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VASOVIEW 7 | Training Manual | English | v1 

Copyright MAQUET Gmbh

3

 |

 | 

MAQUET Medical Systems USA 

| 

ENDOSCOPIC VESSEL HARVESTING

 |

TablE Of cOnTEnTS

 1

   Endoscopic Vessel Harvesting Saphenous Vein 

|  4

    Procedure-at-a-Glance

 2

   Endoscopic Vessel Harvesting Radial Artery 

|  5

    Procedure-at-a-Glance

 3

   Operating Room Instrumentation and Equipment  |  6

 4

   Equipment Testing 

|  7

 5

   Endoscopic Vessel Harvesting Procedure: 

|  8

    Saphenous Vein
    Patient Positioning and Preparation 

|  8

    Incision Site 

|  10

    Inserting the 7 mm Endoscope With Attached 

|  11 

    Dissection Tip
    CO

2

 Insufflation 

|  12

    Endoscopic Dissection 

|  13

    Branch Cauterization and Transection 

|  16

    Optimizing Visualization 

|  19

    Guidelines for Safe and Effective Use:  

|  20

    BiSECTOR™ Bipolar Ligating Forceps
    Running the Vein 

|  21

    Distal Transection and Ligation 

|  21

    Vein Removal and Preparation 

|  22

    Closing and Dressings 

|  22

 6

   Endoscopic Vessel Harvesting Procedure: 

|  23

    Radial Artery
    Patient Positioning and Preparation  

|  23 

    Incision and Tourniquet Deployment 

|  24

    Endoscopic Dissection  

|  24 

    Fasciotomy 

|  26

    Branch Cauterization and Transection 

|  26

    Transection and Retrieval of the Radial Artery 

|  27 

    Hemostasis and Conduit Preparation 

|  28

    Closing and Dressings 

|  28

 7

   Documentation 

|  29

 8

   Nursing Considerations 

|  30

 9

   Case Setup 

|  31

10

   Postoperative Procedures 

|  32

12

   Troubleshooting 

|  33 

13

   Appendix A: Eight Steps for Tying a Ligation Loop  |  34

Содержание VASOVIEW 7

Страница 1: ...VASOVIEW 7 Training Manual English v1 Copyright MAQUET Gmbh Training Manual VASOVIEW 7 Endoscopic Vessel Harvesting System...

Страница 2: ...t judgement of the medical professional performing the procedure VASOVIEW 7 Training Manual MAQUET has a strong history pioneering and advancing endoscopic vessel harvesting systems The VASOVIEW 7 xB...

Страница 3: ...on 13 Branch Cauterization and Transection 16 Optimizing Visualization 19 Guidelines for Safe and Effective Use 20 BiSECTOR Bipolar Ligating Forceps Running the Vein 21 Distal Transection and Ligation...

Страница 4: ...nsecting Branches Insert the VASOVIEW 7 Harvesting Cannula to cauterize and transect branches using the BiSECTOR Bipolar Ligating Forceps Enhanced Visualization For enhanced visualization during vesse...

Страница 5: ...the radial artery pedicle and expose the branches Using the BiSECTOR tool cauterize and transect branches Running the Vessel Deploy the C Ring from the VASOVIEW 7 Harvesting Cannula engage the radial...

Страница 6: ...Video Monitor Light Source Insufflator Insufflator tubing CO2 Source Fiber Optic Cable with appropriate Scope Adaptor End Camera compatible to Endoscope 7 mm Extended Length Endoscope 7 mm Endoscope...

Страница 7: ...t should be checked for damaged fiber optics To do this hold one end toward a direct light source and look into the other end If it illuminates with no more than one third of the area grayed the cable...

Страница 8: ...d the knee area Once the intended incision site is identified mark the area with a surgical marker The saphenous vein can usually be found by using anatomical landmarks For morbidly obese patients an...

Страница 9: ...tor etched on the endoscope shaft Figures 2 and 3 Insert the endoscope with attached Dissection Tip through the BTT Ensure that the Endoscope Seal is on the BTT it comes packaged with this seal attach...

Страница 10: ...dyle Make a 2 cm incision along the posterior border of the tibial epicondyle Figure 7 Above the knee Make a 2 cm incision in the thigh where the vein lies in the groove between the sartorius and grac...

Страница 11: ...nsert the Dissection Tip into the space created and place it onto the anterior surface of the saphenous vein Note on the video monitor the color of the vein and the surrounding yellow fatty tissue It...

Страница 12: ...d can be used to inflate the balloon on the BTT Inflate the balloon with the minimal amount of air needed to create an adequate seal 0 25 cc s of air If there is obvious leakage around the incision us...

Страница 13: ...flation aids the dissection by enabling constant visualization reduces bleeding and helps maintain a working space Mastery of the dissection will enable clear exposure and easy access for branch caute...

Страница 14: ...anipulation If tissue collects on the Dissection Tip use your free hand on the outside of the leg to palpate the tip and dislodge the tissue Figure 16 Maintain the endoscope in a position parallel to...

