Cardiovascular & Thoracic Intervention - CH13 PPT Flashcards
most common form of thoracotomy surgery
posterolateral thoracotomy
what are most cardiac procedures typically performed through
median sternotomy of varying length
what are most pericardium / epicardium procedures typically performed through
subxiphoid incision
what are diaphragmatic procedures most commonly performed through
lateral thoracotomy
or
thoracoabdominal incision
explain therapeutic implications for a patient that has had a posterolateral thoracotomy
trapezius, rhomboid major, teres major, lat and seratus anterior are all cut through and sewn together
- will have to rehab these muscles as well as the cardiopulmonary system
early therapeutic interventions post-thoracotomy
splinting for pain
splinted cough technique
incentive spirometer
functional mobility
what does functional mobility do for pts post-thoracotomy
encourages chest expansion
airway clearance
– reduces risl of atelectasis, pneumonia and venous thromboembolism
explain the incision associated with an anterolateral thoracotomy
from sternal edge
to
midaxillary line at 4th/5th intercostal space in a curve
what muscles are affected in an anterolateral thoracotomy incision
trapezius
serratus anterior
latissimus dorsi
what would a left sided anterolateral thoracotomy be to treat
cardiac tamponade
descending thoracic aorta repair
pericardial effusion
left pneumonectomy / small resection of left lung
what would a right sided anterolateral thoracotomy be to treat
right pneumonectomy / resection of lung
distal esophageal surgeries
access to hilum
mitral valve replacement/repair
explain the incision related to an axillary (lateral) thoracotomy
shorter incision that is either horizontal or vertical
will spare chest/shoulder muscles
advantages and disadvantages of axillary thoracotomy
ad - minimizes change in pulmonary function and mobility which aids recovery
disad - least amount of visibility for surgeon
what is the indication for an axillary thoracotomy
minimally invasive cardiac procedures
epicardial pacemaker placement
explain the incision of a median sternotomy
inferior to suprasternal notch and extend down midline of sternum below xiphoid
sternal retractor divides sternum fully and holds incision open
what is a VATS
video-assisted thorascopic surgery
- minimally invasive cardiothoracic surgery
what is a VATS done for
lung cancer
pleural issues
esophageal / abdominal issues
what is a RATS
robotic assisted thoracoscopic surgery
- robot used for 3D visibility and greater movement in surgical arms
advantage of VATS
greater precision
reduced length of stay
decreased blood loss
lower incisional pain
less pulmonary involvement post-sx
earlier mobility
decreased inflammatory cytokine reaction
what is an alternative to lung volume reduction surgery (LVRS)
endoscopy through various bronchoscopic lung volume reduction procedures
what is an endobronchial coil
coil within the alveoli that improves inspiration and expiration by assisting in the opening of them
what are chest tubes inserted for
evacuation of fluid or air that could impede breathing or collapse a lung
in relation to the ribs, where is a chest tube placed?
between two ribs
at the uppermost part of the lower of the 2 ribs
how does chest tube attachment progress
typically attached to the wall initially
progressed to gravity only as air leak reduces/drainage amount subsides
