Here i present about how to manage patient who under going DVR surgery In this i included some topics like INTRODUCTION TO HEART VALVULAR DISEASES CAUSE OF HEART DISEASES & PREVENTION DIAGNOSIS & TREATMENT OPERATION THEATER PARAMETER OPERATION THEATER TEAM MEMBERS OPERATION THEATER SETUP TYPES OF VALVE VALVULAR SETUP PREPARATION ROOM INTRA OPERATIVE PROCESS IMPORTANCE OF OT DOCUMENTS RECOVERY ROOM DISCHARGE INSTRUCTION SUMMARY
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PRESENTED BY NILESH C PARMAR OPERATION THEATRE MANAGER
MANAGEMENT FOR DVR SURGERY
(DOUBLE VALVE REPAIR / REPLACEMENT) MANAGEMENT OF THE PATIENTS
UNDER GOING DVR SURGERY
PRESENTATION INCLUDES PRESENTATION INCLUDES : INTRODUCTION TO
HEART DISEASES CAUSE OF HEART DISEASES & PREVENTION DIAGNOSIS
& TREATMENT OPERATION THEATRE PARAMETER OPERATION THEATRE TEAM
MEMBERS ESTIMATE OF SURGERY & SCHEMES FOR DIFFERENT CATEGORIES
OF PATIENT OPERATION THEATRE SETUP TYPES OF VALVE VALVULAR SETUP
PREPARATION ROOM INTRA OPERATIVE PROCESS IMPORTANCE OF OT
DOCUMENTS
Cardio Vascular Diseases is also call Heart Diseases that
involve the heart, blood vessels (arteries, capillaries and veins )
Cardio Vascular Disease refers to any disease that affects the
cardiovascular system, principally cardiac disease, vascular
diseases of the brain, kidney and peripheral arterial disease.
FEW HEART DISEASES Aneurysm - Aneurysm Blockage of coronary
Arteries Regurgitation & Stenosis of Valve
TWO TYPES OF VALVE DISEASES 1 INSUFFICIENCY OF VALVE 2 STENOSIS
OF VALVE
CAUSE OF HEART DEASES SMOKING EATING TOBACCO ADDICTED ALCOHOL
DIABETES HYPER TENSION PREVENTION & CARE PROCEDURE SURGERY
HEART disease can be diagnosed by following ways 1.ECG
2.2D-ECHO 3.TMT 4.STRESS TEST 5.If age is above 40 years then
advice for angiography
By Inflating The Balloon Inside The Valve (Procedure is known
as Angiography) Repair the valve By Operating it If Valve Is Not
Working Then Replacement Of Valve
OT PARAMETERS TO BE CONSIDERED : -Theatre Design - Layout -
Structure - Ventilation
THEATRE DESIGN Theatre Design Consideration: Non slippery
floors Walls should not have corners HEPA filters or Laminar Air
flow system is necessary Exhaust fans should be available Fully
equipped operation theatre PRPD/DN/DM/PON/09 11
LAYOUT (ZONES OF OPERATION THEATRE CLEAN ZONE STERILE ZONE HOD
OFFICE ABG ROOM STUDENT, NURSE & DOCTORS ROOM PREPARATION AREA
CLEAN ZONE OPERATING ROOMS CSSD PHARMACY STORE INCHARGE ROOM &
DOCTORS ROOM STERILE ZONE
Structure : STRUCTURE OF OPERATION THEATRE Ideally located on
First Floor Other departments like Recovery Room, Pharmacy Store
& CSSD should be easily accessible Feasible ways for exit in
disastrous situations
VENTILATION Appropriate Ventilation Systems Aid In The Control
Of Infection By Minimizing Microbial Contamination Temperatures In
An Operating Room Should Be Maintain 21c 3 Each Operating Room
Should Have Individual Temperature Controls
OT TEAM MEMEBERS SURGEON ANESTHETIST PERFUSIONIST HOUSEKEEPING
& UTILITY NURSE
PRE OPERATIVE PROCESS IN WARD Conduct Nursing Assessment
Preoperative Counseling About Surgery Psychological support given
to patient & relatives Checking Fitness Taking Consents From
Patient As Well As Their Relatives Pre Anesthesia Assessment
Bitadin Bath In Ward NBM Complete all the Checklist WHEN THE
PATIENT IS ADMITTED IN HOSPITAL FOR SURGERY
OPERATION THEATRE SETUP
EQUIPMENTS AVAILABLE INSIDE CTOT ANESTHESIA MACHINE IABP (INTRA
AORTIC BALLOON PUMP) - HEART LUNG MACHINE TEE MACHINE OT TABLE - OT
LIGHTS - DEFIB - CAUTERY MACHINE - AUTOLOGUS MACHINE(CELL SAVER) -
FLASH MAC. - STERNUM SAW - LIGHT SOURCE
Surgeons pack Anesthetist pack Nurse Pack Perfusionist Pack
Materials Provided By Pharmacy Store Before Starting DVR
Surgery
MECHANICAL VALVES Star-Edwards Barnard-Goosen Lillehei-Kaster
St. Jude Medical Bjork-Shiley Carbomedics ATS TISSUE VALVES
Homographs Hancock Perimount Porcine Pericardial 1) Mechanical
valve like * St Jude Size sizes (17,19,21,23,25) for Aorta sizes
(25,27,29,31,33) for Mitral VALVULAR SETUP
Aorta sizes (16,18,20,22,24) for Mitral sizes
(19,21,23,25,27,29,31,33,35) ATS MEDICAL
- HANCOCK sizes(19,21,23,25,27,29) for Aorta
sizes(25,27,29,31,33) for Mitral PERIMOUNT Sizes(19,21,23,25) for
Aorta sizes(25,27,29,31) for Mitral BIO-PROSTHETIC VALVE
Tricuspid and Mitral ring are available Tricuspid ring like
Medtronic Duran Ancore sizes from 23,25,27,29,31,33,35 RING
Aortic , venous(metal tip & 2 stage), Retrograde & ante
grade cannula, metal & plastic ostial cannula are available in
different sizes. CANNULAS
Once heart is placed on bypass, the valve to be repaired or
replaced is inspected. Incase of repair, non plegeted sutures of
2-0 ethibond are placed VALVE REPAIR In Mitral repair both
carpentier edward physio & medtronic 3D profile ring are
available.
