conduct of perfusion
Download
Skip this Video
Download Presentation
CONDUCT OF PERFUSION

Loading in 2 Seconds...

play fullscreen
1 / 32

CONDUCT OF PERFUSION - PowerPoint PPT Presentation


  • 94 Views
  • Uploaded on

CONDUCT OF PERFUSION. October 16, 2003 Brian Schwartz, CCP. PURPOSE OF CPB. PROVIDE SURGEONS WITH A MOTIONLESS AND BLOODLESS FIELD PROVIDE PROTECTION TO VITAL ORGAN SYSTEMS. Your Objectives. Understand the components of the CPB circuit Understand the sequence for assembly of the circuit

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' CONDUCT OF PERFUSION' - maite-christensen


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
conduct of perfusion

CONDUCT OF PERFUSION

October 16, 2003

Brian Schwartz, CCP

purpose of cpb
PURPOSE OF CPB
  • PROVIDE SURGEONS WITH A MOTIONLESS AND BLOODLESS FIELD
  • PROVIDE PROTECTION TO VITAL ORGAN SYSTEMS
your objectives
Your Objectives
  • Understand the components of the CPB circuit
  • Understand the sequence for assembly of the circuit
  • Able to calculate the predicted hemoglobin and hematocrit
  • Understand the determinants of oxygen consumption
conduct of perfusion1
Conduct of Perfusion
  • Purpose of CPB: support patient’s metabolic needs while providing a motionless, bloodless cardiac surgical field
      • Parameters that must be met:
          • Proper flow rate
          • Oxygen delivery
          • Carbon dioxide removal
          • Anticoagulation
          • Temperature
          • Blood pressure
          • Blood recovery
components of the cpb circuit
Components of the CPB Circuit
  • Oxygenator
  • Heat exchanger
  • Venous reservoir
  • Gas flow meter
  • Variety of pumps
  • Tubing
  • Cannulae
  • Hemoconcentrator
  • Alarms
  • Drugs
assembly
Assembly
  • The set up is dependent upon:
      • Procedure
      • Patient size
      • Surgeon’s preference
      • Perfusionist’s preference
conduct of perfusion2
CONDUCT OF PERFUSION
  • WE ARE TALKING ABOUT OUR DUTIES AND RESPONSIBILTIES PRE-OP, INTRA-OP, AND POST-OPERATIVELY
the perfusionist s time line
THE PERFUSIONIST’S TIME LINE
  • GET A HANDLE ON THE SCHEDULE
  • REVIEW PATIENT’S CHART
  • SELECTION OF DISPOSABLE EQUIPMENT
  • ASSEMBLE HLM
  • PLUG IN POWER AND GAS LINES
  • PLUG IN HEATER/COOLER (WATER TEST)
time line cont
Time Line (cont)
  • CO2 flush the circuit
  • Prime the circuit
  • Test all occlusions
  • Check list
  • Perform all quality controls
  • ALWAYS BE PROPARED TO GO ON CPB
time line continued
TIME LINE (CONTINUED)
  • PRIME CIRCUIT
  • PERFORM CHECK LIST
  • ADMINISTRATION OF HEPARIN
  • INITIATION OF CPB
  • TERMINATION OF CPB
  • ADMINISTRATION OF PROTAMINE
  • BREAKDOWN AND CLEANUP OF HLM
pre bypass calculations
PRE-BYPASS CALCULATIONS
  • PREDICTED HEMATOCRIT
    • 70 X KG = TBV
    • TBV X HCT = TRBC
    • TBV + PRIME + ANES. DRIPS = TCBV
    • TRBC/RCBV = DILUTIONAL HCT
pre bypass calculations1
PRE-BYPASS CALCULATIONS
  • HCT IF SEQUESTERING BLOOD
    • TRBC – { 500 cc x HCT } / TCBV – 500 cc
heparin administration
HEPARIN ADMINISTRATION
  • DESCRIBED AS AN ANTICOAGULANT
  • MUST FULLY ANTICOAGULATE PATIENT
  • SITE OF ACTION: ATlll AND INHIBITS FACTORS IX AND XI OF THE CLOTTING CASCADE
  • GIVE 300-400 UNITS/KG
    • IN RIGHT ATRIUM OR CENTRAL LINE
heparin continued
HEPARIN ( CONTINUED )
  • HALF LIFE = 1-2 HOURS
  • 3-5 MINUTES AFTER ADMINISTERING TAKE AN ACT…..MUST BE >480 SECONDS
  • SOME PATIENTS MAY BE HEPARIN RESISTENT
    • THEY ARE ATIII DEFICIENT
    • GIVE FRESH FROZEN PLASMA
cannulation
CANNULATION
  • SURGEONS NOW PLACE THE CANNULAE INTO THE HEART
  • VENOUS CANNULAE
    • IN RIGHT ATRIUM WITH 2 STAGE
    • SINGLE STAGE IN THE IVC AND THE SVC
cannulation1
CANNULATION
  • ARTERIAL CANNULAE
    • AORTA OR FEMORAL ARTERY
  • RETROGRADE CARDIOPLEGIA
  • ANTEGRADE CARDIOPLEGIA
  • VENT
purpose of vent
PURPOSE OF VENT
  • PLACED IN THE AORTIC ROOT OR IN THE LEFT VENTRICLE
  • USED TO PREVENT DISTENTION OF THE HEART
  • USE A ONE-WAY VALVE
initiation of bypass
INITIATION OF BYPASS
  • SURGEONS READY TO BEGIN CPB. THEY WILL TELL YOU TO “GO ON”
    • ALWAYS REPEAT COMANDS BACK TO AVOID MISTAKES
  • PUT 02 ON 100%, SWEEP ON, REMOVE ARTERIAL CLAMP, SLOWLY TURN PUMP ON. CAREFULLY MONITOR ARTERIAL LINE PRESSURE !!!!!!!!
bypass
BYPASS
  • UNCLAMP VENOUS LINE AND INCREASE FLOW TO YOUR 2.4 INDEX
  • IF YOU SENSE A HIGH LINE PRESSURE AS YOU INITIATE BYPASS…IMMEDIATELY TERMINATE BYPASS!!!!!!
causes of high aortic line pressure
CAUSES OF HIGH AORTIC LINE PRESSURE
  • KINK IN THE A-LINE
  • CANNULAE IMPROPERLY POSTIONED
  • CROSS-CLAMP TOO CLOSE TO CANNULAE
  • ARTERIAL CANNULAE TOO SMALL
  • SYSTEMIC PRESSURE TOO HIGH
  • AORTIC DISECTION
  • ARTERIAL FILTER OBSTRUCTED
causes of poor venous return
CAUSES OF POOR VENOUS RETURN
  • KINK IN VENOUS LINE OR CANNULA
  • AIRLOCK
  • OXYGENATOR IS NOT POSITIONED LOW ENOUGH
  • VENOUS CANNULA PLACED TO FAR DOWN INTO THE CAVA
  • VENOUS CANNULA FALLS OUT
chattering
CHATTERING
  • A TERM USED IF THE HEART IS COMPLETELY EMPTY AND YOU SEE THE VENOUS LINE JUMPING AROURD
  • CHATTERING IS CAUSED BY EXCESSIVE NEGATIVE PRESSURE IN THE VENOUS LINE CAUSING A SUCTION EFFECT….SIMPLY PLACE A CLAMP (PARTIALLY) ON THE VENOUS LINE TO REDUCE THE NEGATIVE PRESSURE
saftey checks to do on bypass
SAFTEY CHECKS TO DO ON BYPASS
  • FLOWING AT PROPER RATE
  • A-LINE PRESSURE IN NORMAL
  • OXYGEN IS ON AND THAT ARTERIAL BLOOD IS RED….COMPARE A/V LINES
  • O2 SAT’S NORMAL
  • MAP BETWEEN 50-70
  • TEMP’S
  • ACT>480
  • MAKE SURE ALL SAFETY DEVICES ARE ON
monitoring
MONITORING
  • EKG
    • WHILE THE CROSS-CLAMP IS ON THERE SHOULD BE NO ACTIVITY
    • WHEN CLAMP COMES OFF, BE ON THE LOOK OUT FOR ST ELEVATIONS, V-TACH, AND V-FIB
  • PA PRESSURES
  • CIRCUIT
  • OPERATING TEAM
  • KEEP COMMUNICATION OPEN
  • TRAFFIC AROUND PUMP
charting
CHARTING
  • VITAL SIGNS MUST BE TAKEN EVERY 15 MINUTES
  • ACT’S MUST BE TAKEN EVERY 30 MIN
  • BLOOD GASES MUST BE TAKEN EVERY 30 MINUTES OR AFTER CHANGES HAVE BEEN MADE
    • FIRST BLOOD GAS SHOULD BE TAKEN 5-10 MINUTES AFTER CPB
    • DON’T FORGET TO GET A WARM GAS BEFORE TERMINATING BYPASS
normal arterial gas
NORMAL ARTERIAL GAS
  • pH: 7.35-7.45
  • p02: Greater than 100
  • 02 Sat: 96-100%
  • K+: 3.5-5.3
  • BICARB: 22-28 MEQ/L
  • BE: -2.5 TO + 2.5
normal venous gas
NORMAL VENOUS GAS
  • pH: 7.35-7.39
  • P02: 38-42
  • 02 Sat: 65-75%
  • pCO2: 44-48mmHG
  • Bicarb: 22-28 mmHG
  • BE: -2.5 to +2.5
determine oxygen consumption
Determine Oxygen Consumption
  • Oxygen content=1.34 x Hb x Sat + .003xp2
  • Oxygen Capacity =1.34 x Hb + .003 x pO2
  • Oxygen Saturation = O2 content/ Capacity
  • Oxygen Consumption= aO2 content – vO2 content x flow (L/min) X 10
calculate amount of bicarb to give
CALCULATE AMOUNT OF BICARB TO GIVE
  • WT (KG) X BASE DEFICIT X .3
  • EQUATION #1 DIVIDED BY 2 = AMOUNT OF BICARB TO GIVE

