Here i present about how to manage patient who under going DVR surgery In this i included some topics like INTRODUCTION TO HEART VALVULAR DISEASES CAUSE OF HEART DISEASES & PREVENTION DIAGNOSIS & TREATMENT OPERATION THEATER PARAMETER OPERATION THEATER TEAM MEMBERS OPERATION THEATER SETUP TYPES OF VALVE VALVULAR SETUP PREPARATION ROOM INTRA OPERATIVE PROCESS IMPORTANCE OF OT DOCUMENTS RECOVERY ROOM DISCHARGE INSTRUCTION SUMMARY

1. PRESENTED BY
NILESH C PARMAR
OPERATION THEATRE MANAGER
MANAGEMENT FOR DVR SURGERY

2. (DOUBLE VALVE
REPAIR / REPLACEMENT)
MANAGEMENT OF THE
PATIENT’S UNDER
GOING
DVR SURGERY

3. PRESENTATION INCLUDES
PRESENTATION INCLUDES :
 INTRODUCTION TO HEART DISEASES
 CAUSE OF HEART DISEASES & PREVENTION
 DIAGNOSIS & TREATMENT
 OPERATION THEATRE PARAMETER
 OPERATION THEATRE TEAM MEMBERS
 ESTIMATE OF SURGERY & SCHEMES FOR
DIFFERENT CATEGORIES OF PATIENT
 OPERATION THEATRE SETUP
 TYPES OF VALVE
 VALVULAR SETUP
 PREPARATION ROOM
 INTRA OPERATIVE PROCESS
 IMPORTANCE OF OT DOCUMENTS

4. Cardio Vascular Diseases is also call Heart Diseases that
involve the heart, blood vessels (arteries, capillaries and
veins )
Cardio Vascular Disease refers to any disease that affects
the cardiovascular system, principally cardiac disease,
vascular diseases of the brain, kidney and peripheral
arterial disease.

5. FEW HEART DISEASES
Aneurysm
- Aneurysm
Blockage of coronary Arteries Regurgitation & Stenosis of Valve

6. TWO TYPES OF VALVE DISEASES
1 INSUFFICIENCY OF VALVE
2 STENOSIS OF VALVE

7. CAUSE OF HEART
DEASES
SMOKING
EATING TOBACCO
ADDICTED ALCOHOL
DIABETES
HYPER TENSION
PREVENTION
&
CARE
PROCEDURE
SURGERY

8. HEART disease can be
diagnosed by following
ways
1.ECG
2.2D-ECHO
3.TMT
4.STRESS TEST
5.If age is above 40
years then advice for
angiography

9. By Inflating The Balloon Inside The
Valve (Procedure is known as
Angiography)
Repair the valve By Operating it
If Valve Is Not Working Then
Replacement Of Valve

10. OT PARAMETERS TO BE
CONSIDERED :
-Theatre Design
- Layout
- Structure
- Ventilation

11. THEATRE DESIGN
Theatre Design Consideration:
 Non slippery floors
 Walls should not have corners
 HEPA filters or Laminar Air flow system is necessary
 Exhaust fans should be available
 Fully equipped operation theatre
PRPD/DN/DM/PON/09 11

12. LAYOUT (ZONES OF OPERATION THEATRE
CLEAN ZONE STERILE ZONE
HOD OFFICE ABG ROOM
STUDENT,
NURSE &
DOCTOR’S
ROOM
PREPARATION
AREA
CLEAN
ZONE
OPERATING
ROOMS CSSD
PHARMACY
STORE
INCHARGE
ROOM &
DOCTORS
ROOM
STERILE
ZONE

13. Structure :
STRUCTURE OF OPERATION THEATRE
Ideally located on First Floor
Other departments like Recovery Room, Pharmacy
Store & CSSD should be easily accessible
Feasible ways for exit in disastrous situations

14. VENTILATION
 Appropriate Ventilation Systems Aid In The
Control Of Infection By Minimizing
Microbial Contamination
 Temperatures In An Operating Room
Should Be Maintain 21°c ±3
 Each Operating Room Should Have
Individual Temperature Controls

