Description
CBS Publishers and Distributors Paediatric Cardiac Surgery Manual For Perioperative Nurses 2018 Edition by Edith D Jonkman
Paediatric Cardiac Surgery Manual For Perioperative Nurses 2018 Edition by Edith D Jonkman
This book is a guide to the most common and some uncommon congenital heart disease and associated surgical interventions as practiced on newborns and children. It is the result of many years of the author’s clinical practice as a paediatric cardiac perioperative nurse and is designed to explain and reveal both the complex surgical procedures and the nature and variety of cardiac defects.
The text of this edition has been modified and refined through discussions with surgeons, consultant surgeons, anaesthesiologists, perfusionists, medical students, and nurses in the hospitals where she has worked. The research and writing began at the King Faisal Hospital, Jeddah, Saudi Arabia, where she saw intense and complex surgical procedures being performed on infants with such skill and grace that she felt that new or re-skilling nurses in a paediatric context would benefit from seeing and reading about the deployment of such surgical ability.
She began taking notes and photographs, interviewing surgeons, reading operative reports, and the information grew to an informal ‘how to assist’ manual — a way of being an expert paediatric cardiac nurse, able to anticipate the surgeon’s needs through education and understanding. She gradually added more procedures and illustrations and her ‘manual’ was in demand not only by nurses working in the cardiac operating theatres but also by medical students, perfusionists and anaesthesiologists.
This book, a result of research and observations made over many years of assisting in paediatric cardiac operations, aims to make complex surgical procedures more accessible to perioperative nurses and help them become more responsive to the cardiac surgeons and their patients where seconds saved can lead to further chances of life.
This book is dedicated to the surgeons who carry-out these complex and life-saving procedures, without whose expertise, many alive today would never have reached adolescence. However, in view of the ongoing research in congenital heart disease and surgical treatment, approaches of individual cardiac surgeons may vary from the surgical procedures presented in the book.
Table of contents:-
1. Congenital Heart Disease and its Risk Factors 1
Introduction 1
Incidence and Causes 3
Adverse Genetic Risk Factors 3
Adverse Environmental Risk Factors 4
Congenital Heart Disease in More Detail 6
Foetal and Newborn Circulation and its Implications for Infants Born with Congenital Heart Disease 10
Diagnostic Tests 15
Non-Genetic Risk Factors 19
Summary of Treatment for Paediatric Congenital Heart Disease—Non Surgical Treatment 24
Surgical Treatment 26
Prognosis 27
2. Understanding C
xii Paediatric Cardiac Surgery
Diagnosis 29
Sequential Segmental Classification 30
Determining the Situs 31
Identifying the Cardiac Position 32
Key Points of the Sequential Segmental Classification 38
3. Nursing the Young Patient in Paediatric Cardiac
Surgery 47
Introduction 47
Preoperative Nursing Care 47
Newborns and Infants 48
Toddlers 49
Preschool Age 50
School Age 50
Adolescent 51
Nursing and Premedication 52
4. Perioperative Nursing in the Cardiac Operating Room 54
Introduction 54
Assisting the Surgeon 54
Positioning the Patient 56
Cardiopulmonary Bypass Preparation 65
Incision 68
Cannulation and Cardiopulmonary Bypass 73
Going on Bypass 85
Coming off the Bypass Machine 87
Sequence for Assisting the Surgeon with Placing a Child on Cardiopulmonary Bypass 91
Sequence for Assisting the Surgeon with Discontinuation of Cardiopulmonary Bypass 95
Effects of Cardiopulmonary Bypass on Neonates and Infants 97
Peritoneal Dialysis Catheter 104
