Cardiac surgery operating room preparation

Cardiac anesthetic, and C P B protocol to follow in the operating room. Let’s discuss the following in the cardiac operating room.

Before taking the patients

1. OT table to check-in regular manner, positioned, locked.
2. Blanket roll on and haemo-therm temperature set is rolled on the table, switched on.
3. Perfusionist, OR technician, anesthetist, surgeons should be in the OR complex.
4. Patients identified relevant investigation checked, blood availability from the blood bank.
5. Appropriate medicine airways equipment, cannulae present inside the OT
6. Ready BVM(AMBU), pacing machines with kit, emergency medicine trolley.
7. The Defibrillator checked and kept undercharging. Appropriate needs like electrode and jelly must be kept ready on the trolley.
8. Transport monitor and O2 cylinder checked and kept ready.
9. Theatre top lights,  diathermy, and other equipment kept ready under working conditions.
10. Generator/electric backup checked and kept ready.
11. Check whether temperature, humidity, pressure level normal needs for the theatre.
12. Check air conditioner, laminar airflow, and pressure relief dampers are working.
13. Availability of nitrous oxide cylinder, oxygen cylinder, air cylinder, and gas pipelines available or not.
14. OR cleaned with disinfectant solutions and equipment must be carbolized with recommended solutions.

Before intubation

Re-identify the patients

Ensure good ECG trace.

Recent investigation and images must be displayed eg.chest x-ray.

 Before starting the surgery

check the baseline ACT, ABG, SPO2, ST changes

Receive bypass tubing if required and ensure no air bubbles.

Check the central line and arterial line. check the patency.

Compare NIBP and IBP

Check the Fibrillation, and turn off

Check the sterilization indicator with the scrub nurse.

swab and instruments count taken and documented

check the diathermy settings and make sure that patient plate kept and intact

check the cardiotomy sucker if taken

autologous blood collection and blood from the blood bank for the need with blood group

Pre bypass procedures

check the anatomy

administer heparin

check ACT

check the air bubble in both arterial and venous lines.

empty the urine bag.

prepare vent site if required.

measure the pressure of various chambers of the heart.

perfusion checklist to be readout.

 

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