Ventricular Repair Periprocedural Care

Updated: Sep 12, 2017
  • Author: Jennifer Kanapicki, MD; Chief Editor: Dale K Mueller, MD  more...
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Periprocedural Care

Equipment

The thoracotomy tray should include the following:

  • Sterile preparatory tray
  • Scalpel, No. 10 or No. 20
  • Mayo or Metzenbaum scissors
  • Rib spreader
  • Tissue forceps (2)
  • Satinsky vascular clamps (2)
  • Lebsche knife
  • Hegar needle holders (3)
  • Nylon (3-0) or polypropylene (2-0) suture on a curved needle
  • Teflon pledgets
  • Suture scissors
  • Surgical stapler
  • Sterile towels
  • Sponges
  • Foley catheter
  • Chest tube
  • Towel clips
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Patient Preparation

Anesthesia

Always attend to the ABCs (airway, breathing, circulation), particularly in trauma patients. Ideally, intubate patients prior to thoracotomy or cardiorrhaphy. If that is not possible, intubate during the procedure. Administer general anesthesia using rapid sequence intubation protocols and postintubation sedation, analgesia, or paralysis. For more information, see Tracheal Intubation, Rapid Sequence Intubation and Tracheal Intubation, Medications.

Local anesthesia is not feasible and may cause life-threatening arrhythmias, as the maximum dose of lidocaine may be exceeded for a thoracotomy incision. Observe the patient for signs of pain or agitation (eg, tachycardia or tachypnea). Choose appropriate sedative and neuromuscular blocking agents to maintain both cardiovascular output and effective anesthesia.

Positioning

Place the patient in a supine position with the left anterior chest wall exposed. Place the patient’s left arm above the head, and place a rolled towel or sheet under the left side for optimal exposure and to ensure a wide incision.

Prepare the left anterior chest wall with povidone-iodine solution and sterile towels. Note, however, that preprocedural antiseptic skin preparation may be ineffective and may delay the procedure. [20]

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