Cardiotomy Suction

Indications Maintain visibility in operative field Prevent distension of cardiac chambers Post-heparinisation suction device ‘Sucker bypass’ – if extreme haemorrhage, until venous cannulation is established Mechanism Suction driven by roller pump. The position adjusted by surgeon and flow rate adjusted by perfusionist to keep pressure as low as needed to prevent injury to blood and

Suction in cardiac surgery

Devices Cardiotomy x 2: ‘Blue’, ‘Clear’ Cardiac Vent x 1: ‘Green’ Cell Salvage (ICS) x 1 Wall/generic suction Suction tips Plastic vs. Metal Yankauer vs  Coronary/small Principles On CPB, Cardiotomy suction to catch all bleeding except: Topical cooling solution – can cause haemodilution Low visibility – use ICS, if not adequate, use wall sucker as well Debris (e.g. irrigation of

Surgical chest drain

Procedure The patient is positioned sitting at 45 degrees, and hands above head to retract scapula. Scrub up (wash hands, hat, mask, gown, sterile gloves) Identify the triangle of safety: anteriorly the lateral border of pectoralis major, posteriorly the lateral border of latissimus dorsi and inferiorly the superior border of the 5th or 6th rib.

Lines – Arterial cannulation

Instruments Positioning – bandage roll, tape Local anaesthesia – 5ml syringe, lidocaine 1%, alcohol wipe Aseptic technique – mask, sterile gloves, hat, gown, chlorhexidine prepping sponges x3, fenestrated drape, sterile swabs Arterial cannula – with needle+cannula or needle+guide-wire, (2ml syringe) Heparinised saline – 10-20 mls, in a syringe. Security – silk suture+straight needle, scissors, adhesive

Setup – Prep and Drape

Procedure Before prep Ensure their chest and whole legs are shaved including the groin. Ensure patient is supine, and the pelvis and the shoulders are square from the end of the table. The urethral catheter is taken under the thighs and hung on the side. If the patient has an intra-aortic balloon pump, ensure it

Surgical tracheostomy

Instruments Scalpels with holders – sizes 11, 20 Swabs Forceps – toothed and non-toothed Needle-holder Diathermy – monopolar/bipolar, 8 Retractors – self-retaining (West), Langenbeck Sutures – absorbable 2-0, non-absorbable for skin Tape for securing tracheostomy tube Tracheostomy tube and connector Suction – Yankauer, Frazier Procedure Patient is supine with sandbags under shoulders to extend neck.

Setup – Median sternotomy close

Instruments Retractors – sternal, double hooks Diathermy – monopolar, setting 7 Swabs – large and small Suction – Yankauer Forceps – toothed, non-toothed Artery forceps – Kocher’s Wire-cutter Needle-holder – heavy for wires and wire-twisting, other for skin Sutures – steel wire for sternum, absorbable for skin Procedure Haemostasis in the pericardial cavity is achieved