Ultrafiltration and Modified Ultrafiltration 104
Cardioplegia and Hypothermia 105
Circulatory Arrest 105
Defibrillation Paddles 106
Pacing the Heart 108
Delayed Chest Closure 112
Extracorporeal Membrane Oxygenation (ECMO) 112
Emergency Chest Reopening in the Neonatal Intensive care Unit 115
5. Nurses’ Overview of Paediatric Cardiac Anomalies, Surgical Procedures and Techniques for Congenital Heart Defects 117
Introduction 117
Section 1: When Chambers and Valves are in Normal Sequence and Normal Position and Shunting is Predominant 118
Patent Ductus Arteriosus (PDA) 121
Patent Ductus Arteriosus Repair—Technique 127
Patent Foramen Ovale (PFO) 132
Atrial Septal Defect (ASD) 135
Atrial Septal Defect Repair—Technique 144
Ventricular Septal Defect (VSD) 149
Ventricular Septal Defect Repair—Technique 157
Atrioventricular Septal Defects (AVSDs) 161
Contents xiii
Common Types of Atrioventricular Septal Defects 164
Atrioventricular Septal Defect Repair—Technique 166
Section 2: When Chambers and Valves are in Normal
Sequence and Normal Position and Stenosis or
Obstruction is Predominant 169
Univentricular Heart 169
Blalock-Taussig Shunt, Glenn and Fontan Procedure 171
Blalock-Taussig Shunt Procedure—Technique 174
Glenn Shunt Procedure—Technique 178
Extracardiac Fontan Procedure—Technique 185
Tricuspid Valve Stenosis or Atresia (Obstructed or Absent Atrioventricular Connection) 193
Ebstein Anomaly 195
Pulmonary Valve Stenosis or Atresia (Obstructed or Absent Ventriculoarterial Connection) 198
Pulmonary Stenosis/Atresia with a Ventricular Septal Defect 203
Pulmonary Stenosis /Atresia with Intact Ventricular Septal Defect 209
Mitral Valve Stenosis or Atresia (Obstructed or Absent Atrioventricular Connection) 210
Aortic Valve Stenosis or Atresia and Subaortic Membrane (Obstructed or Absent Ventriculoarterial Connection) 210
Subaortic Membrane (SAM) 215
Ross Procedure—Technique 220
Bentall Procedure—Technique 234
David Procedure—Technique 236
Section 3: When Chambers and Valves are not in Normal Sequence and Normal Position—Atrioventricular
Discordance and Ventriculoarterial Discordance 240
Double Inlet Left ventricle and Double Inlet Right Ventricle (Atrioventricular Discordance) 240
Congenitally Corrected Transposition of the Great Arteries (Atrioventricular and Ventriculoarterial Discordance) 244
Tetralogy of Fallot (Ventriculoarterial Discordance) 251
Tetralogy of Fallot Repair—Technique 256
Double Outlet Right Ventricle (Ventriculoarterial Discordance) 260
Double Outlet Left Ventricle (Ventriculoarterial Discordance) 265
xiv Paediatric Cardiac Surgery Truncus Arteriosus (Ventriculoarterial Discordance) 266
Truncus Arteriosus Repair—Technique 271
Transposition of the Great Arteries (Ventriculoarterial Discordance) 277
Transposition of the Great Arteries Repair—Technique 283
Rastelli Procedure—Overview 290
Nikaidoh Operation—Technique 294
DKS Procedure—Technique 301
Section 4: Anomalies of the Great Arteries (Anomalies of the Pulmonary Artery and Aorta) 302
Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery 302
ALCAPA Repair—Technique 305
Section 4.1: Anomalies of the Aorta 311
Coarctation of the Aorta (CoA) 312
Coarctation of Aorta Repair—Technique 315
Interrupted Aortic Arch (IAA) 323
Aortopulmonary Window (APW) 329
Aortopulmonary Window Repair—Technique 331
Hypoplastic Left Heart Syndrome 332
Norwood Procedure—Technique 337
Section 4.2: Anomalies of the Venous Connections Anomalies of Pulmonary Veins 355
Partial and Total Anomalous Pulmonary Venous Return or Drainage (PAPVD, TAPVD) 355
PAPVD Repair—Technique 361
TAPVD (Supracardiac and Infracardiac) Repair—Technique 362
TAPVD (cardiac) Repair—Technique 363
Scimitar Syndrome 364
Repair of Scimitar Anomaly—Technique 365
Section 5: Other Cardiac Anomalies 367
Cor Triatriatum 367
Vascular Rings/Slings 368
Ectopia Cordis 372
References 373
Index 382