CABG

Question 1

Draping

Answer 1

Groin towel/tegaderm
Utility drape for each leg
Bottom drape
Towels and stockinettes for feet
Up top - utility drapes X3
Belly towel
Ioban
Top drape
Side drapes X2
Light handles

Question 2

Throw off

Answer 2

Bovie
Misty blower
Waste suction
Cell saver suction (cruvy yankauer)
Cardioplegia
Pump sucker (metal tip)
Bypass tubing (set up w/Jess)

Question 3

Open

Answer 3

10 blade
Lap pad
Bovie (75)
Wheatie
Army navy’s
Suction
Sternal saw
Gel foam/bone wax

*follow Dr with retractors and suction to pull up sternum and protect lungs

Question 4

Take down IMA

Answer 4

Set up rultract
Blue towel & 2 hemostats
Stack of rays
Long bovie tip (35)
Fine debakey (short/fine)
Moist lap on field
Small clips

Two large clips (orange)
Tenotomy tips up
Bovie
Bulldog on applier
Papaverine
Medium clip
Moist lap to wrap IMA

Remove rultract and change gloves
Re-gown and glove Dr Kwon

Question 5

Exposing heart

Answer 5

Thompson Morse retractor
Short bovie (35)
Short debakey
0 silk pop offs (4 forehand, 3 backhand)

Question 6

Cannulating “prep”

Answer 6

Aortic cannulation stitch:
3-0 RB1 single loaded
Hemostat on belly
Rumel (red) to FA
Cut off needle/ take driver w/needle
3-0RB1 double loaded
Rumel (clear) to FA
Hemostat on belly

Venous valuation suture:
3-0 SH single loaded
Blue rumel to FA
Hemostat on belly

Question 7

Cannulating

Answer 7

Aortic:
Metz
Cannula ( skinny first)
11 blade (fat cannula after blade)
0 silk on a passer X1
Tubing clamp
Bowl to catch blood
Heavy scissors to FA
0 silk pop off X2

Venous:
Metz tip down
Venous cannula
0 silk tie on a passer X2
Stylet back from Dr Kwon
Unclamp venous line and pass to Dr to connect

Question 8

Root vent placement

Answer 8

3-0 RB1 double loaded X1
Rumel
Hemostat on belly
Heavy scissor to FA Cut
Connect root vent tubing

Question 9

Vein graft prep

Answer 9

*Will ask for vein
Pass vein in bowl of hep saline
Lay white towel down
Hep saline syringe
Fine thing
11 blade
Fine thing
Forward Potts
Place back in bucket of hep saline

Question 10

Position heart

Answer 10

Heart net laid out on pt
Go around
Peon (calls it a Kelly)
Long debakey
Go around again

Question 11

Everybody ready to clamp?

Answer 11

Cross clamp
3 towel bump
Small towel clip
Slush

we are now cold

Dr Kwon will move heart net and clip w/towel clip (R) and hemostat (L)

Short debakey and curved mayo to cut heart net for exposure to distal target

Question 12

Distal anastomosis

Answer 12

Mammary/Distal forcep (curved)
15 blade
Pig sticker
Forward ports
Reverse Potts
Pass vein graft(carefully/fine thing at top)
7-0 BV1 on distal needle holder (short Castro) clamp other end w/tag set down so Dr Kwon can grab it

Lay white towel down when doing anastomosis

Needles back
Squirt hand when tying
Vein squirt (bloody syringes) X2 to check anastomosis

checking for bleeding/may need repair suture

Bulldog on applier
Distender = hep saline w/out tip

Distal forceps
Tenotomy tips down
Tacking stitch 6-0 BV1 single loaded
Forward Potts
Bulldog remover

Repeat for additional distals

Question 13

Appendage LAAE

Answer 13

Raytec
Bovie (long tip @ 25)
Hockey stick
Atriclip opened to field (wash in Vanco)
Atriclip to Dr Kwon

Question 14

Mammary

Answer 14

Cold laps & long debakey
Marker on hemostat
#15, pig, forward Potts, reverse Potts
Bulldog
Tenotomy
Forward Potts
7-0 BV1 w/tag on the end
Distal forceps
Squirt w/tips
Bulldog remover
6-0BV1 x2 tacking suture to tack mammary on both sides (single armed)

ask what size aortic punch to have opened to field

Question 15

Proximal

Answer 15

Switch to proximal forceps
#11, aortic punch, 6-0RB2 w/tag
(Check the punch to make sure donut is there)
O ring marker on mosquito to FA

wet hands when tying prolene

repeat as needed for more proximals

Insulin needle to de-air
Ask what size medistim to open

Medistim set up and lube

Question 16

Cross clamp coming off

Answer 16

warm fluids
Squirt w/tip

Ready to decannulate

Question 17

Decannulation: Venous

Answer 17

Venous line removed by Dr - take it and submerge fully in hep saline bucket:
Dr Kwon will say give it back = unclamp
Jess will say all good = reclaim and set tube under mayo stand

Venous cannulation site typically closed w/sutures that are already in place
Pass probe and put gel on towel

Question 18

Decannulation: root vent

Answer 18

Hemostat used to remove root vent
Squirt hands when tying
3-0 RB1 pledgeted comeback stitch
Free pledget to FA on mosquito

pump sucker off = remove pump sucker tip

Question 19

Decannulation: Aortic

Answer 19

Have lap pad to cover spray
Cannula removed > connect to pump sucker line
Tourniquets removed and squirt hands when tying suture
3-0 RB1 pledgeted comeback stitch and free pledget on mosquito to FA

Pacing lead to Dr Kwon
Pop off to FA

Question 20

Chest tubes

Answer 20

15, bovie, nurolon (on per chest tube)

Star end away from pt body
Bevel the non star end
Tonsil to pass and then alligator

Once tied, use a hemostat to clamp the end of nurolons and tuck under bovie towel

Question 21

Closing/Dressings

Answer 21

First count

2-0 SH vicryl to close pericardium
0 CT1 vicryl x3 to close xyphoid w/hemostat on the end of each
Place blue towel on field to cover tubes and stats
Steel wires w/Rubio and large wire twister
Make vanco paste and pass
Dr Kwon will pull wires to reapproximate the sternum >large wire twister to tighten
Wire cutter to FA, then small rubio
Rubio to Dr Kwon to lay down cut wire edge
Wheatie
Lube on towel for chest tubes
FA gets irrigation pitcher with 2 laps
Dry lap
1CTX vicryl to close w/bonnie
4-0 monocryl and adson brown w/teeth

Skin count

Drain sponge for each chest tube
Neck dressing
Sternum = glue and mesh