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103 BREAST REDUCTION - BILATERAL

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									103 BREAST REDUCTION - BILATERAL                                                               DR. CUADROS
Note slightly different setups for Main OR and Day Surgery
                                                                                      Updated October 3, 2010
                                                                                                     PAGE 1
OPERATIVE TIME: 3 HOURS                     USUAL LOCATIONS: Pres Main, Pres Day, ASC, NMHH
ASSISTANT: Yes, Cheryl or Gwen              ICD9 CODE: 611.1 Breast hypertrophy
                                            CPT CODE:19318 Breast Reduction

                  ANESTHESIA NOTES          GA: ETT or LMA, Kefzol 1gm IV

          PATIENT POSITION | SETUP          ! supine, 6 chux, arm s out on boards, covered with green
                                               towels and taped w/2" silk.
                                            ! Sequential teds
                                            ! tattoo kit: 22g needle, Kelly clam p, 3cc syringe 18g needle,
                                               4x4, non-sterile gloves
                                            ! Bovie electrocautery m achine at head of bead w/ suction
                      TABLE POSITION        pillow under knees, table in sem i-recum bent position

                          ROOM SETUP        Pre-warm room and table

                            EQUIPM ENT      ! Lower body Baer hugger, m etric digital scale,
                                            ! large specim en containers or sm all suction canisters for
                                               weighing tissue
                                            ! bag decanter
                                            ! W rapping boards
                                            ! for Day surgery and ASC - need headlight
                                 SPECIALS   Main OR need fluid warm er w/ plastic drape for Gwen

                                    PREP    CHG prep set, down to blue chux

 PACKS and DRAPING - Day Surgery            PLASTIC SURGERY PACK
                                            Day Surgery Laparoscopic chole drape (89233),
                                            [1-2] size 8 gloves for Dr. C,
                                            7½ Biogel and 7½ blue for Gwen
     PACKS and DRAPING - M ain OR           PLASTIC SURGERY PACK
                                            Laparoscopic chole drape, m ag pad, [3] quarter sheets, [2]
                                            m ayo stand covers, [6] sticky paper drapes, basic pack, 3
                                            gowns,
                                            [2] size 8 gloves Triflex, extra Micro-cool gown, cassette cover,
                                            fluid warm er drape
                                 CAUTERY    Bovie 50/50 pure with silver tip with Saf-T-Vac, bovie pad

                                 SUCTION    [2] suction: regular with plastic Yankauer and Saf-T-Vac
                                            [2] suction tubing
            SOLUTIONS | IRRIGATION          [3] liters Norm al saline, [2] liters sterile water

                NEEDLES | SYRINGES          [5] 20cc syringes, [2] long Quincke 22g spinal needles

                  LOCAL ANESTHETIC          Solution “C” 200cc - Mix 2%lidocaine w/epi 50cc +
                                            0.5%Marcaine w/epi 50cc + NS 100cc
                         M EDICATIONS       ! Bacitracin ointm ent 2 oz
                                            ! m ethylene blue (to m ark before prep)
103 BREAST REDUCTION - BILATERAL                            DR. CUADROS                     PAGE 2



  SETS TO OPEN                          Dr. C Plastic set, basin for Solution C

  INSTRUMENTS USED (ON M AYO STAND)
                          O FORCEPS     Martin 7x 8 tissue, 01 Adson, 03 Adson, regular adson

                         O SCISSORS     curved Mayo serrated, str Mayo, str Metz,

                   O NEEDLE HOLDERS     [3] Crile wood, [3] Mayo Hagar, [2] Olsen-Hagar

                      O RETRACTORS      none

                     O KNIFE | BLADES   [2] knife handles, [4] No. 10 blades

                            O OTHER     [2] Hem ostats for drains
                                        m etal kidney basins [bring for HHNM]
                                        !   [4] m arking pens
                                        !   [2] Asepto syringes
                                        !   [2] non-disposable light handles (Main OR)
                                        !   [4] No. 10 blades BP
          STERILE SUPPLIES
                                        !   [1] Bag decanter
                                        !   m ed glasses
                                        !   Basin set
                                        !   Saf-T-Vac
              SPONGES and TOW ELS       [6] Lap sponges, towel pack

             NON-STERILE SUPPLIES       W rapping board, large or m edium baby powder
                                        [3] Sm all suction canisters for weighing
                                        No        Type                        SN                       status
                                   M    [2]       3-0 Ethilon PS-1            1663               open
                                   M    [4]       2-0 Vicryl CT-1             J 945              open
                                   M    [6]       3-0 Vicryl SH               J 416              open
          SUTURES                  M    [2]       4-0 Vicryl PS-2             J 496              open
                                   M    [4]       4-0 Monocryl PS-2           Y 426              open
                                   M    [1]       5-0 Plain gut P3            686                          hold
                              DRAINS    [2] 15 Fr. Round Blake drains with connectors and reservoir
                                        bulbs - 2188.
                          DRESSINGS     '   [2]   tongue blades               '    [2]   ABD
                                        '   [2]   3x18 vaseline gauze         '    [2]   6" Ace
                                        '   [2]    4x4                        '    [2]   kerlix
                                        '   [2]    cut drain sponges          '    [2]   safety pins
                     POSTOPERATIVE      Call for bed from GSU x1046
                                        Baby powder to wrapping board, m edium or large
                                        Lift with 3 people
                                        Safety pin reservoirs to ace, m ark 1 & 2 with Sharpie
                              NOTES     weigh specim en on digital scale in sm all suction canister after
                                        zeroing. Record weight on board, chart operative report and
                                        card for Dr. C.
       TO TAKE TO HEART HOSPITAL        #   Saf-T-Vac suction catheter
                                        #   m etal kidney basin
                                        #   Dr.C gloves 7 ½ Protegrity Latex
                                        #   wrapping boards
  DATES MODIFIED                        May 2006, August 2007, October 2007, April 2008. May 2009, Oct 2010

								
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