EXAMPLE: 70 X 3 X .3 = 63

63 / 2 = 32 mEq

post bypass
POST BYPASS
  • MONITOR PATIENTS HEMODYNAMICS
  • NEVER DISMANTLE PUMP UNTIL CHEST IS CLOSED
  • PROTAMINE
      • MANY PATIENTS HAVE REACTION
      • TURN OFF PUMP SUCKERS
      • MONITOR PA AND MAP
protamine reactions
PROTAMINE REACTIONS
  • TYPE I
    • SYSTEMIC HYPOTENSION
    • REDUCED SVR
  • TYPE II
    • ANAPHYLACTIC REACTION RESULTING IN HYPOTENSION, BRONCHOSPASM, AND EDEMA
  • TYPE III
    • CATASTROPHIC PULMONARY VASOCONSTRICTION WITH INCREASED PA PRESSURES, HYPOTENSION, DECREASED LA PRESSURES, AND DILATED RIGHT VENTRICLE
clean up
CLEAN-UP
  • SEND ALL BLOOD TO CELL SAVER
  • DISMANTLE TUBING
  • CLEAN UP PUMP FOR ANY BLOOD STAINS
  • PAPER WORK
  • SET UP BACK UP PUMP
  • SET UP BACK UP CELL SAVER
ad