PRESENTED BY NILESH C PARMAR OPERATION THEATRE MANAGER MANAGEMENT FOR DVR SURGERY

(DOUBLE VALVE REPAIR / REPLACEMENT) MANAGEMENT OF THE PATIENTS UNDER GOING DVR SURGERY

PRESENTATION INCLUDES PRESENTATION INCLUDES : INTRODUCTION TO HEART DISEASES CAUSE OF HEART DISEASES & PREVENTION DIAGNOSIS & TREATMENT OPERATION THEATRE PARAMETER OPERATION THEATRE TEAM MEMBERS ESTIMATE OF SURGERY & SCHEMES FOR DIFFERENT CATEGORIES OF PATIENT OPERATION THEATRE SETUP TYPES OF VALVE VALVULAR SETUP PREPARATION ROOM INTRA OPERATIVE PROCESS IMPORTANCE OF OT DOCUMENTS

Cardio Vascular Diseases is also call Heart Diseases that involve the heart, blood vessels (arteries, capillaries and veins ) Cardio Vascular Disease refers to any disease that affects the cardiovascular system, principally cardiac disease, vascular diseases of the brain, kidney and peripheral arterial disease.

FEW HEART DISEASES Aneurysm - Aneurysm Blockage of coronary Arteries Regurgitation & Stenosis of Valve

TWO TYPES OF VALVE DISEASES 1 INSUFFICIENCY OF VALVE 2 STENOSIS OF VALVE

CAUSE OF HEART DEASES SMOKING EATING TOBACCO ADDICTED ALCOHOL DIABETES HYPER TENSION PREVENTION & CARE PROCEDURE SURGERY

HEART disease can be diagnosed by following ways 1.ECG 2.2D-ECHO 3.TMT 4.STRESS TEST 5.If age is above 40 years then advice for angiography

By Inflating The Balloon Inside The Valve (Procedure is known as Angiography) Repair the valve By Operating it If Valve Is Not Working Then Replacement Of Valve

OT PARAMETERS TO BE CONSIDERED : -Theatre Design - Layout - Structure - Ventilation

THEATRE DESIGN Theatre Design Consideration: Non slippery floors Walls should not have corners HEPA filters or Laminar Air flow system is necessary Exhaust fans should be available Fully equipped operation theatre PRPD/DN/DM/PON/09 11

LAYOUT (ZONES OF OPERATION THEATRE CLEAN ZONE STERILE ZONE HOD OFFICE ABG ROOM STUDENT, NURSE & DOCTORS ROOM PREPARATION AREA CLEAN ZONE OPERATING ROOMS CSSD PHARMACY STORE INCHARGE ROOM & DOCTORS ROOM STERILE ZONE

Structure : STRUCTURE OF OPERATION THEATRE Ideally located on First Floor Other departments like Recovery Room, Pharmacy Store & CSSD should be easily accessible Feasible ways for exit in disastrous situations

VENTILATION Appropriate Ventilation Systems Aid In The Control Of Infection By Minimizing Microbial Contamination Temperatures In An Operating Room Should Be Maintain 21c 3 Each Operating Room Should Have Individual Temperature Controls

OT TEAM MEMEBERS SURGEON ANESTHETIST PERFUSIONIST HOUSEKEEPING & UTILITY NURSE

PRE OPERATIVE PROCESS IN WARD Conduct Nursing Assessment Preoperative Counseling About Surgery Psychological support given to patient & relatives Checking Fitness Taking Consents From Patient As Well As Their Relatives Pre Anesthesia Assessment Bitadin Bath In Ward NBM Complete all the Checklist WHEN THE PATIENT IS ADMITTED IN HOSPITAL FOR SURGERY

OPERATION THEATRE SETUP

EQUIPMENTS AVAILABLE INSIDE CTOT ANESTHESIA MACHINE IABP (INTRA AORTIC BALLOON PUMP) - HEART LUNG MACHINE TEE MACHINE OT TABLE - OT LIGHTS - DEFIB - CAUTERY MACHINE - AUTOLOGUS MACHINE(CELL SAVER) - FLASH MAC. - STERNUM SAW - LIGHT SOURCE

Surgeons pack Anesthetist pack Nurse Pack Perfusionist Pack Materials Provided By Pharmacy Store Before Starting DVR Surgery

PREPARATION OF TRAYS -Mayo Trolley -Instrument Trolley 1 -Instrument Trolley 2 -Anesthesia Trolley DVR Instruments

MATERIALS,SURGICAL,INSTRUMENTS & OTHER RESOURCES NECESSARY IN OT

THE TROLLEY CONSISTS OF VALVE INSTRUMENTS LIKE - Long forceps - Long Needle holder - Long knife handle - Valve cutting scissors - Russian forceps - Rongers - Biopsy forcep - LA retractor TROLLEY DISPOSABLE ITEMS LIKE - Asepto syringe - Cardiac shump ALL CORONARY INSTRUMENTS MAINLY - castro - zerald - mitral hook - clip applicator(medium & small)

TYPES OF VALVE ATRIO VENTRICULAR VALVE Tricuspid valve Bicuspid/Mitral Valve SEMI LUNAR VALVE Aortic Valve Pulmonary Valve

