its official # tomorrow I am watching.. - Page 2 - U2 Feedback

Go Back   U2 Feedback > Lypton Village > It's Official... > It's Official Archive
Click Here to Login
 
 
Thread Tools Search this Thread Display Modes
 
Old 11-14-2003, 11:47 AM   #21
BAW
The Flower
 
BAW's Avatar
 
Join Date: Dec 2001
Location: The OC....!!!!
Posts: 11,095
Local Time: 09:01 PM
Yes, please do DiGi...I'm VERY interested
__________________

BAW is offline  
Old 11-14-2003, 11:48 AM   #22
Sizzlin' Sicilian
Forum Administrator
 
Sicy's Avatar
 
Join Date: Jan 2001
Location: Bay Area, CA
Posts: 71,046
Local Time: 08:01 PM
Wow.....
__________________

__________________
Sicy is offline  
Old 11-14-2003, 12:00 PM   #23
Blue Crack Addict
 
Laura M's Avatar
 
Join Date: Jun 2002
Posts: 18,934
Local Time: 05:01 AM
Before I got my tonsils out my cousin came to visit me
He is a surgeon and well he thought it would be a great idea to tell an 11 year old kid what exactly the operation involved - I cried sore the whole night and didnt want to go to hospital - I was dragged from my room and wouldnt talk to the doctors I clung to my dad until I fell asleep - I wasnt terrified until my cousin told me anything
Well I was on the emergency list to get them out and my mum and dad only told me the night before when my cousin comes to visit.
I think it would be fascinating to watch surgery now though in real life
Laura M is offline  
Old 11-14-2003, 12:19 PM   #24
Rock n' Roll Doggie
 
dizzy's Avatar
 
Join Date: Oct 2001
Location: San Francisco, CA
Posts: 3,247
Local Time: 12:01 AM
Re: its official # tomorrow I am watching..

Quote:
Originally posted by DiGi
cardiac open heart surgery.
I used to watch those things on TV when I was little. I can't anymore.
dizzy is offline  
Old 11-16-2003, 02:13 PM   #25
New Yorker
 
DiGi's Avatar
 
Join Date: Nov 2001
Location: the mountains of southwest VA
Posts: 2,818
Local Time: 12:01 AM
BAW - here you go. I hope my description does not cross any lines I should not. If I do I appologize in advance.

Definitions:
Artery – vessel that carries oxygenated blood
Vein – vessel that carries deoxygenated blood
Aorta – artery coming off the heart moving blood into the other arteries in the body.
Right Ventricle – receives deoxygenated blood from the inferior and superior vena cava. All blood returning from the body enters the vena cava and then enters the heart here
Coronary Artery – artery supplying oxygenated blood to the heart muscle itself. Heart muscle does not actually receive blood from the blood “inside” the heart itself
Saphenous Vein – major vein in the medial or inside portion of the leg that runs the entire length of the leg.
Stenosis – Narrowing of a valve or artery. In the case of this surgery it is a narrowing of the artery due to a blockage of plaque buildup.
CABG – Procedure to fix the Stenosis, or blockage in the artery, by using veins or arteries from other sites in the body to “bypass” the blocked artery and supply more blood flow to the heart.

Images and Guides:


1. Right Coronary
2. Left Anterior Descending
4. Superior Vena Cava
5. Inferior Vena Cava
6. Aorta
9. Right Atrium
10. Right Ventricle
11. Left Atrium
12. Left Ventricle

Saphenous Vein:


Procedure Description:
The procedure was a quadruple Coronary Artery Bypass Grafting (CABG, pronounced “cabbage”), meaning the patient received 4 bypasses. 3 of the Coronary Artery and 1 bypass of the Left Anterior Descending Artery. When the others in the group and I arrived at the observation room, the surgical team had prepped the patient for the procedure, this included shaving any hair on the legs and chest, covering the body with Betadine, this is the orange looking topical solution that I am sure most of you have seen, usually used to prevent against infection in cuts, etc. The body had also been wrapped in a protective covering (I do not remember what this was called) and the sterile fields had all been set up. The patient had also been put to sleep by the anesthesiologist. We did not see these parts so it would be more private for the patient.

