637 Ch13 CVP Interventions

What are the muscles involved in a thoracotomy? What nerve can be damaged and what would a sign of this be?

• Traps, rhomboid major, teres major, serratus anterior, lats

• Long thoracic nerve → winging b/c SA affected

What are the muscles, nerves, and uses for posterolateral incision?

• Lower trap, SA, lat divided “J”

• Long thoracic n., intercostal n.

• Wide visibility for esophagus & trachea i.e. chest tube cannot address quick enough

  • Hemo/pneumothorax, pulmonary resections, lobectomy

What are the muscles and uses for anterolateral incision (left vs right)?

• Pec major, SA, lat, breast tissue “CLAMSHELL”

• Left: descending thoracic aorta repair, pericardial effusion, left resection of lung, pericardiocentesis for cardiac tamponade, distal esophageal surgeries

• Right: right resection of lung, mitral valve repair/replacement

How is a median sternotomy done? Precautions? Uses?

• Sternal retractor divides sternum and holds incision open from clavicles to xiphoid process

• Sternal precautions 6-12wks, limited use of arms & bracing chest for coughing, sneezing, etc.

• Most common for CV operations