Conduct of perfusion
Download as PPT, PDF46 likes13,348 views
1. Conduct of perfusion begins hours before CPB and involves assembling equipment, reviewing patient charts, calculating parameters, and priming the circuit. 2. Prior to initiating CPB, the perfusionist completes a safety checklist and confirms that all components are properly set up and functioning. 3. Once CPB begins, the perfusionist continuously monitors various parameters like blood flow, pressure, and oxygen levels and makes adjustments as needed throughout the procedure.
Conduct of perfusion
- 1. CONDUCT OF PERFUSION NS. Ida Simanjuntak, S.Kep Perfusionist, National Cardiovascular Center Harapan Kita, Jakarta
- 2. Overview Conduct of perfusion begins hours before the start of actual CPB procedure
- 3. Pre-Bypass 1.Begins with the posting of the operating schedule Perfusionist must assemble specific information about the scheduled procedure Specific information about the scheduled procedure : Surgeon, patient’s data, diagnoses, procedure, time of operation
- 4. 2.Review of the patient’s hospital chart Information is recorded on the perfusion record 3.Selection of the disposable equipment and perfusion circuit using existing protocols 4.Assembly of the cardiopulmonary bypass circuit 5. Calculation of BSA, BV, cardiac indeks and blood flow 6. Size of cannulae 7. Drug dose l and laboratories 8. Predicted hemoglobin and hematocrits
- 5. 9. Setting up the HLM & oxygenator 10. Priming the oxygenator 11. Initiating CPB 12. Saffety device on 13. Siapkan es batu
- 6. Pre-Bypass checklist • Patien data entered • oxygenator holder in right place and secure • pump sircuit tubing secure without kinks • luer connectiont tight • gas line connected • gas line not leaking and obstructed • gas supply operational, blenders and vaporizers working • gas exhaust cap removed • power cord secure • back power available • handcranks available • backup light source available • water lines connected
- 7. cont • Water heater-cooler operable and warming • oxygenator checked for leaks (before priming) • occlusion set on roller pump • arterial filter primed • cardioplegiasystem primed and at proper temp • drugs added to cardioplegia • suckers and vent in proper • vent valve in proper direction • pressure tranducers calibrated • level detector operable • bubble detector operable • pressure warning-turn off device operable • temp probes connected • oxygen analizer calibrated • in-line sensor calibrated • supply and backup components available •
- 8. Initiating CPB • “Lines down” connects between table lines & pump lines (in a sterile manner) Debubble • Surgeon : “Heparin in” • Anesthesiologist give heparin ACT check. • “Speed up (speedy)” fast circulating the priming solutions, make sure no bubble exist. • “Stop” debubbling stopped, venous lines clamped. Surgeons prepare to do cannulation • ACT > 300 sec Pump suckers on
- 9. • Insert drugs and manitol • Resirculated of the priming solution • Oksigen on • Before cannulation of the aortic cannula, surgeon will ask the perfusionist to roll forward, to fill in the tubing with priming solution and to make sure no bubble exist. • Reply : “Forward”.. • After the aortic cannula is unclamp, surgeon : “Open to you”. • Reply : “Open/Ok”, check the pressure fluctuation on the pressure module of the pump. • Inform surgeon. Feel for pulsation the arterial line tubing • ACT > 480 ready to on bypass
- 10. • Clamp the venous tubing by occluder • Venous saturation monitoring on • On bypass • Timer on • Increase flow by open the venous tubing slowly until full flow. Contionous Monitoring on CPB : – Reservoir level – pressure line – blood pressure – flow rate – ECG – venous oksigen saturation 65%-75% • Surgion setting the canul of cardioplegia (antegrade - retrograde) • Coolling
- 11. • Surgion : plegic breffing - ok stop • Surgion : solution breffing - ok stop • Surgion : plegic breffing - ok stop • Surgion : solution breffing - ok stop • Surgion : ready to cross clamp ? • Reply : ready • Surgion : low flow, vent high clamp on • Plegic on/ timer plegic on • Cek blood gas, elektrolit and blood sugar after plegic pass in 5 min (temp 28-30) • Plegic on every pass in 10/15/20 min • Surgion : low flow, vent high clamp off • weaning - weaning • of bypass
- 12. Continous Monitoring During CPB • Reservoir level • Blood flow at proper rate/flow rate • Pressure line/arterial line pressure • Blood pressure/patient’s arterial pressure 50-90 mmHg • Oxigen saturation • Temperature appropriate • ECG • Venous oksigen saturation 65%-75%
- 13. Intermittent Monitoring During CPB • Urine output minimal 0,5-1 ml/kgBB/jam • blood gas • electrolit • ACT > 480 sec
- 14. Causes of aortic cannula high line pressure 1. Kink in arterial cannula or line 2. Cannula improperly positioned 3. Clamp too near cannula 4. Cannula to small 5. Arterial systemic blood pressure very high 6. Aortic disection 7. Blockage in arterial filter
- 15. Causes of poor venous return 1. Kink in the venous line or cannula 2. Airlock in the venous line or canunla 3. Oxygenator or venous reservoir is not positioned low enough 4. Non cardiac suction being used instead of pump suckers 5. Fluid rapidly moving to interstitial area, due to decreased intravascular 6. Venous cannula placed too far dawn or up, and vena cava not draining 7. Vent or cardioplegia line inadvertently open and draining blood on field 8. Bleeding due to accidental laceration or puncture in back of heart 9. Bleeding due to other causes such as a bleeding ulcer
- 16. The blood flow to various organs while at rest or on bypass are : BRAIN HEART KIDNEYS LIVER 15 % 4-5% 27% 29%
- 17. Causes of no urine production 1. Kinked or disconected foley catheter or tubing 2. Catheter with tip obstructed by gel 3. Decreased blood pressure 4. Low pump flows 5. Fluid moving to interstitial space
- 18. Corrective Action 1. Straighten or connect tubing 2. Push on bladder 3. Give vasopressors 4. Increase flows 5. Use mannitol or lasix
- 19. Temperature Temperature Cardiac indeks FIO2 Gas/blood flow ratio 37 C 2.4 L 80 1:1 34 C 2.2 L 70 8:1 30 C 2.0 L 65 7:1 28 C 1.8 L 60 6:1 22 C 1.6 L 50 5:1
- 20. Weaning From CPB • Termperature normal • No artimia in ECG • Blood gas and electrolit normal • Ventilator on
- 21. Initiating of bypass 1. Mean Arterial Pressure at least 90-100 2. PA 30/15 mmHg 3. CVP 5-15
- 22. Daftar Pustaka • Brodie,E, John. (1997). The Manual Of Clinical Perfusion. Second ed. USA. Glendale Medical Corporation. • Gravlee, P, Glenn. (2008). Cardiopulmonary bypass. Third ed. USA. Lippincott. • Hidayat, Kuswara. (2005). Penatalaksanaan CPB pada Tn. AA dengan Coronary Artery Bypass Graft (CABG) di ruang bedah RS Pusat Jantung Nasional Harapan Kita. Jakarta