Definition. A hole in the septum between the right and left atria. Causes oxygen-poor blood and oxygen-rich blood to mix.

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1 HASPI Medical Anatomy & Physiology 13d Lab Activity adapted from You Gotta Have Heart: Congenital Heart Defects and Heart Surgery by Rebecca Johns & CDC. Name(s): Period: Date: Common Heart Defects Congenital heart defects can occur during formation of the heart during fetal development. These heart defects can affect the chambers, valves, blood vessels, or general structure of the heart. Some defects are life-threatening, while others may be asymptomatic. Surgical intervention can often help correct congenital heart defects. The following table gives examples of some of the most common forms of congenital heart defects. Type of Defect Definition Aortic Valve Stenosis (AVS) The aortic valve does not open/close sufficiently, allowing blood to leak through the valve. Causes pressure to build up in the heart from trapped blood. Atrial Septal Defect (ASD) A hole in the septum between the right and left atria. Causes oxygen-poor blood and oxygen-rich blood to mix. Coarction of the Aorta (CoA) Narrowing of the aorta that reduces blood flow. Causes high blood pressure and can result in damage to heart tissue. Complete Atrioventricular Canal Defect (CAVC) A hole between the right and left atria AND the right and left ventricles. Causes blood from all four chambers to mix. Patent Ductus Arteriosis (PDA) A hole in the aorta called the ductus arteriosis that allows blood to pass over the lungs. This hole is supposed to close naturally at birth, but sometimes does not and is left open, or patent. 527

2 Pulmonary Valve Stenosis Thickening of the pulmonary valve. Causes the valve to not open completely, and reduces the amount of blood able to flow through the heart. Tetralogy of Fallot A collection of four problems: 1. Hole between the right and left ventricles 2. Aorta lies over the hole 3. Right ventricle thickens 4. Blood flow from the heart to the lungs is blocked Ventricular Septal Defect (VSD) A hole in the septum between the right and left ventricles. Causes oxygen-poor blood and oxygen-rich blood to mix. Body Substance Isolation When working with patients, it is important to ensure that the environment is clean and that the safety of the patient and healthcare workers is a priority. Body substance isolation, or BSI, involves isolating body substances and fluids of the patient and healthcare workers to reduce the risk of disease transmission. These substances may include blood, feces, urine, and vomitus. BSI practices are universal in every healthcare/treatment setting. Personal protective equipment (PPE) used to ensure BSI may include: Non-sterile and sterile gloves Surgical face masks Safety goggles or masks Hospital gowns Shoe covers Hairnets Not all PPE is worn for every treatment or patient. For example, a healthcare worker taking a blood sample may only wear gloves and goggles. On the other hand, orthopedic surgery often requires all PPE and even doubling up on specific items, such as gloves, to ensure there is a reduced risk of bone infection transmitted by contamination during the surgery. All images in this table from:

3 Gown (chief surgeon only) Heart 12 Dissecting pins Surgical scrub brush Suture material Tape Hairnet Scalpel Pen/marker Facemask Forceps Soap Sterile gloves Dissecting pan Paper towels Dissecting kit (optional) Part A. Fix the Heart! Scenario Your surgical team has two procedures to perform today. Patient 111 is a 4-year-old male with an atrial septal defect (ASD) and a ventricular septal defect (VSD). These defects have created holes in the septum allowing oxygen-poor and oxygen-rich blood to combine. This prevents the patient from getting the amount of oxygen he needs. Choose Surgical Team Roles Everyone will switch roles between the two procedures. If you only have 3 members on your team, combine the responsibilities of both he scrub and circulating nurses. The chief surgeon will perform the incision and locate the defect The assisting surgeon will remove and suture the defect The scrub nurse will prepare and handle equipment for the surgeon The circulating nurse will oversee the procedure and ensure the directions are followed Prepare the Surgical Room Collect the dissecting pan (operating table) and the patient (heart). Place them at your lab table. Collect your scalpel, forceps, suture material, and dissecting kit (optional). Lay a paper towel out next to the operating table and lay each tool on the paper towel where it can easily be accessed during the surgery

