Smaller skin incision from sternal angle – if so, free up some soft tissue superiorly. Clear the pericardium of fat and layers using a dry swab after removing the thymus before opening the pericardium. Use scissors to open pericardium to get cleaner edges. Leave the right pleura closed till the end to avoid the lungs…
Category Archives: Skills
Right radial art line. Positioned with a roll under the rib cage and left arm above head with securing tape. Slightly rolled anteriorly. Strapped at the hip to the table. Soft roll between legs. Mark spine, nipple, scapular tip. Feel the rib spaces to note how horizontal or oblique they are, as neonates tend to…
There is no excerpt because this is a protected post.
Position to the top of the bed, towards the middle of the bed, maybe slightly to the right. (Head slightly down makes the vein bigger.) Shoulder roll to extend until chin is away. Head pointing to the left with ETT on the left. (If rotated too much to the left, then the lateral and medial…
Note the following on the existing VAD before scrubbing. Membrane up or Blood up? Inflow and outflow directions? Tubing Length – Measure tubing length including any connectors. Ensure it’s long enough for further device change but short enough it doesn’t cause problems when walking. Connector sizes. Where to clamp, where to reattach Heparin bolus 20-50u/kg…
Dissect out the aortic root, taking care to recognise the coronaries. Mobilise the MPA. Transect the aorta/aortotomy. Transect the main pulmonary artery with the suitable length. Visualise the valve leaflets, use a right-angle and bluntly puncture the RVOT free wall with the finger against the tip. Use fine scissors to cut the anterior wall. Use…
XC. Cardioplegia. Snare the SVC. Wait for the heart to arrest (or continue while snaring the IVC, opening RA fully, and PFO (with 11 blade or right angle to stretch) to vent). Stop cardioplegia, snare the IVC and open the RA. Once open, continue cardioplegia. Open the RA parallel to the AV groove. Table tilted…
Right lateral decubitus position with gamgee roll under right chest. Further gamgee over left face and between legs. Left arm over the head. Mark the tip of the scapula and the vertebral column. Place a small gamgee on the hip and affix a tape across the table over the hip. Prep and drape with ioban.…
Indications Progressive RV impairment or RV dilatation with severe PR; severe PS; Consider TV annuloplasty if TR dilated. Redo sternotomy – RV/RA may be dilated and stuck to sternum. Expose Aorta (sling), SVC (snare if TV), IVC, (snare if TV), MPA. Take care not to injure LAD as it passes behind the PA, or the…
Open the pericardium to the right, so a piece of pericardium may be harvested if needed later to augment the SVC-PA anastomosis. Place stay sutures as usual. Start with the aorta (mosquito) and place a sling. Free the adventitia from the aorto-pulmonary area on the RPA and the LPA. Mobilise the PAs enough to get…