Arteriotomy, njira zoyambira zokokera

• Kupaka heparin m'mitsempha nthawi zonse musanagwiritse ntchito mankhwala oletsa kutupa (kupatulapo wodwala yemwe ali ndi mbiri ya matenda a heparin omwe amayambitsa thrombopenia (HIT)
• Kuti mumvetse kusiyana kwakukulu pakati pa zipangizo zomangira (monga DeBakey vascular clamp vs Overholt clamp)
• Kuyika bwino ma bramp a mitsempha yamagazi (samalani ndi momwe ma calcified plaques amaonekera)
• Kuchita opaleshoni ya arteriotomy molondola (Nr. 11 scalpel (mmwamba!) ndi lumo la Potts)
• Kugwira bwino zida zogwirira ntchito kuti mupewe kuwonongeka kwa makoma a mitsempha yamagazi (musamapanikizike)
• Kuyika singano moyenera mu chogwirira singano (nthawi zambiri 1/3 mpaka 2/3; 30° patsogolo)
• Kugwiritsa ntchito zida zogwirira ntchito bwino komanso malo a thupi ndi manja
• Kusoka bwino kudzera m'makoma a mitsempha yamagazi (njira yolunjika)
• Kusoka molunjika molondola: kuyambiramkati ndi kunjam'mitsempha yamagazi ndi kupita ku kutuluka (kuti tipewe kusweka); kuchokera kukunja mkatimu ma prostheses (ndipo, ngati kuli kofunikira, mu mitsempha yolowera mkati
• Kusagwira ma straight ndi zida (zikhoza kuonongeka kapena kusweka)
• Kuteteza nthawi zonse khoma la mitsempha yamagazi (kuti magazi asakhudze mitsempha yamagazi yomwe imayenda ndi magazi)
• Kumvetsetsa zabwino ndi zoyipa za sutures zosokonezeka poyerekeza ndi zoyendetsa sutures
• Kumvetsetsa malo abwino kwambiri a suture mu suture zoyendetsera kuti muwonetsetse kuti suture ndi yolimba (kutsogolo kwa soketi iliyonse, mtunda waufupi pakati pa soketi yolowera ndi yotuluka)
• Monga wothandizira: komwe mungagwirire suture kuti muteteze chingwe cha suture, pewani kuzungulira kwa suture yotsalayo koma perekani mpata wokwanira wosokeranso (mfundo ya 45% mpaka 55%).
• Monga wothandizira: kukoka suture molunjika pa ulusi, osati kumbuyo (kuti apewe kugwedezeka kwa thumba la chikwama
• Monga wothandizira: kulola dokotala wa opaleshoni kusintha minofu kayeisanafikekukoka chingwe cha suture (kuti tipewe kutuluka magazi m'bowo la suture)
• Kusamba nthawi zonse musanatseke, kumanga mafundo ndi kumasula makoma

1. Ma arteriotomies awiri opingasa / awiri opingasa. Tsekani ma arteriotomies onse awiri pogwiritsa ntchito njira zonse ziwiri: zosokoneza ndi zoyendetsa ma sutures, motsatana.
2. Kugwira khoma la mitsempha yamagazi: gwiritsani ntchito mphamvu zanu zokha
3. Kugwira bwino ntchito kwa mtsempha wamagazi: samalani ndi plaque, gwiritsani ntchito chogwirira cha mitsempha, sinthani mphamvu ya chogwirira, musaiwale kupereka heparin musanagwiritse ntchito chogwirira!
4. Kuchotsa mitsempha yamagazi: gwiritsani ntchito ngati tsamba la scalpel Nr 11, kuduladula kwa mpeni wonyamula tsamba mmwamba
5. Kukulitsa mitsempha yamagazi pogwiritsa ntchito lumo la Potts
6. Kugwira ntchito kwa mtsempha wamagazi pogwiritsa ntchito forceps: musakanikize intima, gwiritsani ntchito forceps ngati mphamvu yotsutsana nayo posoka, gwiritsani ntchito adventitia yokha
7. Gwirani chogwirira singano moyenera
8. Malo a singano molondola
9. Sokani zigawo zonse za khoma ndi soketi yolunjika (osasoka zopingasa)
10. Njira yosokera mkati ndi kunja (m'makoma a mitsempha kuti mupewe kusweka)
11. Kugwirizana pakati pa singano, chogwirira singano ndi zida zogwirira: singano yonyamula, konzani kusoka kwina

Kuwongolera zolinga zophunzirira

• Kusintha
• Kukhazikika kwa stiches
• Kulimba kwa suture