CVP surgical interventions (week 4)

what is an IVC filter used for

DVT or PE

what is the procedure for an IVC

a catheter deployed in the femoral vein to apply a filter to catch clots

what are indications for an IVC filter

people at risk for thromboembolus or known extensive, mobile DVT, typically for those who anticoagulation is contraindicated

what are complications for an IVC filter

filter does not open, retrievable type overgrown with cells, filter travels, perforates vessel walls, multiple emboli clog the filter which results in severe LE and pelvic edema

what are precautions / exercise for IVC filter

may increase activity as tolerated due to no risk from thrown clot, may or may not be anti coagulated which is important for fall precautions and bleeding complications

what is a pulmonary thromboectomy / embolectomy

can be open or endovascular where the clot is gathered or destroyed

what are precautions / exercise considerations for a thromboectomy or embolectomy

sternal precautions if open procedure or right heart cath precautions if endovascular

is there a lot of precautions if the thromboectomy or embolectomy is in a vein

no because it is a low pressure system

what is a treatment for CAD

percutaneous coronary interventions (PCI), CABG

what is included in PCIs

percutaneous transluminal coronary angioplasty (PTCA), atherectomy, stent placement, direct / localized thrombolytic therapy performed via LHC

what is the PCI procedure

femoral or radial artery is accessed with a catheter to thread the coronary vessels and to the left ventricle

what are the indications for PCI

lesions that do not completely occlude the lumen, calcified lesions or more occluding lesions that require atherectomy, 1 or 2 arteries are affected, stents can be bare metal stents (BMS) or drug eluting stents (DES)

what are complications of PCI

acute stent thrombosis, re-stenosis, spasm of artery wall, MI, dissection / rupture of artery wall, bleeding or hematoma at entry site

precautions / exercise considerations

strict precautions are bed flat bed rest x 4-12 hours while checking order for pressure at sheath site. The patient should be observed for unresolved myocardial ischemia.

what is a CABG

a procedure that restores blood to an ischemic area of the heart by bypassing a blockage in a coronary artery using a vascular graft which starts at the aorta and goes to the coronary artery distal to the blockage.

what are indications for a CABG

completely occluded coronary artery, PTCA ineffective or impossible, unresponsive to medical therapy, three or more vessels are affected

what are common donor vessels for a CABG

saphenous vein graft and left internal mammary artery

what are complications of a CABG

cardiogenic shock, difficulty coming off the pump, MI during surgery, CVA during surgery, "pump head" neurocognitive deficits, brachial plexus damage, hiccups, phrenic nerve injury / hemidiaphrgam paralysis

CABG precautions / exercise considerations

lots of lines and tubes to manage

what are sternal precautions

no lifting, pulling, pushing > 10# for 6-8 weeks, then you can add 5# per week, no driving for four weeks, no grossly asymmetrical UE movements for 6-8 weeks, avoid prone lying for 6-8 weeks, splint sternum with pillow during cough or sneeze

what are sternal precuations based on

what the surgeon says so they may varry

what type of breathing should you promote for someone who has had a CABG

deep breathing to avoid pneumonia

what is the procedure for a peripheral bypass graft

it re-perfuses an area that has been ischemic from PVD using the saphenous vein or a synthetic material to bypass a blockage in a peripheral artery.

what are indications for a peripheral bypass graft

PVD

what are complications for a peripheral bypass graft

wound dishisence especially with the diabetic population. Inguinal incisions frequently have hematomas and infections.

what are precautions / exercise considerations for a peripheral bypass graft

limit prolonged / sustained hip flexion, gastroc / soleus pulling, must educate on lifestyle management

what is a carotid endarterectomy procedure

to remove plaque from the carotid artery to improve blood flow to the brain. Can be done through endovascular or open atherectomy

what are the indications for a carotid endarterectomy procedure

stenosis >60% to prevent CVA

what are the complications for a carotid endarterectomy procedure

CVA

what are precautions / exercise complications for a carotid endarterectomy procedure

bed rest the day of surgery and look for signs and symptoms of a CVA / stroke

what is an aortic aneurysm repair / replacement procedure

typically an open procedure through the chest or abdomen especially if a graft is needed. Less complicated cases may be by minimally invasive placement of an endovascular stent. Reframes the aorta to prevent dissection.

