CVOR Scrubbing Processes Questions With 100% Correct Answers.

Putting in Chest Tubes - Answer-For all chest tube placement you will cut through skin with a 15 blade and bovie the incision. Then Max will pass one silk stitch per tube, and Matt and Jim will pass two silk stitches per tube. Once the stitches are in place have a snap or tonsil (depending on pt size) to help them pass the tube through the chest and skin. Once the clamp is through pass them the part of the tube that should be on the outside of the body. Max will then tie the one stitch around the tube and cut the tails. Matt and Jim will tie the first stitch around the tube and cut the tails. The second stitch they will wrap around the tube and secure with a steri-strip. Putting in Pacing Wires - Answer--They will often want to use a vein retractor to look at the area they will be going though to place the pacing wires. The dark blue wires are v-pacing and light blue for apacing. You will leave the curved needles on the v's unless the pt is very small and/or they ask you to cut them off. The a's you will almost always cut the curved needle off (if it's a large pt ask). When you remove the curved needle leave a cm of the wire to then fold the wire to create a hook. They will tell you which ones they will pass first. -If you are putting on v's be careful to pass the straight needles to the surgeon. They will place from inside the incision through the skin to the outside and make a lose knot with the wires together. Then you will pass a silk stitch for them to secure the lose knot to the skin. They will tie and cut the silk, break off the sharp tips of the straight needles and pass them to you. Then when they sew the curved needle to the heart the will do one shallow pass through the heart and with a wire cutter cut off the curved needle. They will often take two pick-ups after to fray the wire so it will stay. -If you are putting in a's be careful to pass the straight needles to the surgeon. They will place from inside the incision through the skin to the outside and make a lose knot with the wires together. Then you will pass a silk stitch for them to secure the lose knot to the skin. They will tie and cut the silk, break off the sharp tips of the straight needles and pass them to you. Then with a 6-0 prolene they will shallowly sew one of the little wire hooks to the heart. The assistant will help hold the little hook in place while the surgeon ties the prolene. Once they cut the prolene they will use the other half of it to sew on the second little wire hook. -If you need to start pacing remember the white cable Putting in Purse-Strings - Answer--A purse string stitch will most of the time be used to prepare for a cannula. This will often be used before the placement of Aortic, RA, SVC, IVC, LV vent, cardioplegia, and innominate cannulas (on the rare occasion apical cannulas for VAD placement, LSVC, etc). -When placing a purse string, you may use prolene or ethibond depending on where the purse string is going and surgeon preference. You will load the first needle and pass it to the surgeon, and thencarefully load the second needle of your same stitch to pass to the surgeon after they place half of the purse string with the first stitch. They will finish the rest of the purse string with the other half. Once the purse string has been placed then they will use the needle driver to hold the two needles and you will cut the needles off. Then the surgeon will hold out the strings of the purse string for you to place a tourniquet in which a snap or crile will follow to hold the tourniquet in place. Cannulation 1 vs 2-3 venous cannulas - Answer--After you've placed your aortic cannula if you have one straight venous, then that will be placed in the RA (this is usually your largest venous cannula) and you will not have a Y when dividing lines. -If you additionally have right angles or maleables then this will be for your SVC/IVC and there will be a Y when dividing lines. -If you only have one right angle/malleable that will go in either the SVC or IVC then they will often snake the straight cannula up or down (SVC/IVC) opposite the right angle/malleable. -If you have two right angles/maleables, then the larger will be for the IVC and the smaller the SVC. As you prepare to put in the IVC and SVC cannulas you will still go on bypass with your straight, then usually place your IVC cannula and then the SVC to follow. At this point your straight RA cannula and IVC will be hooked up to your Y. Once your SVC cannula is in place the straight RA cannula will be moved to your blue vent line and the SVC will take the place of the straight cannula on the Y. This is often the type of cannulation you will do if you are going inside the heart. The RA cannula is hooked to the vent to start decompressing the heart to prepare for you to go inside the heart after you cross clamp and give cardioplegia. Opening a Fresh Chest - Answer-Opening a fresh chest can go very quickly. They will make incision with a 15 blade and then bovie down to the sternum. Sometimes they will take a right angle to get under the xyphoid process prior to using the saw. When they ask for the lungs to go down, with the saw they'll go up the sternum from xyphoid process to manubrium. Occasionally they will use a straight mayo scissor to get through the last portion of the sternum. Then they will bovie the sternum a little bit, place the chest retractor, and then work on getting the thymus out of the way and opening the pericardium