clamps ▪ Fogarty Clamps  Femoral Popliteal Bypass GOAL: Re-establish/improve blood flow to distal leg Cause: plaque build up in femoral artery Vein grafts have longevity but depend on the health of the artery – Prosthetic graft – Saphenous vein – In situ graft  Pacemaker Insertion ▪ Insertion of one or two electrodes into the heart chamber (RA +/- RV) – Atrial – Ventricular ▪ Helps control abnormal heart rhythms ▪ Pulse generator senses brady/tachy dysrhythmias ▪ Initiates atrial or ventricular contraction to resume normal heart rate Pacemaker  Implantable Cadioverter Defibrillator (ICD) Insertion ▪ An electronic device that monitors cardiac electrical activity ▪ Helps control life-threatening arrhythmias ▪ Delivers defibrillator shocks if _____________or fibrillation detected ▪ Capable of pacing and defibrillating ICD  References ▪ Rothrock, J. (2022). Alexander’s care of the patient in Surgery (17th ed.) Mosby Elsevier ▪ Tighe, S. (2015). Instrumentation for the Operating Room (9th ed.) Mosby. ▪ ORNAC Standards 2023 ▪ Spry, C. (2010) Essentials of Perioperative Nursing (4th ed.) Jones and Bartlett ▪ John Hopkins Medicine (2021)