130 EVACUATION HEMATOMA BREAST


This operation is done as an emergency following a previous breast reduction


March 19, 2016 PAGE 1

 

OPERATIVE TIME: 1 HOUR

USUAL LOCATION: Pres Main

ASSISTANT: Sometimes, Gwen

FREQUENCY 2-3/years, as emergency add-on procedure

ICD10 CODE: M79.81 POSTOP HEMATOMA

CPT CODE:19020 MASTOTOMY FOR DRAINAGE

 

ANESTHESIA NOTES

GA: ETT or LMA, Kefzol 1gm IV

PATIENT POSITION | SETUP

supine, 6 chux, arms out on boards, covered with towels and taped, 2" silk. Sequential teds

TABLE POSITION

pillow under knees

ROOM SETUP

Pre-warm room and table

 

EQUIPMENT

■ Lower body Baer hugger

■ Wrapping board

■ Headlight with light source

● Wrapping boards - medium and large

● [1-2] rolling stools in room

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

PREP

CHG prep set, 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

 

SOLUTIONS | IRRIGATION

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

NEEDLES | SYRINGES

20cc syringe, 22g spinal needle

LOCAL ANESTHETIC

 [2] 0.25%Marcaine w/epi 30cc

MEDICATIONS

Bacitracin ointment 2 oz

130 EVACUATION HEMATOMA BREAST (emergency)

  PAGE 2

 

SETS TO OPEN

Dr. C Plastic set and retractor set

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

01 Adson, 03 Adson, 08 Adson, regular Adson

     SCISSORS

curved Mayo serrated, str Mayo, str Metz,

     NEEDLE HOLDERS

[3] Mayo-Hagar for 2-0 Vicryl

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

     RETRACTORS

Breast retractor, Gold retractor

Deaver, army-navy, Richardsons

     KNIFE | BLADES

[2] No. 10 blades

     OTHER

[2] Hemostats for drains

 

STERILE SUPPLIES

■ [2] Asepto syringes

■ [2] non-disposable light handles

■ [2] No. 10 blades BP

■ Basin set (in pack)

SPONGES and TOWELS

[6] Lap sponges, towel pack

NON-STERILE SUPPLIES

 

 

 

No

Type

SN

status

SUTURES 

[ 2 ]

3-0 Ethilon PS-1

1663

open 1

hold 1

[ 4 ]

2-0 Vicryl CT-1

J 945

open 2

hold 2

[ 6 ]

3-0 Monocryl SH

Y 416

open 3

hold 3

[ 4 ]

4-0 Monocryl PS -2

Y 426

open 2

hold 4

[ 1 ]

5-0 Plain gut P3

686

open 1

 

 

DRAINS

[1-2] 15 Fr. Round Blake drains with connectors and reservoir bulbs - 2188.

DRESSINGS

(hold all)

[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

 

DATES MODIFIED

Nov 2008, July 2009, Dec 2012, Marc 2016