Carotid Endarterectomy Flashcards
Exam 2
What is a Carotid Endarterectomy?
A surgical procedure to plaque from the Common Carotid and Internal Carotid Arteries
Why is Local Anesthesia sometimes used during a Carotid Endarterectomy?
If patient is at risk for a stroke
-Patient is not asleep so team is able to monitor for strokes
True or False: Carotid Endarterectomies are performed on vessels that are less than 100% occluded.
True
What is Reperfusion Syndrome?
When a Carotid vessel is 100% occluded, the brain gets used to lack of oxygen
-Revascularization could shock the brain
What is Patient Positioning for a Carotid Endarterectomy?
- Supine with Bilateral Arms tucked
- Neck extended (Head in Jelly Ring)
- Shoulder roll under Axilla
- Head turned away from operative side
What are the key instruments used in a Carotid Endarterectomy?
- Potts Scissors
- Gerald Forceps
- Vessel Loops
- Carotid Shunt
- Fogarty Hydragrip Clamp
- Profunda Clamp
How much of the patient’s skin is prepped for a Carotid Endarterectomy?
From Ear to Clavicle
True or False: The tip of the earlobe is covered when draping for a Carotid Endarterectomy?
False
-The tip of the earlobe is left exposed for orientation
Which type of drape is used for a Carotid Endarterectomy?
Thyroid drape
- With four sterile towels
- With two towels to “build up” the neck
Where is the skin incision made for a Carotid Endarterectomy?
Parallel to the anterior border of the Sternocleidomastoid
Which type of retractor is used when dissecting the SCM for a Carotid Endarterectomy?
Dull Weitlaners
Why do we ligate the Facial Vein for a Carotid Endarterectomy?
It runs right over the Carotid Bifurcation
Why must you avoid DeBakey manipulation of the Carotid Sinus during a Carotid Endarterectomy?
Patient can go into Bradycardia due to stimulation of the Aortic Baroreceptors
What structure must be avoided when dissecting the Carotid Sheath during a Carotid Endarterectomy?
Hypoglossal Nerve (CN XII) -Runs right over the Carotid Bifurcation
What is given to the patient to prevent blood clotting during a a Carotid Endarterectomy?
5000 mL of Heparin
What is Clamp Order for a Carotid Endarterectomy?
- Common Carotid Artery
- External Carotid Artery
- Internal Carotid Artery
Why is the Internal Carotid Artery the last one clamped during a Carotid Endarterectomy?
We want as much blood to reach the brain before we start
What do we use to make the initial incision for the arteriotomy during a Carotid Endarterectomy?
#11 blade -Continue incision with Potts Scissors
What instrument is used to separate the plaque from the artery during a Carotid Endarterectomy?
Freer elevator
What is the Shunt Order during a Carotid Endarterectomy?
- Internal Carotid Artery
2. Common Carotid Artery
What is the SA’s role in Carotid Artery Shunting during a Carotid Endarterectomy?
Control clamps and suction
What suture is used to tack floating plaques to arterial walls during Carotid Endarterectomies?
5-0 Prolene
What suture is used on the patch that covers the arteriotomy during a Carotid Endarterectomy?
5-0 Prolene (C1 Needle)
-Running stitch
What is the SA’s role while suture the patch over the arteriotomy during a Carotid Endarterectomy?
Follow the suture
What is the Shunt Removal Order during a Carotid Endarterectomy?
- Internal Carotid Artery
- External Carotid Artery
- Common Carotid Artery
What is the Unclamp Order during a Carotid Endarterectomy?
- External Carotid Artery
- Common Carotid Artery
- Internal Carotid Artery
Why must hemostasis be perfect during a Carotid Endarterectomy?
You don’t want a hematoma to form in the neck and depress the trachea causing airway issues
What is given to the patient to reverse the effects of Heparin?
50 mg of Protamine
What suture is used to close the Carotid Sheath during a Carotid Endarterectomy?
2-0 Vicryl (CT1 Needle)
-Running stitch
What suture is used to close the Dermis during a a Carotid Endarterectomy?
3-0 Vicryl (CT1 Needle)
-Running stitch
What suture is used to close the Skin during a Carotid Endarterectomy?
4-0 Monocryl (PS2 Needle)
-Intracuticular stitch
What dressings are used after a Carotid Endarterectomy?
- Steristrips
- 4x4s
- Tegaderm
Why must you avoid using Dermabond after a Carotid Endarterectomy?
To allow release of pressure from the wound
-You don’t want a hematoma forming in the neck
What is the SA’s role during Emergence (waking up) after a Carotid Endarterectomy?
Hold light pressure on neck
-Prevents patient from ripping suture in case of cough
What are the signs of stroke that are checked for after a Carotid Endarterectomy?
- Tongue deviation
- Hand strength
- Feet movement
- Speech
