N-Trivia
| Correction Of Scoliosis Posted: 01 Oct 2010 10:20 PM PDT 
 Correction of Scoliosis Definition - The insertion of various rods, frames, or other fixation devices that act as internal splints until the vertebrae involved in the curvature fuses, correcting deformity.
Discussion - Scoliosis is described as a lateral "S" or "C" deviation of the spine, which may include a rotation or deformity of the vertebrae. Scoliosis can be idiopathic or congenital, and may result from muscular or neurologic disease.
- Surgical treatment is usually performed when musculoskeletal and respiratory functions become compromised or for cosmetic purposes.
- Indications may also include an increase in spinal curvature in a growing child or pain from the curvature in adults, uncontrolled by conservative methods.
Positioning - Prone, on a Wilsom frame or chest bolsters with arms placed on armboards, angled to wand the head; hands pronated.
Packs/ Drapes - Laparotomy pack
- Sterile adhesive drape
- Extra drape sheets
- Towels
- Minor pack
Instrumentation - Laminectomy tray
- Kerrison and pituitary tray
- Spinal fixation device tray
- Steinman pins and protractors
- Self-retraining retractor
Supplies/ Equipment - Special frame; positioning aids
- Suction
- Fiberoptic headlight
- Cell saver
- Cast cart
- Basin set
- Blades
- Needle counter
- Bone wax
- Medications
- Solutions
- Closed drainage systems
Procedure Harrington Rod with Fusion - The appropriate incision is made, and the vertebral levels are identified.
- Muscular and ligamentous structures are denuded from the spinous processes laterally to the transverse processes on both sides before placement of the rods.
- Distractor hooks are placed on the concave side, and the distraction rod is then placed.
- Hooks for the compression rod are also applied.
- Large amounts of cortical and cancellous bone placed over the rods and the denuded area.
- Suction drains are placed and the wounds are closed.
Perioperaitve Nursing Considerations - The individual is placed in a posterior plaster shell or Rizer jacket for approximately 6 to 12 months or until fusion is solid.
- Have X-rays taken in the room.
- Check with blood bank for available units.
- Measure blood loss accurately.
- Have additional suction available if cell saver is not used.
image from adam.about.com Related posts: - Vasectomy
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| Percutaneous Transluminal Coronary Angioplasty Posted: 01 Oct 2010 10:09 PM PDT 
Definition - Percutaneous transluminal coronary angioplasty is used to treat coronary artery disease. It offers some patients a nonsurgical alternative to coronary artery bypass surgery.
Discussion - PTCA is performed for occlusion that decreased the artery lumen by 70% or greater.
- A tiny balloon catheter is used to dilate a coronary artery that has been narrowed by atherosclerotic plaque.
Positioning - Supine, with arms extended on armboards.
Packs/ Drapes - Cardiovascular pack
- Drape sheet
Instrumentation - Cardiac procedure tray
- Specialty tray
- Hemoclips
Supplies/ Equipment - Fluoroscopy
- Guide wire
- Cardioverter with internal paddles
- Cell-saver unit
- Heart-lung machine
- Hemodynamic monitoring lines
- Basin set
- Blades
- Beaver blade
- Assorted syringes and needles
- Asepto syringes
- Foley catheter
- Medications
- Solutions
- Heparinized saline
- Chest tube with Y-connector
- Sealed chest drainage unit
Procedure - After preparing and anesthesizing the catheter insertion site, the surgeon inserts a guide wire into the femoral artery by a percutaneous approach.
- The surgeon threads the catheter into the coronary artery with the help of fluoroscopy and confirms the lesion by angiography.
- The surgeon introduces a small double-lumen balloon-tiped catheter through the guide wire, positions it, and repeatedly inflates the balloon with normal saline solution and contrast medium.
- The duration of inflation and the amount of infusion may vary, depending on the severity of the patient's symptoms and myocardial ischemia.
- Several inflations with different balloon sizes may be necessary to expand the arterial wall.