MECHANICAL VALVES Star-Edwards Barnard-Goosen Lillehei-Kaster St. Jude Medical Bjork-Shiley Carbomedics ATS TISSUE VALVES Homographs Hancock Perimount Porcine Pericardial 1) Mechanical valve like * St Jude Size sizes (17,19,21,23,25) for Aorta sizes (25,27,29,31,33) for Mitral VALVULAR SETUP

Aorta sizes (16,18,20,22,24) for Mitral sizes (19,21,23,25,27,29,31,33,35) ATS MEDICAL

- HANCOCK sizes(19,21,23,25,27,29) for Aorta sizes(25,27,29,31,33) for Mitral PERIMOUNT Sizes(19,21,23,25) for Aorta sizes(25,27,29,31) for Mitral BIO-PROSTHETIC VALVE

Tricuspid and Mitral ring are available Tricuspid ring like Medtronic Duran Ancore sizes from 23,25,27,29,31,33,35 RING

Aortic , venous(metal tip & 2 stage), Retrograde & ante grade cannula, metal & plastic ostial cannula are available in different sizes. CANNULAS

Once heart is placed on bypass, the valve to be repaired or replaced is inspected. Incase of repair, non plegeted sutures of 2-0 ethibond are placed VALVE REPAIR In Mitral repair both carpentier edward physio & medtronic 3D profile ring are available.

In case of replacement mechanical valve of ATS & ST Jude are available For replacement Bio-prosthetic valve of Perimount and Hancock are available REPLACEMENT

PREPARATION ROOM CHECKLIST Patient and Patient File Hanover Check ID Belt and ask his/her name Angiography CD, X-Ray Physical examination of the patient Check all consent Laboratory Investigation results NBM & Vital signs assessed Requirement of Blood Patient is wearing a gown and cap Jewelry removed Dentures removed Check shaving Insertion of Cannulation Arterial and venous lines by anesthesiologist. 32

33 SHIFTING PATIENT TO OPERATING ROOM

INTRA-OPERATIVE PROCESS WHEN THE PATIENT TRANSFERRED TO OPERATING ROOM Patient is shifted on OT table & the anesthetist ensures that he/she feels comfortable. ECG leads are placed on patients body for monitoring vitals Patient is induced by anesthetist Skin cleansing with an alcohol swab Painting & Draping is done by Scrub Nurse & nurse ensures that patient is ready for the surgery. Asepsis is maintained.

INTUBATION 35 ET Tube inserted inside trachea For the ventilation of the patient This insertion is done by Anesthetist once the patient is in OT This process is known as INTUBATION of the patient Or else in other words it is said that patient is now induced & ready for the surgical process

CENTRAL VENOUS PRESSURE ( CVP )

PREPARING OT & PATIENT FOR DVR SURGERY SKIN PREPARATION . PAINTING DRAPING

THORACOTOMY STERNOTOMY VALVE SURGERIES CAN BE DONE IN 2 WAYS 1) MEDIAN STERONOTOMY 2 ) THOROCOTOMY

INCISION STERNOTOMY STERNOTOMY DONE

Once the sternum is opened with spreader, pericardiotomy is done PERICARDIOTOMY

PERFUSIONIST OPERATES HEART LUNG MACHINE DURING SURGERY The Heart Is Canulated Using Venous & Aortic Cannula

Once the surgery is done all the instruments & disposable items used in the surgery are counted by the scrub nurse & circulating nurse. (ex Mop-soft touch, needles., etc) After closing sternum steel Wiring is done. Later after completion of OT the items like Mop, Soft Touch, Needles, R.Shods,Snugger,Mosquito are counted & written on the board. COUNTING

BIO MEDICAL WASTE

IMPORTANCE OF OT DOCUMENTATION IMPORTANCE (Especially for DVR cases) - The sticker of the valve which has been placed inside the patient is sticked on the Discharge card so that the patient & their relatives can come to know that which valve is placed. 9 DOCUMENTS ARE ADDED IN OPERTING ROOM Operative Note Form for anesthetist & surgeon Surgery safety checklist Time out form CMSO drugs list Sponge count Blood Transfusion ( BT ) form Check list for cleaning of OT Discharge card

WHEN THE SURGERY IS DONE PATIENT SHIFTED IN RECOVERY ROOM

POST OPERATIVE X-RAY

BEFORE SURGERY AFTER SURGERY

Follow Up For A Medical Appointment As Per Your Doctor Advice Check Up Your Blood Investigations PT & INR Test For ( Blood Thinner / Thick) Care Of The Incision Walk Slowly Clean Body & Operative Area Do Not Drive Vehicle Up To 6 Weeks ( 1 Months & 12 Days ) Care About DIET Avoid Green Vegetable ( Exp Mathi , Palak , Kobich & Salad ) Use Soft Tooth Brush & Slowly Clean Teeth Removal Of Stitches Spiromatry Exercise for Lungs Improvement Restrict Heavy Weight Lifting 49

SUMMARY Patient shift by staff Nurse & utility staff Handover the patient & file documents PATIENT SHIFT WARD TO OPERATING ROOM Taken handover of pt & file Pre-operative check list Insertion of cannula by Anesthesiologist PREPARATION ROOM Patient shift in operating room by staff nurse & utility staff Before patient comes in operating room prepare all instrument trays by scrub nurse, check all equipments are working properly, anesthetist check circuit leakage, calibration of machine & prepare drugs and assemble heart lung machine by Perfusionist OPERATING ROOM

PATIENT FLOW