Arterialotomy, nzira dzekutanga dzekusungirira

• Kugara uchiisa heparin mutsinga usati waisa arterial clamping (kunze kwekunge murwere ane nhoroondo yeheparin induced thrombopenia (HIT)
• Kuti tinzwisise mutsauko wakakosha uripo pakati pezvishandiso zve'clamping' (semuenzaniso DeBakey vascular clamp vs Overholt clamp)
• Kuisa ma arterial clamp nemazvo (teerera pakatarisa ma calcified plaques)
• Kuita arteriotomy nemazvo (Nr. 11 scalpel (kumusoro!) uye chigero chePotts)
• Kubata maforceps nemazvo kudzivirira kukuvara kwemadziro etsinga (usadzvanya)
• Kuisa tsono zvakanaka muchibatiso chetsono (kazhinji 1/3 kusvika 2/3; 30° mberi)
• Kubata zviridzwa zvakanaka uye nzvimbo yemuviri nemaoko
• Kusona nemazvo nepakati pemadziro etsinga (nzira yakatwasuka)
• Kutungamira mastitches nemazvo: kubvamukati nekunzemutsinga dzeropa uye kuenda kunobuda (kudzivirira kupatsanurwa); kubvakunze mukatimuzvigadzirwa zveprostheses (uye, kana zvichidikanwa, mutsinga dzinoenda kunopinda
• Kusambobata machira nemidziyo (zvinogona kukuvara kana kutyoka)
• Kugara uchidzivirira madziro etsinga (kudzivirira kusangana kweropa nematishu akabatana)
• Kunzwisisa zvakanakira nezvayakaipira zve sutures dzakakanganiswa vs kumhanya sutures
• Kunzwisisa nzvimbo yakanakisisa ye suture mu suture dzinomhanya kuti uve nechokwadi chekuti suture iri tight (kumberi kwe stitch yega yega, daro pfupi pakati pe stitch ne out stitch)
• Semubatsiri: pekubata suture kuti usimbise tambo yekusungirira, dzivisa kutenderedza suture yasara asi ipa mukana wakakwana wekusona kunotevera (45% kusvika 55%).
• Semubatsiri: kudhonza suture nenzira yekusona, kwete kumashure (kudzivirira kukuvara kwemusana
• Semubatsiri: kubvumira chiremba wechiremba kugadzirisa matishu kutangapamberikudhonza suture (kudzivirira kubuda ropa muburi re suture)
• Kugara uchigeza usati wavhara, kuputira uye kubvisa jira

1. 2x transverse / 2x longitudinal arteriotomies. Vhara arteriotomies dzese dziri mbiri nenzira mbiri: interrupted uye running sutures, zvichiteerana
2. Kubata madziro etsinga: bata adventitia chete ne forceps yako
3. Kubata zvakanaka kwetsinga yeropa: teererai plaque, shandisai vascular clamp, gadzirisai simba re clamp, musakanganwa kupa heparin musati mabata!
4. Kuvhiya kwetsandanyama: shandisa sebanga re scalpel Nr 11, kubaya nebanga uchibata banga mudenga
5. Wedzera arteriotomy uchishandisa chigero chePotts
6. Kubata tsinga dzeropa uchishandisa forceps: usadzvanya intima, shandisa forceps senzira yekudzivisa panguva yekusona, bata adventitia chete
7. Bata chibatiso chetsono nemazvo
8. Nzvimbo yetsono nemazvo
9. Sona madziro ese ne stitch yakatwasuka (hapana ma stitches akatwasuka)
10. Nzira yekusona nayo mukati-kunze (mumadziro etsinga kudzivirira kutsemuka)
11. Kudyidzana pakati petsono, chibatiso chetsono uye maforceps: tsono yekutora, ronga kusonesa kunotevera

Kudzora zvinangwa zvekudzidza

• Kuchinja
• Kurongeka kwe stiches
• Kusimba kwe suture