- The expanding balloon compresses the atherosclerotic plaque against the arterial wall, expanding the arterial lumen.
- Quantitative measurements of the procedure's success are derived from pressure gradient measurement across the stenotic area of the artery.
- The surgeon then performs a repeat angiogram.
- After completing the procedure, the surgeon leaves the catheter in place to provide access in case coronary artery occlusion develops.
Perioperative Nursing Considerations - Aseptic surgical technique must be established and maintained during the insertion procedure.
- Confirm with the surgeon the type and length of the catheter to be used.
- An instrument count in not required; however, sponges and sharps are to be counted according to protocol.
Related posts: - Coronary Artery Bypass Grafting (CABG)
- How Coronary Artery Bypass Graft Surgery is Carried Out
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| Coronary Artery Bypass Grafting (CABG) Posted: 01 Oct 2010 10:01 PM PDT 
Definition - Coronary artery bypass grafting (CABG) circumvents an occluded coronary artery with an autogenous graft, thereby restoring blood flow to the myocardium.
Discussion - Intracardiac procedures will necessitate the use of cardiopulmonary bypass. To fully comprehend cardiac abnormalities and the function of extracorporeal perfusion, knowledge of the anatomy of the heart and the circulatory system is mandatory.
Position - Supine with arms extended on armboards.
Packs/ Drapes - Cardiovascular pack
- Adhesive incise drape sheet
- Extra drape sheet
Instrumentation - Cardiac procedure tray
- Sternal saw/ cord
- Specialty tray
- Vein harvesting tray
- Hemoclips
Supplies/ Equipment - Thermal blanket with control unit
- Cardioverter with internal paddles
- Cell-saver unit
- Heart-lung machine
- Mayfield overhead table
- Hemodynamic monitoring lines
- Basin set
- Large graduated pitcher
- Blades
- Beaver blade
- Assorted syringes and needles
- Asepto syringes
- Foley catheter
- Medications
- Solutions
- Heparinized saline
- Pacemaker wire with external pacemaker
- Chest tube with Y-connector
- Sealed chest drainage unit
Procedure - The patient is properly positioned, and a median sternotomy incision is performed.
- The internal mammary artery or segment of the greater saphenous vein is harvested and properly prepared for reimplantation.
- Cannulation for cardiopulmonary bypass is achieved.
- The aorta is occluded and the cardioplegia solution is infused.
- The occluded coronary artery is isolated and dilators may be inserted.
- The graft is anastomosed to the coronary artery and tested for leaks.
- Multiple grafts may be necessary, and are placed sequentially.
- The aortic cross-lamp is gradually released, and a portion of the aorta is then occluded.
- The grafts are measured, cut, and anastomosed to the aorta.
- The clamp on the aorta is removed.
- The grafts are again inspected for leaks. All sources of air bubble accumulation are vented.
- Cardiopulmonary bypass is discontinued.
- The wound is irrigated with warm normal saline, with or without antibiotics.
- Temporary pace maker electrodes are sewn to the heart.
- Chest tube are inserted and the wound is closed in a routine manner.
- The chest tubes are connected to a sealed drainage unit and suction is applied.
Perioperative Nursing Considerations - Circulating nurses and scrub personnel must be thoroughly familiar with the sequence of events and the routine of the surgeon since time is crucial.
- All instruments must be kept clean and free of tissue debris.
- Sterile iced saline slush should be available and transferred to the field in an aseptic manner before and during cardiopulmonary bypass.
- Once the patient is on the pump, urinary output is measured every 15 minutes, with amount and color noted.
- Warm saline solution is used during the closing sequence once the patient is off the pump.
- A separate tray of instruments for the vein harvesting may be requested.
- Communication with the family and significant others should be continual throughout the procedure.
- The circulating nurse should accompany the team to the postoperative unit.
Watch How Coronary Artery Bypass Graft Surgery is Carried Out Related posts: - How Coronary Artery Bypass Graft Surgery is Carried Out
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