When the others and I watching the surgery entered the observation room, the surgical team was ready to get started. The main surgical team included the Surgeon, the RNFA’s (registered nurse first assistant), the Anesthesiologist, the CRNA (the nurse anesthestist), the perfusionist, another scrub nurse or two and a few roaming nurses. Prior to starting the procedure the team counts everything that will be used in the surgery, needles, gauze, etc. All items have to be accounted for before closing the patient. All gauze and towels used to soak up blood when discarded where eventually placed in a hanging holder, which looked like a hanging shoe rack with plastic pockets. Each pocket would hold one towel, piece of gauze, etc.

First thing that was done in the procedure was that the RNFA (this person is a registered nurse, with further schooling, certification and scrub time) starts to harvest the Saphenous Vein out of the leg; the left leg was used on this patient. The RNFA made an incision starting at the ankle and eventually finished up at about the groin. The steps to do this were not just a long incision and pulling the vessel out. A short incision is made; the skin is cut and pulled back, then a pencil like device carrying an electrical current would be used on the surrounding vessels to stop loss of blood. Because this device was used the patient is grounded before the procedure commences. When the end of the Saphenous vein closest to the ankle is completely harvested a small catheter like plug is placed on the end of the vein. This cap is placed on the vessel, so the surgical team always knows which end is the far end. Veins have valves which move blood back up through the body, when these vessels are used the bypass; the valves have to be pointed so they are not obstructing blood flow. The tip placed on the vein allows the surgical team to remain aware of direction; as well, allowing them to push saline through the vein as it is harvested to make sure there is no damage to the vessel. After a small amount of the vein is out, she moved a few more inches up the leg, cutting a small amount, pulling tissue back, then harvesting the vein. This was repeated over and over.

In conjunction with the Saphenous vein harvesting the surgeon has scrubbed in and is about to start work on the thoracic cavity. At this point the leg is opened up and a little bit of the Saphenous Vein has been harvested, the RNFA and the surgeon are working on both parts now at the same time. The surgeon first makes an incision in the skin down the midline; this incision is the length of the majority of the Thoracic cavity. Another electrical pen is used to stop bleeding here as well. At times, when this piece of equipment is being used you can actually see some smoke coming off the patient where the vessels are being closed. Then layers of fat are cut through and pulled back until the surgeon and another RNFA (assisting the surgeon) come to the Sternum (breast bone). Now the Surgeon takes a small handsaw to cut through the Sternum, The saw enters up near the neck and the cut is made going away from the head. Once the ribs were separated the next phase involved separating the ribs and attaining access to the heart. Various retracting devices where used through out the procedure to keep the area open. The ribs are not completely opened up like some people believe, the space is large enough to get a hand in, the ribs however are not pulled all the way back to the table by any means.

Once access to the heart has been gained, fatty tissue has been cut through as have some of the other protective layers of the heart, the procedure becomes much more interesting. At this point you can see the heart beating, pumping blood throughout the body. It is amazing really to watch this organ work and move around completely exposed. The amount of movement that the heart has is unreal and would make this procedure very difficult if left beating. To accommodate for this the surgical team places the patient on a heart-lung machine to create a cardiopulmonary bypass (blood bypassing oxygenation in the lungs), in effect using artificial lungs and heart. Once the cardiopulmonary bypass is established, (which I will describe below) the heart slowly stops, and the machine oxygenates and pumps the blood throughout the body. Blood is returned to the machine, re-oxygenated and sent to the body again over and over while the patient is hooked into the machine.. In the case I saw, the patients heart was stopped for 1 hour and 50 minutes. During this time the heart-lung machine keeps the person alive.

In order to get the patient on the heart-lung machine, blood flow has to be diverted to and from the heart. To do this, the main trunk of Aorta is clamped off, an incision is made into the Aorta and a stitch is sewn in a circle around the Aorta. A large catheter, called a Cannula, is then placed in the Aorta; the stitch is pulled tight around the catheter and tied off to keep the catheter in place. The lines are cleared of air by running a bit of blood through the end of the catheter. This is done prior to hooking the catheter up to tubing running to the heart-lung machine. Blood that is run through the end of the catheter is let off into a sterile pan, eventually collected and run through a machine that purifies the blood (separating blood from saline and other fluids). This blood will eventually be given back to the patient. This same purification process is used for blood that is suctioned off the patient during the procedure.