15. OT TEAM MEMEBERS
SURGEON
ANESTHETIST
PERFUSIONIST
HOUSEKEEPING
& UTILITY
NURSE

16. PRE – OPERATIVE PROCESS IN WARD
 Conduct Nursing Assessment
 Preoperative Counseling About Surgery
 Psychological support given to patient & relatives
 Checking Fitness
 Taking Consents From Patient As Well As Their
Relatives
 Pre – Anesthesia Assessment
 Bitadin Bath In Ward
 NBM
 Complete all the Checklist
WHEN THE PATIENT IS ADMITTED IN
HOSPITAL FOR SURGERY

17. OPERATION THEATRE
SETUP

18. EQUIPMENTS AVAILABLE
INSIDE CTOT
ANESTHESIA
MACHINE
IABP
(INTRA
AORTIC
BALLOON
PUMP)
- HEART
LUNG
MACHINE
TEE
MACHINE
OT TABLE
- OT LIGHTS
- DEFIB
- CAUTERY
MACHINE
- AUTOLOGUS
MACHINE(CELL
SAVER)
- FLASH MAC.
- STERNUM SAW
- LIGHT SOURCE

19. Surgeons
pack
Anesthetist
pack
Nurse Pack
Perfusionist
Pack
Materials Provided By Pharmacy Store
Before Starting DVR Surgery

20. PREPARATION
OF TRAYS
-Mayo Trolley
-Instrument Trolley – 1
-Instrument Trolley – 2
-Anesthesia Trolley
DVR Instruments

21. MATERIALS,SURGICAL,INSTRUMENTS & OTHER RESOURCES
NECESSARY IN OT

22.  THE TROLLEY CONSISTS OF
VALVE INSTRUMENTS LIKE
- Long forceps
- Long Needle holder
- Long knife handle
- Valve cutting scissors
- Russian forceps
- Rongers
- Biopsy forcep
- LA retractor
TROLLEY
DISPOSABLE ITEMS LIKE
- Asepto syringe
- Cardiac shump
ALL CORONARY INSTRUMENTS
MAINLY
- castro
- zerald
- mitral hook
- clip applicator(medium & small)

23. TYPES OF VALVE
ATRIO –VENTRICULAR VALVE
 Tricuspid valve
 Bicuspid/Mitral Valve
SEMI LUNAR VALVE
 Aortic Valve
 Pulmonary Valve

24. MECHANICAL VALVES
 Star-Edwards
 Barnard-Goosen
 Lillehei-Kaster
 St. Jude Medical
 Bjork-Shiley
 Carbomedics
 ATS
TISSUE VALVES
 Homographs
 Hancock
 Perimount
 Porcine
 Pericardial
1) Mechanical valve like –
* St Jude Size
sizes (17,19,21,23,25) for Aorta
sizes (25,27,29,31,33) for Mitral
VALVULAR SETUP

25. Aorta sizes
(16,18,20,22,24) for
Mitral sizes
(19,21,23,25,27,29,31,33,35)
ATS
MEDICAL

26. - HANCOCK
sizes(19,21,23,25,27,29) for Aorta
sizes(25,27,29,31,33) for Mitral
PERIMOUNT
Sizes(19,21,23,25) for Aorta
sizes(25,27,29,31) for Mitral
BIO-PROSTHETIC VALVE

27.  Tricuspid and Mitral ring are available
Tricuspid ring like – Medtronic Duran Ancore
sizes from 23,25,27,29,31,33,35
RING

28.  Aortic , venous(metal tip & 2 stage), Retrograde & ante
grade cannula, metal & plastic ostial cannula are
available in different sizes.
CANNULAS

29.  Once heart is placed
on bypass, the valve to
be repaired or replaced
is inspected.
 Incase of repair, non
plegeted sutures of 2-0
ethibond are placed
VALVE REPAIR
In Mitral repair both carpentier edward
physio & medtronic 3D profile ring are
available.