4 Let s Scrub In! There is a protocol for scrubbing in and preparing for surgery. It may differ slightly from hospital to hospital. Follow the directions to prepare for surgery. Hand Washing and Scrubbing 1 Open the surgical scrub kit and place it near the sink. The surgical scrub kit will be shared amongst your surgical team. Use several drops of soap and work it into a heavy lather with 2 the hands. Wash the hands and arms all the way to the elbow. Rinse the soap from the hands and arms. 3 4 Remove the small plastic nail cleaner from the scrub kit. Clean under the fingernails under running water Lather the fingertips with the sponge of the brush, then use the bristle side to scrub under the fingernails of both hands. Use 30 circular strokes for each hand. Add soap and water to the brush at any time if it starts to get dry. Move to the fingers and use the sponge to lather the fingers. Use the bristle to scrub on all four sides of each finger, including between the fingers. Use 20 circular strokes for each hand. Lather the palm and back of the hand with the sponge. Use the bristles to scrub with 20 circular strokes for each hand. Lather the wrist and forearm with the sponge. Use the bristles to scrub with 20 circular strokes for each arm. 9 Thoroughly rinse hands and arms. Use a hand towel or paper towel to thoroughly dry the hands and arms. In an actual surgery, the towel would be sterile and you would avoid touching any surface that would contaminate your clean hands/arms. Gowning In this simulation, there may be only one gown for your team. In 1 this case, the chief surgeon will be wearing the gown and the team will assist the gowning process. The chief surgeon will now avoid touching anything, while the surgical team picks up the gown and lets it unfold. Open and 2 locate the sleeves/armholes. 3 Place arms into sleeves. The gown will tie at the back. Hold the arms up and out. Have the circulating nurse pull the gown closed in the back and tie the gown closed

5 Hairnet and Facemask 1 If you have long hair, secure it in a ponytail. Place your hairnet on your head, ensuring no hair is visible 2 outside the hairnet. The hairnet should cover your ears. The facemask will either loop behind the ears or tie at the back. 3 Once your facemask is on, it cannot be removed! If you have a hard time breathing with it on, you can pull the bottom out slightly for a breath of fresh air. Sterile Gloves Putting on sterile gloves is very different than non-sterile gloves. 1 The surface of sterile gloves cannot be touched by your hands or they will be contaminated! Place a pair of gloves on a paper towel with the thumbs facing 2 up. Fold the bottom cuff up exposing the inside of the glove (see image). FROM HERE ON OUT, YOUR HANDS SHOULD ONLY TOUCH THE INSIDE OF THE GLOVE! Using your non-dominant hand, grab the folded cuff of the glove 3 for your dominant hand. For example, if you are right-handed use your left hand to grab the cuff of the glove for your right hand. Pull the glove onto your dominant hand only using the folded cuff. 4 5 Now that you have one sterile glove on, you can only touch a sterile surface with the gloved hand! Slide your gloved hand under the cuff of the second glove. Pull the second glove onto your non-dominant hand. 6 Now you are ready for surgery (and you look good, too!) In an actual surgery, the room and equipment would also be sterilized. For this activity, we will assume that everything that has been setup has been sterilized. You should still avoid touching any part of your skin, hair, or clothes while wearing the sterile gloves. 531

6 Correcting the Atrial-Septal Defect Follow the procedure below to fix the atrial-septal defect. For the sake of this activity, the atrial-septal defect is marked by a black plastic object within the heart to make it easier to identify. Step 1 The circulating nurse will be responsible for keeping the surgical team on task and following these directions. Look at Diagram A to orient yourself on the parts of the heart. Place the heart on the operating table (dissecting pan) with the anterior surface facing up. Step 2 Step 3 Use a probe to locate the superior vena cava. Locate the right and left atria. Anterior Surface Atria The chief surgeon will carefully make an incision in the right atrium. Step 4 Right Atrium Once the incision has been made, the scrub nurse will use forceps to hold the Step 5 incision open, allowing the chief surgeon to locate the atrial-septal defect (marked with a black object). The assisting surgeon will use forceps or a probe to remove the atrial-septal Step 6 defect. (If this was an actual ASD repair, the hole in the septum would be sewn shut.) Once the ASD has been removed, the assisting surgeon and the scrub nurse will work together to suture the incision Step 7 created in the right atrium. If you learned suturing technique in an earlier lab, make sure to review and follow that technique. Call your instructor over to check your work. Show the instructor the black object Step 8 you removed, and your completed sutures. Step 9 Your team has successfully completed the repair of the atrial-septal defect! 532

