Rikk Price's - DIY Surgery

Steps one to six

You should have everything from the shopping list ready to go. I hope you have read the first page before you try this.

Step one

First make sure your patient is not awake. Your anaesthetist should have taken care of this. Using a scalpel, power saw and retractors, make an incision from the top of the pericardial area to the bottom of the ribcage. Once the sternum is exposed saw through the breastbone and retract, exposing the heart.

Step two

The recipients aorta and superior and inferior vena cava should be tied off and clamped close to the heart with nylon tape and purse string sutures, and cannula connected in preparation for cardiopulmonary bypass. Begin pump.

Step three

The right artium of the heart is separated just above the aortic valve and removed, leaving the vena cava inflow tracts intact. Left artium separated and removed just above the pulmonary valve, leaving the pulmonary viens and their inflows intact. Be sure to leave part of the recipients arteries so that the donar heart can be stitched on. Palpate the pulmonary artery for the presence of thrombosis. With a needle and surgical thread 120cm long, place the first suture at the base of the left artrium.

Step four

All the remaining attachments are then severed to the patient's heart and the heart removed. Hand this to the nurse for disposal.

Step five

As the removal of the recipients heart is nearing completion, ask a member of your surgical team to open the igloo containing the donated heart and remove the lid of the transport container. Cut the tape tying the outer plastic bag containing the heart. With the aid of two forceps remove the inner plastic bags and place them in a 22cm bowl on the main instrument trolley. Have the circulating nurse fill this bowl with cold ringers solution for irrigation.

Step six

Meanwhile the donor heart is prepared. Get someone else to do this. With a scalpel, separate the aorta and pulmonary arteries. The separate the pulmonary artery and veins. Left and right arteries are connected with stiches to provide a large orifice for attachment.

Only Six more steps left to go

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