The same procedure is performed on the Right Atrium, where blood returns to the heart, to divert deoxygenated blood to the machine. The only difference between the catheter in the Aorta and the Right Atrium is that the catheter in the right atrium is larger to account for the volume of blood. Once these two catheters are established and hooked up to the heart-lung machine, the perfusionist will start the machine, which takes over for the patient’s heart for a little while. Prior to being hooked up to the heart-lung machine the patient receives a large does of Heparin, which is an anticoagulant to prevent clotting in the machine and tubing running to and from the machine. On a side note, I had to administer myself Heparin when I was at home doing my IV antibiotics last month for bacterial meningitis. I had to do this for the same reason, to keep my PICC line from clotting up.

Once the heart was stopped, it has to be kept cool in order to slow down the metabolic rate, keeping the heart healthy. To keep the heart cool, a slushy mix was poured over the heart. Ice chips are not used as that could damage heart tissues. The slush is soft so that puncturing or tearing of the heart tissue will not occur. There is a machine in the room that actually makes the slush throughout the procedure. At about this same time, the RNFA had finished harvesting the Saphenous vein, which is a few feet long. She then started to suture the patient’s leg wound back together. While the RNFA working on the leg was doing this, the other RNFA, assisting the surgeon, stepped away and another surgeon came into OR to assist the primary surgeon with the bypass grafts. The procedure I watched, in addition to using the Saphenous vein for a graft, also used the Internal Thoracic Artery (better know as the Left Internal Mammary Artery) for a bypass graft, since this vessel was used it had to he separated from the chest wall before any of the grafting got underway. The Left Internal Mammary Artery (LIMA) is used to bypass the Left Anterior Descending Artery (LAD), when this happens, the procedure is known as LIMA to LAD. The left anterior descending artery is on the left side of the heart, the LIMA is sewn from the LAD to the Aorta bypassing the blockage. After the LIMA to LAD graft was sewn into the artery, the surgeon cuts the Saphenous vein into various lengths, for each bypass graft he will use it for. The length is important because if the vein is too long or too short various blood flow problems can arise. This will be double-checked once the patient is off the heart-lung machine and before being closed up. If there are length issues they are corrected at that time. The coronary bypasses are performed on both sides of the heart, so an additional nurse scrubbed in and helped hold the heart when it needed to be flipped over. In both the Saphenous Vein Grafts (SVG’s) and the LIMA to LAD graft, the vessels were sewn into the coronary arties and left anterior descending artery, then all four unattached ends were attached to the Aorta.

After all the grafts were completed the patient was slowly taken off the heart-lung machine. As blood started to be returned to the heart, the catheters were removed eventually as the heartbeat is gradually restored to a normal level. Watching the heartbeat come back was, well, amazing. Once blood flow returned, the heart just automatically started contracting again (if it does not then it is shocked) Very slowly at first, but it picked up pretty quick.. 21 beats a minute, then 27, then in the 30’s and so on and so forth until it was back up to 70 beats or so a minute. Before the patient is completely taken off the heart-lung machine the non-clotting effects of the Heparin have to be reversed, so the patient is given a pretty large dose of Protamine. The area was then double-checked, cleaned up, checked some more, etc. Any remaining blood was suctioned off for purification so it could be given back to the patient. Chest tubes were then inserted to drain the area. This is to keep any fluid build up from impeding the space the heart needs to function properly.

Once the chest tubes where in the patient’s sternum needed to be tied back together. This was done with a permanent wire, which pulls both sides of the sternum together. After the sternum wiring is completed the surgeon and the assistant both start suturing the skin back together and the procedure is more or less completed. Once the chest wound was nearly completed we left, but the patient is then taken to ICU for recovery.

If anyone has any interest in watching one of these I would encourage you to go check it out.
DiGi is offline  
Old 11-16-2003, 03:31 PM   #26
Blue Crack Addict
 
meegannie's Avatar
 
Join Date: Oct 2001
Location: Norwich, England
Posts: 15,798
Local Time: 04:01 AM
Wow! That sounds so interesting. (Though the slushy mention is really making me crave a Slush Puppy or frozen Coke )
meegannie is offline  
Old 11-16-2003, 04:01 PM   #27
BAW
The Flower
 
BAW's Avatar
 
Join Date: Dec 2001
Location: The OC....!!!!
Posts: 11,095
Local Time: 09:01 PM
Sorry if this bores the hell out of everyone but this is SO interesting to me, I have to comment extensively!

btw...THANK YOU for taking the time to do this DiGi

Quote:
Originally posted by DiGi
BAW - here you go. I hope my description does not cross any lines I should not. If I do I appologize in advance.



