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Clinical ProcedureStudent Name: Jazzeree ferrell Date: 1/30/2010Procedure Name (5pts): Right Carotid artery EndarterectomyAnesthesia type (5pts): Local anesthesia (The patient was awake)Medication (5pts): Bacitracin injection,Heparin 30,000 units in 0.9 NaCL 1000ml, Lidocaine Patient position (5pts): The patient was placed in the supine position with both arms tucked. Blankets were placed over the patient to keep the patient warm during surgery. A safety strap was placed over the patient to keep the patient from falling. A foam egg crate was placed under the heels of the feet and elbows of the patient.Prep boundaries (5pts): Towels were placed around the neck. This is to prevent the addition chloraprep solution from pooling under the neck. If this happens it can cause skin breakdown. The patient was prepped was then prepped from above the infra-auricular to the axilla. The axilla area was also prepped.Drapes (5pts): Four utility drapes are placed. Marking sure that the chin and ear lobe on the surgical site side would be exposed. An antimicrobial incision drape is placed over the area. A half drape is placed on the lower half of the patient, and a laparotomy drape is placed exposing the surgical site. Incision (5pts):A vertical incision is made using a #10 skin blade on a 3 knife handle.Instrument sets, supplies, suture, and any specialty equipment (5pts):Sponge Lap X- RayDressing Tegaderm (2)Dressing Non- AdherentMarker Skin UtilityCounter Needle MagHypo Needle10ml Syringe20ml SyringeElectrode Drape IobanSuture strip2-0 Suture3-0 Suture(3) 6-0 proleneSuture Silk 2-0Suture Silk 3-0ChloraprepUltrasound gelknife super 15degRed loop vesselblue loop vesselDrape Trib ancillaryDoppler boxESUSet MinorSet VascularRetractor CerebellarOperative Procedure (50pts):After performing scrub and donning a gown and gloves, a “Timeout” was performed to ensure that everybody was aware of the right surgical site and that we had the right patient in the operating room. After that was completed the surgeon then felt for a pulse to ensure the incision is made in the correct location. A vertical incision is made using a #10 blade.. The subq tissue was dissected using the bovie device, and a Weitlaner retractor is placed. The surgeon then used a Metzenbaum scissors and Debakey forceps to cut the soft tissue exposing the carotid artery and where it divides. The surgeon then used a right angle is used to pass umbilical tapes around the artery. This isolates the external, internal and common carotid arteries. The carotid bulb was injected with 1% lidocaine. 5,000 units Heparin was given for anticoagulation. After the heparin is given, the surgeon stopped and waited three minutes before clamping the arteries. Once the three minutes were over the internal, external and common carotids were clamped with vascular clamps and two angled Debakey clamps. The internal carotid artery is opened with a #11 blade, and the incision was widened with Potts scissors. An intravascular shunt was placed in the common carotid and internal carotid. This is done to ensure blood flow to the brain while the artery is clamped. Next plaque is removed. During the entire surgery the patient was asked to squeeze a toy during the operation to ensure no brain damage had occurred. The shunt in the vessel was marked a 3.0 silk tie. Which was placed around the shunt. The plaque is removed from the site using a Freer elevator. The arterial wall was irrigated with heparinized saline solution. Mills forceps were used to remove pieces of plaque from the arterial wall. The area was then swept with a wet Q-tip to remove any pieces of plaque that was remaining. A 7-0 prolene suture were used to tack open the vessel ensuring the edges of the vessel do not curl. This helps the surgeon to align the patch to close the vessel. The vessel was closed using a 1-6 cm bovine patch cut to size and a 5-0 prolene suture. The shunt was removed once the vessel was almost closed and the carotid arteries were allowed to back-bleed removing any air from the vessel. The vessel was closed and the suture was then tied down. A sponge is packed into the incision to provide pressure. The sponge was then removed and the surgeon checked to ensure that hemostasis has been reached. Closure begins and the surgical technologist and circulating nurse perform counts. The platysma muscle and subcutaneous layer are closed using a 2-0 monocryl suture. The skin is closed, using a 4-0 vicryl suture. Once the incision is closed a sterile dressing is placed.Postoperative Care (5pts): The patient was then transported to PACU. Patients typically stay in the hospital for one to two days who have had this surgery. Very often the patient can ambulate on the same day the surgery was performed. Complications (5pts): The main postoperative complication of this surgery would be CEA is stroke. Once the patient is awake, we check the patient to ensure there is no drooping of the face and they have no weakness on any side of their body. If it shows signs it may be signs of a stroke. During this surgery nerve damage also can occur. Nerve damage can cause difficulty swallowing or speaking. Controlling the patient’s blood pressure post surgery is also very important. A patient with high blood pressure has a higher risk for bleeding and a patient with low blood pressure is a risk for cerebral ischemia.