Exposure Feel for the groove between the medial malleolus and tibialis anterior, just above the medial malleolus. Make a 1-2 inch incision in the line of the saphenous vein direction using the 22-blade. Use Mcindoe scissors to dissect and expose the vein. Insert the larger curved Mayo’s above the vein and create a tunnel travelling…
Category Archives: Skills
Thoracotomy may be described as posterior, postero-lateral, lateral, anterolateral and anterior. The patient is positioned on their contralateral side ensuring that the arm is flexed at the shoulder, drawing the scapula up the trunk is ‘broken’ at the subcostal margin with a sandbag and bent table. the knee and ankles are protected with jellybags to…
Fashioning the vein This is undertaken after checking for leaks, usually during initial cardioplegia delivery, or just before going on bypass. The proximal end of the vein is held between the left thumb and index finger. Cut the vein end obliquely to make a rhombus-hood using a Mcindoe scissors. Ensure the edges are clean off adventitia.…
Ingredients Mayo vein stripper 11-blade scalpel Artery forceps Ties Ligaclips Technique Make an incision in the groin to find the saphenous vein. Ligate the vein. The distal part of the graft is tied off with a long tie. Insert the tied off distal part into the lumen of the Mayo vein stripper. Push it…
Ingredients Sterile field – gown, gloves, swabs, drapes, povidone-iodine, wound kit with scissors, scalpel, forceps, swab clamp Local anaesthetic – syringe, large needle, small needle, LA agent Balloon – introducer needle, 11 scalpel, guide-wire, dilator(s), balloon Pressure trace – pressurised hepsal bag, long connector Pump – connector Securing – #1 suture, swabs, adherent dressing …
Preparing for bypass Before the operation Ensure cross-matched blood available for perfusionist, to prime pump if needed, for cardioplegia, for blood loss. Check imaging, planned procedure for anatomy that could complicate cannulation. Aortic: e.g. calcification/plaques, porcelain aorta, aneurysms, number of proximal graft anastomoses, aortic aneurysm/dissection surgery, Venous: type of venous cannulation (bicaval or atrial) Ensure…
Procedure The aortic adventitia is dissected with McIndoe’s scissors away from the proposed site of anastomosis. A side-clamp is applied to the ascending aorta, and its position fine-tuned with a Duvall clamp. A stab incision is made with a 15-blade scalpel and an aortotomy punch passed inside to make a circular hole. Any pieces of…
Procedure After haemostasis of the median sternotomy wound, apply an internal mammary retractor to elevate the left hemi-sternum. The pericardium may be left closed. Position the patient so the internal sternal edge is just above eye-level. This would mean raising the bed and rotating it away from the operator. The operator may be standing. A…
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.…
Procedure The landmark and ultrasound-guided techniques may be used to cannulate usually the right IJV. The patient is supine in a Trendelenburg position (head down) to distend the right IJV. With the head turned to the left, the IJV may be identified superiorly in the carotid triangle anterior to the anterior border of sternocleidomastoid muscle,…