7 Correcting the Ventricular-Septal Defect Follow the procedure below to fix the ventricular-septal defect. For the sake of this activity, the ventricular-septal defect is marked by a white plastic object within the heart to make it easier to identify. Step 1 Step 2 Exchange roles. The new chief surgeon will need to wear the gown. The circulating nurse will be responsible for keeping the surgical team on task and following these directions. Look at Diagram A to orient yourself on the parts of the heart. Place the heart on the operating table (dissecting pan) with the anterior surface facing up. Use a probe to locate the aorta. Locate the right and left ventricles. Step 3 The chief surgeon will carefully make an incision in the left ventricle. Step 4 Once the incision has been made, the scrub nurse will use forceps to hold the Step 5 incision open, allowing the chief surgeon to locate the ventricular-septal defect (marked with a white object.) The assisting surgeon will use forceps or a probe to remove the ventricularseptal defect. (If this was an actual Step 6 VSD repair, the hole in the septum would be sewn shut.) Once the VSD has been removed, the assisting surgeon and the scrub nurse will work together to suture the incision Step 7 created in the left ventricle. If you learned suturing technique in an earlier lab, make sure to review and follow that technique. Call your instructor over to check your work. Show the instructor the white object Step 8 you removed and your completed sutures. Step 9 Your team has successfully completed the repair of the ventricular-septal defect! 533

8 Part B. Heart Dissection Now that you have had the opportunity to fix the heart. It is time to take a closer look at the structures of the heart. You can choose to keep or exchange your group roles. Step 1 Obtain 12 dissecting pins, a marker/pen, and a long piece of masking tape. Tear a 2 to 3-inch piece of masking tape from the long piece of tape. Wrap it Step 2 around the dull end of one of the dissecting pins, and push the sticky sides together. Repeat this process for all 12 of the dissecting pins. Using the marker/pen, write each of the 12 heart structures listed in Table 1 on the Step 3 tape wrapped around the dissecting pins. The labeled pins will eventually be placed into the structure of the heart listed on each pin. Place the heart on the operating table (dissecting pan) with the anterior surface facing up. Step 4 Step 5 The chief surgeon will carefully make an incision ventrally to cut the heart in half starting at the apex. You may have to cut through some of the sutures you made in Part A. Open the heart to expose the internal structures. Step 6 Step 7 Step 8 Step 9 Step 10 Step Use the comparison Diagram A to place the 12 labeled dissecting pins into the heart in the correct locations. Once all of the pins have been placed, call your instructor over to check your work. Incorrectly placed pins will be marked with an X in Table 1 by your instructor. Practice memorizing the parts of the heart by turning the label around and identifying the location of each pin aloud in your group. Continue until you are able to identify all 12 pins without looking. Remove the pins from your heart and discard the heart according to your instructor s directions. Remove all of your PPE starting with the gloves first, followed by the hairnet, gown, and facemask last. The gowns will be saved and collected. Discard the rest and wash your hands.

9 Diagram A 535

10 Table 1. Structures of the Heart Heart Structure 1 Right atrium 2 Tricuspid valve 3 Right ventricle 4 Papillary muscle 5 Apex 6 Left ventricle 7 Interventricular septum 8 Chordae tendneae 9 Bicuspid valve 10 Left atrium 11 Aortic semilunar valve 12 Aorta Correct Placement (Your instructor will check your work and X any structure that was incorrectly placed on your sheep heart) Label the heart diagram below with all of the structures from Table

11 Analysis Questions - on a separate sheet of paper complete the following 1. In this activity, you simply removed an object to signify correcting the atrial- and ventricularseptal defects. How would ASD and VSD be corrected if this was a real surgical setting? 2. Why must ASD and VSD be corrected? 3. What was the purpose of wearing PPE during the surgery? 4. Why is it important to wear sterile gloves during a surgical procedure? 5. Why is it important to have a surgical team, rather than an individual surgeon? 6. Why was it important to make sure you were at the anterior surface of the heart before making an incision? 7. Describe the path of blood through the heart, starting at the superior and inferior vena cava and leaving the aorta. 8. CONCLUSION: In 1-2 paragraphs summarize the procedure and results of this lab. Review Questions - on a separate sheet of paper complete the following 1. What is a congenital heart defect? 2. Choose 3 of the common heart defects, give an explanation, and draw an image showing the defect. 3. What is body substance isolation and why is it important? 4. List 3 body fluids that could transmit disease. 5. What does personal protective equipment include? 6. Why is PPE important in a healthcare setting? 537

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