Cervical Rib Resection Procedure

Cervical Rib Resection Procedure
Presentation by:April Carter RN,MSN,CNOR
NorthWest Florida State College

Objectives

* Assess the related terminology and pathophysiology of the lungs.
* Analyze the diagnostic interventions for a patient undergoing a cervical rib resection
* Plan the intraoperative course for a patient undergoing
* Assemble supplies, equipment, and instrumentation needed for the procedure.
* Choose the appropriate patient position
* Identify the incision used for the procedure
* Analyze the procedural steps for cervical rib resection.
* Describe the care of the specimen

Terms and Definitions
* Thoracic outlet: formed by the first ribs, spine, and sternum
Definition/Purpose of Procedure

* Decompression of the thoracic outlet through partial or entire removal of the rib
* Surgical Goal: release compression of the neurovascular tissue and restore neurovascular function to the affected upper extremity, neck, or shoulder

Pathophysiology
* Thoracic Outlet Syndrome
o Compression of the subclavian vessels and the brachial plexus at the apex of the thorax.
o Other names: cervical rib syndrome, first thoracic rib syndrome, costoclavicular syndrome, hyperabduction syndrome
o Classifications
+ Arterial thoracic (result compression of subclavian artery and results in severe ischemia of arm)
+ Neurological
+ Venous thoracic

Surgical Intervention:
Special Considerations
Surgical Intervention: Positioning
* Position during procedure
Surgical Intervention: Special Considerations/Incision
Surgical Intervention: Supplies
Surgical Intervention: Instruments
Thoracic Instrumentation
Surgical Intervention: Equipment
Surgical Intervention: Procedure Steps
Surgical Intervention:
Procedure Steps
Specimen & Care
Resources
For visualization of the pleurae, lower and middle mediastinum, and pericardium, the surgeon would need a:

* Thorascope
* Mediastinoscope
* Bronchoscope
* Laryngoscope
As the STSR, with which of the following procedures would you anticipate the use of chest tubes and a water-seal drainage system?
* Lobectomy
* Scalene Node Biopsy
* Percutaneous Transluminal Coronary Angioplasty
* Cardiac Pacemaker Insertion

Which of the following retractors would be most useful in a posteriolateral Thoracotomy?
* Balfour
* O’Sullivan-O’Connor
* Davidson scapula
* Weitlaner

With which of the following procedures would you expect the greatest amount of bleeding?
* Wedge Resection of the Lung
* Decortication of the Lung
* Open Thoracotomy fro Closure of a Ruptured Bulla
* Closure of a Patent Ductus Arteriosus

The removal of a lung is referred to as a/an:
* Pneumonectomy
* Endarterectomy
* Blalock-Hanlon operation
* Cryoablation

Cervical Rib Resection is performed to relieve:
* Thoracic Inlet Syndrome
* Thoracic Outlet Syndrome
* Adult Respiratory Distress Syndrome
* pneumothorax

The procedure performed to remove a fibrous covering from the lung following empyema formation is:
* Aneurysmectomy
* Thoracostomy
* Thymectomy
* Pulmonary Decortication

When two chest tubes are placed into the pleural space, the uppermost tube is used to:
* Evacuate air/re-establish negative pressure
* Evaluate blood/re-establish positive pressure
* Evacuate serous fluid/re-establish positive pressure
* Evacuate pus/re-establish negative pressure

When a rib is removed, the remaining bone edges are trimmed with a:
* Doyen raspatory
* Bethune shear
* Lebsche knife
* Stille-Luer rongeur

When transporting a patient with a closed water-seal drainage:
* The bottle should be kept at or above the height of the patient’s chest
* The chest tube should always be clamped
* Chest tube clamps should accompany the patient at all times
* The patient should be placed in Trendelenburg position

Mediastinoscopy is usually performed with the patient in what position?
* Lateral
* Sims
* Dorsal recumbent
* prone

Removal of air or fluid from the pleural cavity via needle aspiration is:
* Thoracoscopy
* Thoracotomy
* Hemocentesis
* Thoracentesis

Cervical Rib Resection Procedure.ppt