No, not at all...this is fascinating! First of all, how in the world did you ever remember it in such detail? Admittedly I got a little squeamish at some parts because I was too out of it to really comprehend what was being done to me at the time I had mine done, but its still fascinating to read about!

Quote:
The surgeon first makes an incision in the skin down the midline; this incision is the length of the majority of the Thoracic cavity.
I was lucky in my case that due to my young age, I was given a 'vanity incision." It's much shorter than usual and doesn't start until maybe 5" below the top of my sternum and probably only 8"or 9" long.

Quote:
Then layers of fat are cut through and pulled back until the surgeon and another RNFA (assisting the surgeon) come to the Sternum (breast bone). Now the Surgeon takes a small handsaw to cut through the Sternum, The saw enters up near the neck and the cut is made going away from the head. Once the ribs were separated the next phase involved separating the ribs and attaining access to the heart. Various retracting devices where used through out the procedure to keep the area open. The ribs are not completely opened up like some people believe, the space is large enough to get a hand in, the ribs however are not pulled all the way back to the table by any means.


This is the squeamish part mentioned above LOL! I had a pretty good idea of how this was done but reading actual details puts it in a whole new light!

If there is any one thing that makes recovery from this surgery so painful, I would have to says its the separation of the sternum. You don't realize how many upper body movements are affected by this...4 weeks after the surgery, something as simple as wiping the counter with a dishcloth hurt like hell.

And since my surgery, one side of my ribcage is slighly higher than the other...I think my surgeons were off just a few centimeters when they wired me back together.

Quote:
In the case I saw, the patients heart was stopped for 1 hour and 50 minutes. During this time the heart-lung machine keeps the person alive.
This was a very emotional part of the whole ordeal for me...to realize that my heart was actually stopped and I was in a sense brought back to life.

I'm sure you know the feeling of being near death Digi as sick as you were recently.

Quote:

Prior to being hooked up to the heart-lung machine the patient receives a large does of Heparin, which is an anticoagulant to prevent clotting in the machine and tubing running to and from the machine. On a side note, I had to administer myself Heparin when I was at home doing my IV antibiotics last month for bacterial meningitis. I had to do this for the same reason, to keep my PICC line from clotting up.
Yikes! Did you actually have to inject yourself in the stomach?

I received twice daily Heparin shots while I was in the hospital...my stomach was covered in black and blue marks.

Quote:
Once the heart was stopped, it has to be kept cool in order to slow down the metabolic rate, keeping the heart healthy. To keep the heart cool, a slushy mix was poured over the heart. Ice chips are not used as that could damage heart tissues. The slush is soft so that puncturing or tearing of the heart tissue will not occur. There is a machine in the room that actually makes the slush throughout the procedure.
I had no idea this is how the cooling down was done.

Quote:

After all the grafts were completed the patient was slowly taken off the heart-lung machine. As blood started to be returned to the heart, the catheters were removed eventually as the heartbeat is gradually restored to a normal level. Watching the heartbeat come back was, well, amazing.
I can probably speak for most people who had this kind of surgery in saying that one of the last things you think about before you go under is this part of the procedure...you just hope and pray that your heart DOES start up again and that you will wake up in recovery.

Quote:
Chest tubes were then inserted to drain the area. This is to keep any fluid build up from impeding the space the heart needs to function properly.
Um...I don't know if I can properly describe the feeling of having this chest tube pulled out a week after surgery. Painful is a good word but the sound it made was the worst part...I could actually hear air being sucked into my chest before the doctor covered it with the sterile dressing.

Quote:
Once the chest tubes where in the patient’s sternum needed to be tied back together. This was done with a permanent wire, which pulls both sides of the sternum together.
hehe...I set off airport metal detectors on occasion

Quote:
Once the chest wound was nearly completed we left, but the patient is then taken to ICU for recovery.
The first few hours are really tough...you're on a ventilator and can't talk and every muscle in your body aches. Your chest feels like its being pierced by knives but despite all of that, there is just this amazing feeling of "I'm ALIVE!"