In case of replacement mechanical valve of ATS & ST Jude
are available For replacement Bio-prosthetic valve of Perimount and
Hancock are available REPLACEMENT
PREPARATION ROOM CHECKLIST Patient and Patient File Hanover
Check ID Belt and ask his/her name Angiography CD, X-Ray Physical
examination of the patient Check all consent Laboratory
Investigation results NBM & Vital signs assessed Requirement of
Blood Patient is wearing a gown and cap Jewelry removed Dentures
removed Check shaving Insertion of Cannulation Arterial and venous
lines by anesthesiologist. 32
33 SHIFTING PATIENT TO OPERATING ROOM
INTRA-OPERATIVE PROCESS WHEN THE PATIENT TRANSFERRED TO
OPERATING ROOM Patient is shifted on OT table & the anesthetist
ensures that he/she feels comfortable. ECG leads are placed on
patients body for monitoring vitals Patient is induced by
anesthetist Skin cleansing with an alcohol swab Painting &
Draping is done by Scrub Nurse & nurse ensures that patient is
ready for the surgery. Asepsis is maintained.
INTUBATION 35 ET Tube inserted inside trachea For the
ventilation of the patient This insertion is done by Anesthetist
once the patient is in OT This process is known as INTUBATION of
the patient Or else in other words it is said that patient is now
induced & ready for the surgical process
CENTRAL VENOUS PRESSURE ( CVP )
PREPARING OT & PATIENT FOR DVR SURGERY SKIN PREPARATION .
PAINTING DRAPING
THORACOTOMY STERNOTOMY VALVE SURGERIES CAN BE DONE IN 2 WAYS 1)
MEDIAN STERONOTOMY 2 ) THOROCOTOMY
INCISION STERNOTOMY STERNOTOMY DONE
Once the sternum is opened with spreader, pericardiotomy is
done PERICARDIOTOMY
PERFUSIONIST OPERATES HEART LUNG MACHINE DURING SURGERY The
Heart Is Canulated Using Venous & Aortic Cannula
Once the surgery is done all the instruments & disposable
items used in the surgery are counted by the scrub nurse &
circulating nurse. (ex Mop-soft touch, needles., etc) After closing
sternum steel Wiring is done. Later after completion of OT the
items like Mop, Soft Touch, Needles, R.Shods,Snugger,Mosquito are
counted & written on the board. COUNTING
BIO MEDICAL WASTE
IMPORTANCE OF OT DOCUMENTATION IMPORTANCE (Especially for DVR
cases) - The sticker of the valve which has been placed inside the
patient is sticked on the Discharge card so that the patient &
their relatives can come to know that which valve is placed. 9
DOCUMENTS ARE ADDED IN OPERTING ROOM Operative Note Form for
anesthetist & surgeon Surgery safety checklist Time out form
CMSO drugs list Sponge count Blood Transfusion ( BT ) form Check
list for cleaning of OT Discharge card
WHEN THE SURGERY IS DONE PATIENT SHIFTED IN RECOVERY ROOM
POST OPERATIVE X-RAY
BEFORE SURGERY AFTER SURGERY
Follow Up For A Medical Appointment As Per Your Doctor Advice
Check Up Your Blood Investigations PT & INR Test For ( Blood
Thinner / Thick) Care Of The Incision Walk Slowly Clean Body &
Operative Area Do Not Drive Vehicle Up To 6 Weeks ( 1 Months &
12 Days ) Care About DIET Avoid Green Vegetable ( Exp Mathi , Palak
, Kobich & Salad ) Use Soft Tooth Brush & Slowly Clean
Teeth Removal Of Stitches Spiromatry Exercise for Lungs Improvement
Restrict Heavy Weight Lifting 49
SUMMARY Patient shift by staff Nurse & utility staff
Handover the patient & file documents PATIENT SHIFT WARD TO
OPERATING ROOM Taken handover of pt & file Pre-operative check
list Insertion of cannula by Anesthesiologist PREPARATION ROOM
Patient shift in operating room by staff nurse & utility staff
Before patient comes in operating room prepare all instrument trays
by scrub nurse, check all equipments are working properly,
anesthetist check circuit leakage, calibration of machine &
prepare drugs and assemble heart lung machine by Perfusionist
OPERATING ROOM