CABG Flashcards
Draping
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
Throw off
Bovie
Misty blower
Waste suction
Cell saver suction (cruvy yankauer)
Cardioplegia
Pump sucker (metal tip)
Bypass tubing (set up w/Jess)
Open
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
Take down IMA
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
Bovie
Bulldog on applier
Papaverine and Fine/short forceps
Medium clip
Moist ray to wrap IMA
Remove rultract and change gloves
Re-gown and glove Dr Kwon
Exposing heart
Thompson Morse retractor
Short bovie (35)
Short debakey
0 silk pop offs (4 forehand, 3 backhand)
Cannulating “prep”
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
Cannulating
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
Root vent placement
3-0 RB1 double loaded X1
Rumel
Hemostat on belly
Heavy scissor to FA Cut
Connect root vent tubing
Hemostat??
Let’s go on
Curved mayo to cut white clamp thingy
Bovie to Dr Kwon
Flush plege
Vein graft prep
*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
Position heart
Heart net laid out on pt
Go around
Peon (calls it a Kelly)
Long debakey
Go around again
Everybody ready to clamp?
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
Distal anastomosis
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
Tag to FA
Forward Potts
Bulldog remover
Needle back from FA
Repeat for additional distals
Appendage LAAE
Raytec
Bovie (long tip @ 25)
Hockey stick
Atriclip opened to field (wash in Vanco)
Atriclip to Dr Kwon
Mammary
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
Proximal
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
Dr Kwon may splice a graft if he does not have a good proximal/aortic site to graft to, meaning he will do an end to side anastomosis of the vein graft to another vein graft rather than to the aorta. In this case he does not need a punch or the 15 blade; he can use the poker and Potts to prep the target site directly on a vein graft and then will still need a 6-0RB2 for the anastomosis
Cross clamp coming off
warm fluids
Needle for deairing
Squirt w/tip
Ready to decannulate
Decannulation: Venous
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..if not it would be a pledgeted SH 3-0 prolene for the oversew
Pass probe and put gel on towel for medistim before aortic decannulation
Decannulation: root vent
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
Decannulation: Aortic
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
Chest tube prep/placement
15, bovie, nurolon (on per chest tube)
Bevel the non star end
trim the 19s because they’re too long
Once tied, use a hemostat to clamp the end of nurolons and tuck under bovie towel
Once he asks for the chest tubes later, pass bevel end to field
Tonsil to pass/possibly alligator
Hold up tubes while Kwon and FA tie nurolon
Trim to the same length and connect to atrium
Closing/Dressings
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
Dry lap on field
Steel wires w/Rubio and large wire twister
Make vanco paste and pass
Dr Kwon will pull wires to reapproximate the sternum
Wire cutter to FA, then small rubio
Wire cutter once all 8 wires are placed
Place wheatie and dry lap on field
Rubio to Dr Kwon to lay down cut wire edge
Lube on towel for chest tubes
FA gets irrigation pitcher with 2 laps
Dry lap on field again
Bovie to 30 for Carlos
1CTX vicryl to close w/bonnie
4-0 monocryl and adson (brown for chad)
Skin count
Drain sponge for each chest tube
Neck dressing
Sternum = glue and mesh
