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OR Observation

TEE, CABG, ARV

Angela McCue

10/26/2017

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Today I had the pleasure of observing a lengthy procedure that included TEE, CABG,

and AVR. When I got to the OR suite the patient was already there and intubated. The OR crew

was prepping him and also getting the OR set up so that the procedure could start.

I did not ask

why the patient was getting these procedures done however; most often times the reason for an

aortic valve replacement is required for someone who is experiencing stenosis and regurgitation.

CABG is also required when there is a blockage of the coronary arteries. In this case, the patient

only required one bypass. The signs and symptoms often experienced from blockage of these

arteries include: angina, SOB, fatigue, lightheadedness, sweating, indigestion, nausea, tightness

or heavy pressure in your chest, and palpitations.

The procedure is a lengthy one which

involves performing a TEE beforehand to assess the back of the heart for any abnormalities

which would cause the surgery to be cancelled. Then a vein from the leg is removed.

This vein

will be used for the bypass and has to be tested right then for leakage by insert water through it

and any holes are sutured closed. This vein is then set aside in some water until the surgeon has

the chest cracked and the heart exposed. At this point, the surgeon will then attach one side of

the vein and let it set aside until the valve is replaced. Attaching the other end of the bypass vein

is done at the very end before closing the chest wall.

The aortic valve replacement involves

removing the damaged valve and any damaged around the old valve. Once this is done, the

“hole” is measured using a specific tool made for valve sizes. The size needed should be tightly

fitted but not so tight that the valve will not work and it should not be loose so that it allows

blood to leak. Once the correct size or at least a size the surgeon feels comfortable using is

determined, the valve is sutured into place and is tested to make sure there are no leaks. After

ensuring that the valve works and no leaks are found, the surgeon then attaches the other end of

the bypass vein, tests the hearts’ pumping action by slowly turning off the perfusion machine and

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once satisfied, allows the heart to once again perform its function on its own. He then closes up

the chest cavity and the procedure is over.

I did not have much time to ask question since I walked into an already started procedure

but I can ascertain that pre-op prep included being NPO after midnight, having a patent IV site,

prophylaxis antibiotic right before surgery, IV fluids, patient being SAGE’d, and any morning

medications that the surgeon decided were necessary. Once in the OR suite the patient was once

again washed with chlorohexidine from head to toe, sites on the leg were marked for vein

retrieval, the patient was strapped to the table so as not to fall off, he was then covered in sterile

drapes, and internal thermometer was placed to make sure the body temp remained constant.

I’m sure there were other things done but I walked in late and missed a lot.

There were a lot of people in the OR suite. There were 3 anesthesiologist, 2

perfusionists, 2 Physician Assistants, 2 surgical techs (which were actually RN’s), 2 scrubs, 2

circulating RN’s (which were the “bosses” of the room), and 1 surgeon (who came in after the

bypass vein was retrieved). There was a lot of commotion with all those people in one tiny room

but they all were focused on their duties.

Communication prior to the surgeon coming into the

room was light hearted, casual, and focused. It was a little loud beforehand but once the surgeon

came into the room, everyone became quiet in their speaking and a lot of the time there was no

talking unless the surgeon asked a question or told a particular person to do something. When

the surgeon asked questions, the answers were short and precise. Often times, you would hear

the person repeat what the surgeon ordered them to do to ensure no miscommunication.

The

time for certain things was called out so it could be recorded by the circulating nurse.

The

different teams often communicated between themselves in a quiet and reserve manner and this

was done throughout all teams present.

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The surgical techs (RN’s) and the circulating nurses all played a part in protecting the

patient. The surgical techs ensured the patient was covered, cleaned, and safely bound to the

table so as not to fall.

The circulating nurse’s role was to document the whole procedure from

what tools were used, how many were used, what times different parts of the procedure started

and stopped, as well as calling for time outs to ensure this was the correct patient, allergies, and

what procedure was being done. The circulating nurse did this at the start of each of the 3

procedures that were being done.

The circulating nurse accompanied the patient to CCU and

gave a verbal hand off report that included, how long the procedure was, the type of procedure

done, medications used, allergies, and anything else pertinent for the CCU nurses to be aware of

in order to appropriately care for the patient. By doing all these things, the circulating nurse was

advocating for the patients safety during the procedure but for after care as well.