Cardiothoracic Manual for Perioperative Practitioners

481 Pages·2020·48.783 MB·English

Cardiothoracic Manual
for Perioperative Practitioners
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Cardiothoracic Manual
for Perioperative Practitioners
Editor: Dr Bhuvaneswari Krishnamoorthy
Sub-editors: Mrs Jean Hinton and Professor Nizar Yonan
All profits from this book will be donated to support the widening
of educational opportunities for low-income students.
Cardiothoracic Manual for Perioperative Practitioners
Dr Bhuvaneswari Krishnamoorthy
ISBN: 978-1-905539-48-2
First published 2020
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Notice
Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as
knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or
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be administered and verify the dosages and correct administration, as well as contraindications. It is the responsibility
of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment
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Contents
Foreword vii
Preface ix
Acknowledgements x
Contributors xi
Abbreviations xv
1 Healthcare professional roles within the operating room 1
Mrs Jean Hinton
2 Legal and ethical implications in the perioperative area 29
Mr Richard Thompson and Dr Bhuvaneswari Krishnamoorthy
3 Operating theatre preparation for cardiothoracic surgical procedures 43
Mrs Teresa Hardcastle and Mr Bibleraj Gnanasekaran
4 Cardiac and thoracic anatomy 57
Mr Andrew Brazier and Mrs Charlene Tennyson
5 Preoperative assessment in cardiothoracic surgery 87
Mr Mohamed Ahmed Ghazi Suliman and Mr Roberto Mosca
6 Coronary artery disease 105
Mr Vipin Mehta, Mrs AnneMarie Brunswicker
and Dr. Bhuvaneswari Krishnamoorthy
7 Aortic valve disease and aortic valve surgery 127
Mr Marcus Taylor and Mr Rajamiyer Venkateswaran
8 Mitral valve disease and mitral valve surgery 141
Mr James Barnard
9 Cardiopulmonary bypass 159
Dr Rob Bennett, Mr Simon Colah, Mrs Lindsay Mclean
and Mr Andrew Wallhead
10 Surgery for aortic root disease 193
Miss Caroline Toolan, Mr Omar Nawaytou and Professor Aung Oo
11 Thoracic surgery 217
Mr Asghar Nawaz, Mr Piotr Krysiak, Mr Rajesh Shah
and Dr Bhuvaneswari Krishnamoorthy
12 Cardiothoracic critical unit postoperative care 239
Dr Alan Ashworth and Dr Fiona Wallace
13 Responsibilities of the post anaesthetic care unit practitioners
and enhanced recovery 273
Mrs Denise Walker
14 Overview of advanced practice in cardiothoracic surgery 307
Mrs Linda Nesbitt
15 Congenital cardiac surgical procedures 333
Dr Georgios Kalarouziotis
16 Step by step cardiac surgical procedure with instrumentation 387
Dr Bhuvaneswari Krishnamoorthy and Mr Janesh Nair
17 Transcatheter aortic valve implantation 419
Dr. Anthony D Pisaniello
18 Transcatheter mitral valve implantation 443
Dr Mamta Buch
Index 455
vi
Foreword

