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Natalee Bommer

10.28.2015
0700-1230
SEHY OR Experience
In my operating room experience at St. Elizabeth Hospital - Youngstown, I observed a 68 year
old patient undergo both mitral and aortic valve replacements with the use of a transesophageal
echocardiogram. The patient had a relatively normal BMI and no health problems other than
hyperlipidemia and stenosis of both valves. Dr. Henn was the surgeon for the procedure and replaced
the patient's mitral valve with a mechanical valve and the aortic valve with a bovine valve so it was
interesting to see both types used. I remarked to the nurses that the operating room where the procedure
was performed was the largest I had ever seen, which was necessary with all the high-tech equipment
and sterile supply tables that filled the room. There was a mishap with the patient's surgical paperwork
which made the surgery almost an hour late but transport finally brought the patient to the OR where
the OR team quickly began preparing the patient. First, anesthesia worked with the patient by inserting
a peripheral line into the patient's right arm, applying oxygen, and preparing the general anesthetic. The
resident doctor assisting Dr. Henn inserted an arterial line. Then, after general anesthetic was
adminstered, the registered nurses on the team inserted a foley catheter and began to disinfect and
drape the patient. I thought the Ioban 2 drape was interesting, applied to the patient's disinfected skin as
a final layer of sterility. A transesophageal echocardiogram scope was inserted to verify that valve
function was poor in the previously identified valves then the medical team floated a Swan-Ganz
cathether by entering through the patient's right femoral artery. After all the lines were inserted, the
medical team finally began their incision into the patient's thoracic cavity using cauterizing
instruments. They then connected the cardiopulmonary bypass pump to the patient's inferior vena cava
to draw away blood to the machine and connected the returning cannula to the patient's aorta. The
purpose of the cardiopulmonary bypass (CPB) machine is to perfuse the body's systemic tissues with
oxygen and electrolytes and cool the blood to maintain hypothermia, decreasing the body's demand for

oxygen. As a result of the cooled blood becoming viscous, crystalloid IV fluids are used to keep the
blood flowing properly. After the CPB machine was attached to the patient's circulatory system, the
medical staff finally began preparing the heart for a mitral valve insertion. After exposing and
removing the old mitral valve leaflets, a new mechanical valve was inserted with several sutures
tightened all at once. The heart then was returned to it's normal position for the bovine aortic valve
replacement, which was much easier to access than the mitral valve. Before insertion of the bovine
valve, a nurse washed it in two containers of sterile saline for one minute each to remove any
formaldehyde or preservatives the valve was stored in. She showed me the aortic valve up close and it
was amazing to see a real valve, whether human or bovine. The aortic valve suturing was done using
the same technique as the mitral valve replacement, then Dr. Henn and the perfusionists tested out the
new heart valves using the CPB machine. They filled the heart, got it back into a regular rhythm by
physically manipulating it, then observed it for some time before removing the patient's circulatory
system from the CPB machine and closing the patient's thoracic cavity. I was amazed by how rough the
doctors had to be with the sternum and surrounding tissue in order to close the cavity, pulling the
ribcage back together in tandem with metal wires and twisting them closed. After the surgery, we
transported the patient to the SICU and the patient was still under the effect of general anesthesia well
after I left the surgical area.
A potential ethical concern with open-heart surgery, namely a valve replacement surgery, is
working around religious beliefs when selecting what mechanical or biological materials to use for the
surgery. For example, a patient that is a Jehovah's Witness cannot accept any blood transfusions that
may need to be made during the surgery so other methods for perfusion must be explored. A Jewish
patient would not be able to accept a porcine biological valve or the heparin needed to anti-coagulate a
new mechanical valve so other options must be used. With all these religious considerations, what if an
unconscious patient of unknown religious identification needs an emergency coronary bypass surgery,
the family cannot be reached for informed consent, and the medical team violates the patient's religion

in the process of trying to save their life? Religion certainly brings up surgery-related ethical questions,
especially when one is working with transplants of several different sources.
With a coronary artery bypass surgery, nursing responsibilities include education about the
procedure pre- and post-operatively; pre-, intra-, and post-operative administration of narcotics; presurgical verification or a time-out of the patient and procedure to be performed; preparation of sterile
surgical supplies; setting up and maintaining the sterile field during the surgery, among other tasks.
Post-operatively, the nurse should confirm the presence of a patent airway, administer analgesia as
ordered, ensure correct function of chest tubes, obtain an ECG, obtain blood samples for post-operative
laboratory tests, obtain vital signs, and assess and monitor for complications.
Overall, I had a fantastic experience in the OR and I would certainly recommend this experience
for future students. There is nothing like getting to view a beating heart or a real heart valve before it is
inserted into a patient. As this may be one of the last surgeries I get to view as a nursing student, I
consider it a great last surgery experience.