what are indications for aortic aneurysm repairs

aneurysms >5-6 cm, aortic dissection

what are complications for aortic aneurysm repairs

spinal cord ischemia, leaks / internal bleeding, endoleaks which result in blood between the stent and vessel wall, cardiogenic shock

what are precautions / exercise considerations for aortic aneurysm repairs

sternal precautions if open chest, abdominal binder if abdominal incision, no valsalva, BP < 120 mmHg.

what is the procedure for valvuloplasty

helps valve stenosis and is a repair of a valve, suture of torn leaflet, removal of atherosclerotic plaques or vegetations. can be OH or cath procedure.

what is the procedure for annuloplast

for regurgitation / insufficiency where they tighten and suture malfunctioning valve leaflets and annulus via an open procedure. Or the mitriclip is a catheter based procedure to close the non-closing part of the mitral valve to treat mitral regurg.

what are the indications for valvulo/annulo plasty

severe and or symptomatic valve disease and dysfunction. Helps to treat non-ischmic cardiomyopathy d/t valve diseae

what are complications for valvulo/annulo-plasty

same as open heart or LHC for femoral artery access

what are precautions / exercise considerations for valvuo-annulo-plasty

sternal precautions or lifelong anticoags if mechanical

what are the two types of valve replacements

mechanical or bioprosthetics

how are valve replacements done

mostly through open heart procedures however transcatherter based procedures for the TAVR and now mitral valve are becoming more common.

mechanical valves require the pt to be on

lifelong anticoagulants

how are pacemakers / ICD placed

electrodes a fixated by screw or anchor, wires go in the subclavian vein, unit is placed in the left infraclavicular sub-q pocket, and leads sense and fire

what is a pacemaker for

an electrical signal to help the heart fire and maintain cardiac output

what is an IVD for

a defibrillator for the heart

what are indications for pacemaker / ICD

ICD if high risk of VT/VF by hx or by LVEF <35%, management of arrhythmias, external transvenous pacemaker temporary after CABG or heart transplant

what are complications of pacemaker / ICD

pocket infection, infection around leads, lead fracture or displacement, malfunction

what are precautions / exercise considerations for pacemaker / ICD

LUE ROM <90, avoid strong magnets, microwaves, ok if touching pt while ICD fires

what is an ablation

cauterization with laser or radio frequency of an area that may be initiating an arrhythmia. For afib you can have pulmonary vein isolation, maze procedure via incisions or ablation, AVN ablation for RVR

what are indications for an ablation

anomalous electrical pathways, irritable areas, reentry pathways

what are complications of an ablation

same as Open heart

what are precautions / exercise considerations for an ablation

sternal precautions and monitor for recurrent of AF or other arrhytmias

what is the lariat procedure used for

reducing stroke risk when there is a blockage in Left atrial appendage of the heart

what does the endobronchial valve treat

COPD

what is the procedure for an endobronchial valve treatment

bronchoscopic placement of a one way valve to deflate hyper inflated lung segments, prevent re-inflation, and allow secretion removal

what are the complications for endobronchial valve treatment

valve migration, PTX, hemoptysis

what are precautions for endobrocnhial valve treatment

bed rest for 48 hours due to risk of PTX

what is LVRS used to treat

COPD

what is the LVRS procedure

resection of hyperinflated segments of lung tissue to restore normal positioning of chest wall and ventilatory muscles to reduce dyspnea. It is performed via thoracotomy, sternotomy, or by videp assisted surgery.

what are complications of LVRS

PTX / air leak, hemothroax, infection / empyema

what are precautions of LVRS

thoractomy 10# x 4 wks or sternal precautions depending on the incision