103 BREAST REDUCTION - BILATERAL





Updated July 3, 2016

PAGE 1

 

OPERATIVE TIME: 3 HOURS

USUAL LOCATIONS: Pres Main, Kaseman, Lovelace Woman’s

ICD10 CODE: N62Breast hypertrophy

CPT CODE:19318 Breast Reduction

 

ANESTHESIA NOTES

GA: ETT or LMA, Kefzol 1gm IV; fluid warmer

PATIENT POSITION | SETUP

● supine, 6 chux, arms out on boards, covered with green

    towels and taped w/ 2" silk.

● Sequential pneumatic compression devices

tattoo kit: 22g needle, Kelly clamp, 3cc syringe 18g needle,

    4x4, non-sterile large vinyl gloves

● Bovie machine and suction at head of bed

TABLE POSITION

pillow under knees

ROOM SETUP

Pre-warm room to 70o; place Baer hugger on OR table prior

Bring patient back wrapped with warm blankets

 

EQUIPMENT

● Lower body Baer hugger

● Digital scale

● [3] specimen containers or suction canisters for weighing

● bag decanter

● Wrapping boards - medium and large

● [1-2] rolling stools in room

***new*** Dornoch OR Fluid Waste Management System

PREP

CHG (chlorhexidine) prep, down to blue chux

STERILE PACKS and DRAPING

PLASTIC SURGERY PACK

Laparoscopic chole drape

[2] size 7½ Protegrity latex gloves for Dr. C

[1] ea 7½ Biogel and 7½ blue for Gwen

[6] sticky paper drapes

[1] mag pad

[2] half sheets to cover arms; [1] bottom sheet

[2] mayo stand covers -> cut one in half for draping

CAUTERY

Bovie 50/50 pure with Covidien coated tip

Saf-T-Vac

bovie pad

SUCTION

[2] suction: regular with plastic Yankauer and Saf-T-Vac

[2] suction tubing - head of bed

***new*** Dornoch OR Fluid Waste Management System

 

SOLUTIONS | IRRIGATION

[3] liters Normal saline, [2] liters sterile water

NEEDLES | SYRINGES

[3] 20cc syringes, [3] long Quincke 22g spinal needles

LOCAL ANESTHETIC

Solution “C” 200cc - Mix 2%lidocaine w/epi 50cc + 0.5%Marcaine w/epi 50cc + NS 100cc

MEDICATIONS

● [2] Bactroban ointment tubes

● methylene blue (to mark before prep)

 

 

TO BRING TO OTHER FACILITY

(Lovelace Woman’s Hospital)

● Dr. C Plastic/Breast set

● Vinyl gloves

● digital scale

● [1] Kelly clamp

● [2] Saf-t-Vac

● [2] Blake 15 fr drains

● [2] Soft sponge packs

● [4] sterile marking pens

● [2] coated bovie tip

● wrapping board

● baby powder

● Sharpie

● [2] tongue depressors

● [1] package of 2 large safety pins

● [2] 7½ Protegrity latex gloves

● [3] copies of this Preference Sheet

103 BREAST REDUCTION - BILATERAL PAGE 2

SETS TO OPEN:

► Dr. C Plastic set, metal basin for Solution C

    ► Dr. C metal pan set

          2 Mayo stands

 

INSTRUMENTS USED (ON 2 MAYO STANDS)

     FORCEPS

Martins, 01's Adson, 03's Adson, 08's 6" Adson

     SCISSORS

curved Mayo serrated, str Mayo, str Metz, Lister bandage

     NEEDLE HOLDERS

[3] Mayo-Hagar for 2-0 Vicryl

[4] serr Aesculup Crile-Wood for 3-0 & 4-0 Monocryl

     RETRACTORS

none

     KNIFE | BLADES

[3] round knife handles w/ [6] No. 10 blades

     OTHER

[2] hemostats for drains

[1] large metal kidney basin

[3] towel clamps to lift breast flaps

     SUPPLIES

 

STERILE SUPPLIES

[4] Devon green double ended marking pens

[2] Asepto syringes

[2] non-disposable light handles

[6] No. 10 blades BP ***Do not use from pack***

[1] Bag decanter

[1] Basin set - Hold for Kaseman

[1] Saf-T-Vac

[5] 20cc syringes

[4] long Quincke 22g spinal needles

SPONGES and TOWELS

[6] Lap sponges, [2] towel packs

NON-STERILE SUPPLIES

Wrapping board, large or medium, baby powder

[3] specimen containers or small suction canisters for weighing

 

 

No

Type

SN

status

SUTURES

[ 2 ]

3-0 Ethilon PS-1

1663

open

 

[ 4 ]

2-0 Vicryl CT-1

J 945

open

 

[ 6 ]

3-0 Monocryl SH

Y 416

open

 

[ 4 ]

4-0 Monocryl PS -2

Y 426

open

 

[ 1 ]

5-0 Plain gut P3

686

open

 

 

DRAINS

[2] 15 Fr. Round Blake cat #2228 drains with connectors and reservoir bulbs - [do not use Bard]

DRESSINGS

[2] tongue blades

[2] 3"x18" Vaseline gauze

[2] packs 4"x4" soft sponges

[2] drain sponges

[2] 22g tube Bactroban ointment

[2] ABD pads

[2] 6" Ace

[2] Kerlix

[2] safety pins

bandage scissors

 

POSTOPERATIVE

Baby powder to wrapping board, medium or large

Lift with 3 people

Safety pin reservoirs to ace, mark 1 & 2 with Sharpie

NOTES

Weigh specimen on digital scale in small suction canisters after zeroing. Record weight on board, chart in operative report and card for Dr. C.

 

DATES MODIFIED

May 2006, Aug 2007, Oct 2007, Apr 2008, May 2009, Oct 2010, Mar 2012,

May 2012, Jan 2013, Feb 2013, Mar 2013, Jun 2014, Sept 2014, Dec 2014, Aug 2015, Mar 2016, Jul 2016