Страница 15: ...sue that is still adhered Figure 18 When a branch is encountered dissect it with short controlled gentle probes with the Dissection Tip Con tinue until all branches are adequately exposed to facilitat...

Страница 16: ...handle of the VASOVIEW 7 Harvesting Cannula The endoscope is secured with an audible click locking it into place Figure 21 Attach the Bipolar Cord to the VASOVIEW Harvesting Cannula Ensure that the Bi...

Страница 17: ...de Rotate the BiSECTOR tool manually to orient the blade upward for ease of visualization and branch capture Figures 23a 23b When the branch is captured rotate the BiSECTOR tool away from the vein the...

Страница 18: ...my to further expose the branch Set the bipolar generator wattage according to the type of bipolar generator being used Refer to the VASOVIEW 7 xB Endoscopic Vessel Harvesting System Instructions for...

Страница 19: ...of the Harvesting Cannula If the distal lens of the endoscope becomes obscured by blood or fat use the integrated endoscope wash feature Fill the 5 cc syringe with saline and attach it to the blue Sc...

Страница 20: ...vessel branch cauteri zation and transection working back towards the incision If branches prohibit advancement of the Harvesting Cannula it may be less traumatic to the vein to perform vessel branch...

Страница 21: ...f the vein Externalize the vein through the stab wound and divide it under direct vision per surgical protocol Figure 30 Allow the harvested vein segment to retract back into the tunnel Ligate the ter...

Страница 22: ...f the vein for vessel preparation Measure the vein to ensure adequate length for the bypass grafting Figure 31 If additional length is needed further dissection can be carried out through the same inc...

Страница 23: ...assembly information see the Product Assembly section of the Endoscopic Vessel Harvesting of the saphenous vein portion of this manual page 9 Attach the 7 mm Extended Length Endoscope to the camera co...

Страница 24: ...under wrist Note the time of tourniquet deployment Generally tourniquet time is kept under one hour ENDOSCOPIC DISSECTION The radial artery is dissected as a pedicle with the accompanying venae comit...

Страница 25: ...Endoscope along the posterior aspect of the radial artery again avoiding contact with the radial artery Although anatomy varies from patient to patient posterior branches are likely to be encountered...

Страница 26: ...e settings differ by type of generator The fascia should be released from the distal forearm to the mid or proximal forearm Figure 39 BRANCH CAUTERIZATION AND TRANSECTION Once the fasciotomy is comple...

Страница 27: ...ures without a tourniquet the radial pedicle should be clamped at the wrist with a soft bulldog type clamp prior to proximal division This is intended to keep the pedicle from bleeding into the tunnel...

Страница 28: ...onal hemostasis Procedure Using a Tourniquet Deflate the tourniquet and note the tourniquet time Check pulse oximetry on the digits to ensure adequate perfusion to the hand The radial artery is prepar...

Страница 29: ...SOVIEW 7 Endoscopic Vessel Harvesting System kit to identify the location and the length of the vessel harvested A sticker is in cluded for the patient s hospital record and a card is included for the...

Страница 30: ...primary troubleshooter once the procedure has begun See Troubleshooting Section Turn on all components to the video system including those that may not be used Once the various cords are handed off fr...

Страница 31: ...vein harvesting is completed and to simplify the general set up Sterile items Components of the VASOVIEW 7 xB EVH System kit VASOVIEW Harvesting Cannula with BiSECTOR tool and C Ring Short Port BTT w...

Страница 32: ...fragile than shorter or larger diameter endoscopes It is recommended that the endoscopes be kept in the instrument tray available through MAQUET Cardiovascular More detailed instructions can be found...

Страница 33: ...on tunnel wall Remove scope and clean it externally Use scope washer within the Harvesting Cannula to clean the lens Endoscope Fogging Use anti fog solution on the end of the endoscope only with the...

Страница 34: ...both suture ends be tween the thumb and index finger as shown Step 2 Take the shortest suture tail in front of the 2 sutures forming a complete circle around the index finger Step 3 Take the shortest...

Страница 35: ...OVIEW 7 Training Manual English v1 Copyright MAQUET Gmbh Step 5 Pull short and long strand to tighten knot Step 6 Pull short strand and one of the 2 strands to tighten knot securely Remember one of th...

Страница 36: ...the knot is secure cut the short tail leaving 2 to 3 mm of suture Do not cut right next to the knot Step 8 Thread the knot pusher and advance knot and knot pusher into insufflated tunnel Push the knot...

Страница 37: ...osition 16 When performing radial artery harvesting the radial artery harvesting procedure should be performed prior to placing the patient on cardiopul monary bypass 17 Do not touch the coagulating s...

Страница 38: ...38 ENDOSCOPIC VESSEL HARVESTING MAQUET Medical Systems USA VASOVIEW 7 Training Manual English v1 Copyright MAQUET Gmbh...

Страница 39: ......

Страница 40: ...s on patient mobility and wound management solutions GETINGE pro vides solutions for infection control within healthcare and contamina tion prevention within life sciences MAQUET specializes in soluti...

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