Managment for dvr surgery
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Managment for dvr surgery

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Here i present about how to manage patient who under going DVR surgery ...

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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Managment for dvr surgery Managment for dvr surgery Presentation Transcript

  • PRESENTED BY NILESH C PARMAR OPERATION THEATRE MANAGER MANAGEMENT FOR DVR SURGERY
  • (DOUBLE VALVE REPAIR / REPLACEMENT) MANAGEMENT OF THE PATIENT’S 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 & DOCTOR’S 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 21°c ±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
  • PREPARATION OF TRAYS -Mayo Trolley -Instrument Trolley – 1 -Instrument Trolley – 2 -Anesthesia Trolley DVR Instruments
  • MATERIALS,SURGICAL,INSTRUMENTS & OTHER RESOURCES NECESSARY IN OT
  •  THE TROLLEY CONSISTS OF VALVE INSTRUMENTS LIKE - Long forceps - Long Needle holder - Long knife handle - Valve cutting scissors - Russian forceps - Rongers - Biopsy forcep - LA retractor TROLLEY DISPOSABLE ITEMS LIKE - Asepto syringe - Cardiac shump ALL CORONARY INSTRUMENTS MAINLY - castro - zerald - mitral hook - clip applicator(medium & small)
  • TYPES OF VALVE ATRIO –VENTRICULAR VALVE  Tricuspid valve  Bicuspid/Mitral Valve SEMI LUNAR VALVE  Aortic Valve  Pulmonary Valve
  • 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
  • PATIENT FLOW