CV & Thoracic Interventions Flashcards
Median sternotomy
Most common for cardiac procedures
Begins inferior to suprasternal notch and extends to below the xiphoid
Issues w/ t spine when retracting chest -> ribs get squished
Posterolateral thoracotomy
Easiest way to access lungs
Lower trap, serratus anterior, last divided
-pain, mobility and pulmonary issues
Used for:
-hemo or pneumo thorax
-pulmonary resections
Anterolateral thoracotomy
Incision from eternal edge to midaxillary at level of 4th/5th intercostal space
Affects pec muscles
L incision: cardiac tamponade, pericardial effusion
R incision: distal esophageal surgery, access to hilum, mitral valve repair
Axillary (Lateral) Thoracotomy
Used for:
-minimally invasive cardiac procedures and pericardial pacemaker placement
Shorter incision to be muscle sparing
Least amount of visibility, aids recovery
Subxiphoid
Pericardium or epicardium procedures
Below xiphoid to L clavicle
Small incision
Thoracoabdominal
Diaphragmatic procedures
Ribs and abdominals affected
VATS & RATS
Delicate handling and precision
Reduced LOS
Decreased blood loss
Lower incisional pain
Less negatively affected lung volumes
Early patient mobility
Decreased cytokine reaction to surgery (decrease heart attack risk)
Causes of perioperative morbidity/mortality
Respiratory complications:
-atelectasis, pneumothorax, pneumonia, respiratory failure
Prolonged air leaks
Cardiac complications:
-arrhythmias and ischemia
Therapeutic interventions after thoracotomy
Splinting for pain
Splinted for cough/sneeze technique
Incentive spirometer use (prevent atelectasis/pneumonia)
Functional mobility to enocurage chest expansion and airway clearance
Reduce atelectasis, pneumonia, VTE risk
Chest tube
Removes air, fluids, blood from pleural space
Prevent air/fluid from reentering pleural space
Reestablish intrapleural/intrapulmonary pressures after surgery/trauma
Inserted into mediastinum to drain fluid from pericardial sac
-cardiac tamponade or pericarditis)
Remove air: tube in top of lungs in pleural space
Remove fluid: tube placed lower
Circulatory support devices - pacemakers
Correct and maintain normal cardiac rhythm by emitting low energy electrical impulses via leads placed in heart
Cardiac defibrillators
Within pacemaker
Manage uncontrolled, life threatening, ventricular arrhythmia by defibrillating myocardium as needed
Intra-Aortic Balloon Pump (IABP)
Assist w/ circulation of blood
Reduces O2 consumption
Diastole: balloon inflated; pushes blood into ventricle (preload)
Systole: balloon deflated; less resistance to flow (after load), larger preload (increases CO and EF)
Percutaenous Ventricular Assist Device (PVAD)
Unloads filling ventricle to improve system perfusion to other organs
External (LVAD is implanted)
Restore adequate CO and help recover from LV failure or secondary organ dysfunction
ECMO
Management of cardiac/pulmonary failure
Takes blood out of femoral artery -> into pump -> pumped thru oxygenator -> return to femoral vein
Renal Dialysis
For acute/chronic kidney failure
Filter fluid/electrolytes
Correct imbalances caused by kidney failure
Traditional: blood out, process, put back in
Peritoneal: fluid/chemicals to help filter blood into abdomen and drained out