I think I spent 24 hours in cardiac ICU, 36 hours in regular ICU and another 48 hours in a regular room. Its amazing what an accomplishment taking 4 steps across the room becomes the first time you get out of bed.

Quote:
If anyone has any interest in watching one of these I would encourage you to go check it out.
I would LOVE to watch an actual open heart procedure...you probably already answered this but just how did you arrange to see this?
BAW is offline  
Old 11-16-2003, 05:38 PM   #28
New Yorker
 
DiGi's Avatar
 
Join Date: Nov 2001
Location: the mountains of southwest VA
Posts: 2,818
Local Time: 12:01 AM
I was completely engaged in what was happening and it was just really easy for me to remember the steps of what happened. I think I want to go to med school though so I had an interest.

I watched this at a hospital just outside of DC near where I live. This hospital will let anyone who wants to observe this surgery come in and watch. I volunteer at this hospital once a week, so I just made some calls, found out who coordinates the viewings (I think she works in marketing for the hospital), called her and picked a date. If you want to see one, just find a hospital that actually does the surgery and I would bet you can observe. I would bet a large university hospital (if there is one near you) would do this for sure. Start with information I guess.

I’ll give you more reason to let you know why your chest hurt for so long. The observation room was right on top of the table in the OR. Directly above the table, 8-10 feet above was a large circular opening that extended up another few feet with glass windows. This is where I was watching. The windows were pretty tight; I could not hear anything at all really throughout the surgery. The Nurse in the room with us answering questions, use to do these surgeries as an RNFA. She was saying how there was probably a little music being played early on in the procedure and talking amongst the people in the room. I heard only 2 sounds in the 3.5 hours I was there. 1. The sound of the saw. 2. The crack the sternum made when the initial break occurred. It was a loud noise from where I was. I was thinking at the time about how much pain that would cause. I remember my grandfather coughing and hurting so much after he had this surgery. I can completely empathize with you, as to why you hurt 4 weeks later.

Watching the heart work again after being stopped was really awesome. It’s hard to describe even from my perspective. I can’t imagine thinking about this as someone like yourself, who went through this. I am sure every time I thought about this I would get a bit choked up.

I can’t imagine the feeling of waking up from this surgery. Even though you are in massive pain, the smile on your face must be great. I know when I woke up the morning after I was admitted to the hospital last month I was so happy to be alive, even though I could not tolerate looking at light, was puking my guts out, had a massive headache, and generally felt terrible all around, I can honestly say it was one of the best days of my life. Or at least a day, which I am guessing, will have a huge impact on my life. I went through so little pain compared to this surgery, your surgery or to what so many other people deal with.

As for my experience with heparin, I luckily had a PICC (peripherally inserted Central Catheter) placed in me. Think of it as a long IV, 16 inches long in my case, running from just above my elbow to outside my heart. Although this was not the most pleasant thing to have inserted, it made for a lot less sticks. These can remain in for a while and since they are placed in large vessels that can handle very large large/strong dose of medicines without the problems of smaller IV lines. For the 2 weeks I had to give myself medicine at home, I could just hook the syringe and IV lines up to this line. Here is a picture: http://www.15five.com/static/other/picc_line3.jpg
DiGi is offline  
Old 11-16-2003, 08:08 PM   #29
Blue Crack Addict
 
verte76's Avatar
 
Join Date: May 2002
Location: hoping for changes
Posts: 23,331
Local Time: 04:01 AM
OMG, BAW!! What a horrible experience!
verte76 is offline  
Old 11-17-2003, 10:26 AM   #30
New Yorker
 
jkayet's Avatar
 
Join Date: Feb 2002
Location: Washington, DC
Posts: 2,551
Local Time: 11:01 PM
Wow, what a thing to see....I don't know that I could watch something like that, although I guess it's so interesting that you almost forget to be squeamish.

BAW - glad you are ok...I had a friend in high school who had gone through the same thing...I can't imagine.

Digi - i saw something yesterday on meningitis on tv...how scary. I'm glad you are feeling better.
__________________

jkayet is offline  
 

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off



All times are GMT -5. The time now is 11:01 PM.


Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2023, vBulletin Solutions, Inc.
Design, images and all things inclusive copyright © Interference.com
×