30.  In case of replacement mechanical valve of
ATS & ST Jude are available
 For replacement Bio-prosthetic valve of
Perimount and Hancock are available
REPLACEMENT

32. PREPARATION ROOM
CHECKLIST
 Patient and Patient File Hanover
 Check ID Belt and ask his/her name
 Angiography CD, X-Ray
 Physical examination of the patient
 Check all consent
 Laboratory Investigation results
 NBM & Vital signs assessed
 Requirement of Blood
 Patient is wearing a gown and cap
 Jewelry removed
 Dentures removed
 Check shaving
 Insertion of Cannulation Arterial and venous lines by
anesthesiologist.
32

33. 33
SHIFTING PATIENT TO OPERATING ROOM

34. INTRA-OPERATIVE PROCESS
WHEN THE PATIENT TRANSFERRED TO
OPERATING ROOM
 Patient is shifted on OT table & the anesthetist
ensures that he/she feels comfortable.
ECG leads are placed on patients body for
monitoring vitals
Patient is induced by anesthetist
Skin cleansing with an alcohol swab
Painting & Draping is done by Scrub Nurse &
nurse ensures that patient is ready for the surgery.
Asepsis is maintained.

35. INTUBATION
35
ET Tube
inserted inside trachea
For the ventilation of
the patient
This insertion is done
by Anesthetist once the
patient is in OT
This process is known
as INTUBATION of the
patient Or else in other
words it is said that
patient is now induced
& ready for the surgical
process

36. CENTRAL VENOUS PRESSURE (
CVP )

37. PREPARING OT & PATIENT FOR DVR SURGERY
SKIN PREPARATION
. PAINTING DRAPING

38. THORACOTOMY
STERNOTOMY
VALVE SURGERIES CAN BE DONE IN 2 WAYS
1) MEDIAN STERONOTOMY 2 ) THOROCOTOMY

39. INCISION STERNOTOMY STERNOTOMY
DONE

40.  Once the sternum is opened with spreader,
pericardiotomy is done
PERICARDIOTOMY

41. PERFUSIONIST OPERATES HEART LUNG MACHINE
DURING SURGERY
The Heart Is Canulated Using Venous & Aortic Cannula

43.  Once the surgery is done all the instruments & disposable items used in the
surgery are counted by the scrub nurse & circulating nurse.
(ex – Mop-soft touch, needles., etc)
 After closing sternum steel Wiring is done.
 Later after completion of OT the items like Mop, Soft Touch, Needles,
R.Shods,Snugger,Mosquito are counted & written on the board.
COUNTING

44. BIO MEDICAL WASTE

45. IMPORTANCE OF OT DOCUMENTATION
IMPORTANCE (Especially
for DVR cases)
- The sticker of the valve
which has been placed
inside the patient is
sticked on the Discharge
card so that the patient &
their relatives can come to
know that which valve is
placed.
9 DOCUMENTS ARE ADDED IN
OPERTING ROOM
Operative Note
Form for anesthetist &
surgeon
Surgery safety checklist
Time out form
CMSO drugs list
Sponge count
Blood Transfusion ( BT )
form
Check list for cleaning of OT
Discharge card

46. WHEN THE SURGERY IS DONE PATIENT SHIFTED IN
RECOVERY ROOM

47. POST OPERATIVE X-RAY

48. BEFORE SURGERY AFTER SURGERY

49.  Follow Up For A Medical Appointment
 As Per Your Doctor Advice Check Up Your Blood Investigations
 PT & INR Test For ( Blood Thinner / Thick)
 Care Of The Incision
 Walk Slowly
 Clean Body & Operative Area
 Do Not Drive Vehicle Up To 6 Weeks ( 1 Months & 12 Days )
 Care About DIET
 Avoid Green Vegetable ( Exp Mathi , Palak , Kobich & Salad )
 Use Soft Tooth Brush & Slowly Clean Teeth
 Removal Of Stitches
 Spiromatry Exercise for Lungs Improvement
 Restrict Heavy Weight Lifting
49

50. SUMMARY
• Patient shift by staff Nurse & utility staff Handover
the patient & file documents
PATIENT SHIFT WARD TO OPERATING ROOM
• Taken handover of pt & file Pre-operative check list Insertion of
cannula by Anesthesiologist
PREPARATION ROOM
• Patient shift in operating room by staff nurse & utility staff
Before patient comes in operating room prepare all instrument
trays by scrub nurse, check all equipments are working
properly, anesthetist check circuit leakage, calibration of
machine & prepare drugs and assemble heart lung machine
by Perfusionist
OPERATING ROOM

51. PATIENT FLOW