scrubbing AAA

NabiRN, BSN, RN · May 2, 2009

This message is a little bit late since you probably have already scrubbed the case. You can go to AST.org (Association of Surgical Technologists) and do a search on their web site for articles. AORN.org also has articles for members.

Hope you had fun with the procedure. Great anatomy in those cases. Just make sure you have those lumbar sutures and the big cherry clamp ready.

GadgetRN71, ASN, RN · May 4, 2009

Hi everyone, I was wondering if someone can help me , I am being trained to scrub and tomorrow I will be doing a
aaa. I do have Alexander's but I need to get into specifics. Like for example when to get the shods ready, or when to get the vascular clamps ready, what to have on the mayo after clamping the aorta ..etc.. I know it may seem like common sense to some but I am really nervous, I have circulated AAA but have not scrubbed it. Or if someone can direct me to a website that has those step by step type of thing. Any help would be greatly appreciated and will help me go to bed tonight Thanks !

Will you be scrubbing this alone the first time? I hope not..that's not fair to the patient or you.

Anyway, when I scrubbed these I did the shods up early , when I was setting up. I did several ruptured AAAs-so on the mayo I'd have a variety of clamps and if I had time, I'd ask the doc which one of the big clamps he or she wanted for the aorta..the ruptured ones move very fast. I had suction ready, a buttload of sponges. Pretty much anything I could get ready ahead of time I did, like the suture for the iliacs etc. Good luck. PS..at some point you will need the longer instruments..that just comes down to paying attention to where they are at in the surgery. To start, you will need the instrumentation to dissect down to the aorta..scissors, schnidts, kelly clamps the basics.

Scrubby · May 6, 2009

I haven't done one in years but my advice is to have your prolene or whatever vascular sutures ready and loaded and your shods ready at the start of the case.

From my sketchy memory they make a midline incision, they check the bowel for any perforations (if there is a bowel perforation then they may not go ahead with the case because of the risk of infection) then they'll sling the bowel around with some damp sponges/hutt towels. The deeper they go then the longer the instrument.

If you see them dissect around the iliacs then have a lahey/mixter handy. Next will come the vessel loop/sling and have an artery clip ready so they can clamp the ends of the loop.

I have seen surgeons clamp the iliacs first. At my hospital they use the wiley hypogastric clamp for this, i have no idea what they call this in the US.

After clamping the aorta they'll open up the aortic sack so have some scissors ready i.e curved mayo. When they open the aortic sack have a kidney dish ready for them because they'll scoop the contents of the aortic sack into it. This keeps your sterile field cleaner as well.

They then suture the sack closed with prolene, a 3-0 (probably...)

When handling the vascular graft (or any prosthesis) avoid handling it with your hands to decrease the risk of infection. An infected aortic graft would be very bad for the patient. , use a rochester/howard kelly clamp when taking it from the scout nurse and keep it in a clean dish.

And have double suction going at all times. I've seen them prang the spleen with a bookwalter retractor during a AAA which resulted in huge blood loss.

I can't think of anything else.