This book is aimed at theatre practitioners, surgical first assistants, recovery practitioners,
operating department practitioners, surgical care practitioners, advanced nurse practitioners and
perfusionists, all of whom are vital members of the cardiothoracic multidisciplinary team. The book
lays down the foundations of underpinning knowledge required for the different cardiothoracic
perioperative practitioners’ roles. It also enables students and junior staff to explore the different
roles and responsibilities available to them in the field of cardiothoracic surgery.
Theatre staff used to be given a graduated training in the theatre environment in order
to meet the needs of surgeons and the different surgical procedures. Traditionally, students and
junior staff began with minor and intermediate surgical procedures, and then progressed to major
surgery to develop their skills appropriately. However, due to current pressures on healthcare
services, junior staff can now sometimes find themselves assisting with major and complex
cases. This can be challenging but training and education are key to alleviating their anxieties. In
addition, active participation increases surgical interest and gives junior staff more confidence in
acting as the patient’s advocate.
This book provides an excellent introduction to the ways in which healthcare professionals
can influence the perioperative environment and ensure it is fit for purpose. The relevant aspects
of anatomy, physiology and pathophysiology are included to support the reader in understanding
the context of certain surgical procedures. The book also gives the perioperative practitioner an
understanding of the development strategies and career opportunities available to them within
cardiothoracic surgery.
By navigating through the key aspects of the patient’s journey (from preoperative
assessment to postoperative recovery in intensive care and the ward, through to discharge),
the book adds value for the reader. It promotes the concept of holistic care, and highlights the
importance of multidisciplinary team working, at every stage of the patient’s journey.
This book is a valuable resource for the cardiothoracic community, encompassing all the
perioperative roles and informing the reader of the context and knowledge required to deliver
high-quality patient care. Patients remain at the forefront of our clinical practice. The content of
this book reflects the achievements of the last 25 years for the cardiothoracic multidisciplinary
surgical team. It is a marker of where we stand in 2020 on that journey.
Mr Simon Kendall President Elect SCTS GB&I
Mrs Tara Bartley OBE, Ex AHP lead for SCTS GB&I
Simon Kendall completed his medical training at the Middlesex Hospital Medical School in 1984
and trained in cardiothoracic surgery in Leeds, Manchester, Papworth and Oxford. In 1993 he
was appointed as a consultant at South Tees and has been one of the most productive UK cardiac
surgeons, treating over 6,500 patients. He has enjoyed a career focused on multi-professional
training, and has also served as the regional Training Programme Director and on the national
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Specialist Advisory Committee for Cardiothoracic Surgery. His commitment to the profession was
recognised in 2012 when he became the first UK surgeon to be presented with the European Da
Vinci Award for excellence in training. Since 2009, he has been an examiner for the Intercollegiate
Specialty Examination.
Tara Bartley is currently Corporate Advanced Clinical Practice Lead and Lead Advanced Nurse
Practitioner Cardiac Surgery, Brighton and Sussex University Hospitals NHS Trust and Western
Hospitals Foundation Trust. She also works as the Lead Advanced Nurse Practitioner, Cardiac
Surgery, at Queen Elizabeth Hospital, Birmingham. Tara received a Fellowship of the Royal College
of Nursing in 2011 and was made an Officer of the Order of the British Empire in the New Year’s
Honours List of 2014.
viii
Preface
Cardiothoracic surgery is constantly evolving and there are many textbooks available that help
to highlight new evidence and practice. However, most of these books are written for surgeons
and anaesthetists and many of them tend to omit important areas of surgical practice. This
book is aimed at all perioperative practitioners, including surgical care practitioners, surgical
cardiothoracic trainees, anaesthetic trainees, anaesthetic practitioners, recovery practitioners,
ward advanced nurse practitioners and perfusionists.
The contributors acknowledge that it is vital for any perioperative practitioner who wants
to start a career in cardiothoracic surgery to understand surgical procedures step by step. This
book therefore aims to cover all aspects of cardiothoracic surgery, with an emphasis on the
individual role played by each member of the theatre team. Details will be provided throughout,
including the initial theatre set-up and surgical instrumentation selection. A step-by-step walk-
through of routine surgical procedures, cardiopulmonary bypass guidance, investigations
undertaken during the intraoperative period and detailed surgical anatomy background will be
included. The book will also look at the recovery of the patient, as well as common pitfalls in
surgery and recovery and how these can be avoided. The structure and organisation of the
theatre environment, ethical and legal issues, preventive and protective measures and the
importance of swab counts will all be explained succinctly and systematically by experts in the
field, giving the reader reliable and complete guidance and preparing them to work efficiently
and effectively in the theatre environment.
All the chapters are written by experienced practising surgeons, anaesthetists and surgical
theatre practitioners, and the entire book is fully supported by references for further reading and
greater in-depth study.
ix