Operations at the heart wounds
Cardiovascular Diseases / / May 08, 2016
operations on the pericardium and heart
(method of operation)
1. Access. anterolateral thoracotomy in the fourth intercostal space is used more often than others, but for closing the wounds of the heart and use the right-thoracotomy and sternotomy.
2. pericardiotomy. When cardiac tamponade pericardium tense and distended with blood.His incised with a scalpel.For small amounts of blood in the pericardial cavity pericardiotomy produce long scissors.The pericardium dissected over 8-10 cm. The blood is collected in a jar with electric pumps sodium citrate or heparin.Loaded should be a system for the collection of blood.
If the wound penetrates into the cavity of the heart, of the pericardium is allocated a significant amount of blood.The surgeon presses a finger injury in the myocardium.Mikulicz clamps grab the edge of the pericardium dissected and assistants tighten them up, thus ensuring a certain fixation of the heart and decreases the depth of the wound.
3. Closure of the heart wound. myocardial wound sutured by separate U-shaped sutures.Small puncture wounds sutured Z-shaped suture.Needle holder must be 25 cm long, medium-sized round needle, thread or silk lavsanovaja length of 40 cm, №3-4.Before submitting the needle holder sister surgeon must itself check the thread tensile strength.If my sister had not done, and not examined carefully thread to detect pulping, then at the time of the thread through the myocardium, it can tear or bulge is formed, interfere with the thread through the fabric.An even greater danger is thread breakage during assembly or after tying operation, which may lead to re-bleeding wound from the heart.In case of rupture of the ligature during surgery accounts for re-flashing of the myocardium, it is highly undesirable since it can result in eruption of sutures.When sclerosis infarction may also occur teething seams.To prevent this complication of using Teflon graft gaskets or seals, through which carried out the thread and tie knots.
at all stages of the transaction sister should remain aware of the need to collect and preserve the patient's blood.The surgeon and his assistants, absorbed in performing the operation, and the stress occurring at a very fast pace, at certain moments can forget about it and remove the blood of electric pumps in non-sterile jar.To avoid this, you should at the very beginning of the operation to connect the electric pump with a large sterile jar and add sodium citrate as a blood accumulation.
4. Drainage of the pericardium. Given the possibility of accumulation of a certain amount of blood in the pericardium after surgery, pericardial drain.For drainage is necessary to prepare a soft, better than the silicone tube with side holes 5 mm in diameter.Drainage is output to the lowest point of the pericardial sac through a small incision and a separate fix to the pericardium catgut.Vnutriperikardialnuyu of the drainage stack on the rear wall of the heart.The wound was sutured pericardium rare nodal catgut sutures.Then straighten light by forced ventilation, pleural cavity is drained, and the wound is sutured the chest wall.After applying sterile dressings from the pleural cavity aspirated air through the drainage tube or syringe Janet suction with a small vacuum.