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Peds > 2. Circuits- Exam 1 > Flashcards

2. Circuits- Exam 1 Flashcards

1
Q

define neonatal and pediatric in regards to age

A

Neonatal: < 30 days
Pediatric: up to 18 yo (< 18)

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2
Q

Pediatric patients are ___ small adults

A

NOT

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3
Q

Neonates have higher or lower metabolic demands

A

higher

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4
Q

Neonates have immature myocardium. When does it mature and what is the immature myocardium prone to?

A

matures 3-12 months

Immature myocardium prone to “stretch injury”

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5
Q

Neonates utilize what for of energy consumption

A

glucose oxidation

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6
Q

What form of blood gas management do neonates utilize?

A

Utilize alpha-stat and pH-stat blood gas management

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7
Q

Adults utilize what for energy consumption?

A

fatty acid dependent

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8
Q

What form of blood gas management do adults utilize

A

Utilize mostly alpha-stat and some pH-stat blood gas management

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9
Q

<10 kg= _____ cc/kg blood volume

A

85 cc/kg

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10
Q

11-20 kg= _____ cc/kg blood volume

A

80 cc/kg

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11
Q

21-30 kg= _____ cc/kg blood volume

A

75 cc/kg

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12
Q

31-40 kg= _____ cc/kg blood volume

A

70 cc/kg

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13
Q

> 40 kg= _____ cc/kg blood volume

A

65 cc/kg

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14
Q

Circuits fitting for Neonatal Pack

A

3/16” x ¼”

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15
Q

Circuits fitting for Infant Pack

A

¼” x ¼”

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16
Q

Circuits fitting for Pediatric Pack

A

¼” x 3/8”

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17
Q

Circuits fitting for Small Adult Pack

A

3/8” x 3/8”

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18
Q

Circuits fitting for Adult Pack

A

3/8” x ½”

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19
Q

What are the 9 steps to building a Peds circuit

A

It is Imperative to ascertain kg weight prior to choosing

  1. Determine BSA (kg weight may suffice)
  2. Determine max flow rate (KG weight or BSA based)
  3. Choose appropriate pump boot
  4. Pick arterial cannula
  5. Determine arterial line size
  6. Pick venous cannula
  7. Determine venous line size
  8. Choose oxygenator
  9. Choose arterial filter
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20
Q

0-3 kg= ______ Flow (cc/kg/min)

A

200 cc/kg/min

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21
Q

3-10 kg= ______ Flow (cc/kg/min)

A

150 cc/kg/min

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22
Q

10-15 kg= ______ Flow (cc/kg/min)

A

125 cc/kg/min

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23
Q

15-30 kg= ______ Flow (cc/kg/min)

A

100 cc/kg/min

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24
Q

> 30 kg= ______ Flow (cc/kg/min)

A

75 cc/kg/min

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25
Q

> 55 kg= ______ Flow (cc/kg/min)

A

65 cc/kg/min

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26
Q

Formula to determine max flow

A

Weight * flow for that group

EX: (5.3kg*150cc/kg/min= 795 cc/min or 0.795 L/min)

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27
Q

Boot diameter of 3/16”= ______ stroke vol/revolution and ______ max RPM’s

A

7 cc

700 rpm

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28
Q

Boot diameter of ¼””= ______ stroke vol/revolution and ______ max RPM’s

A

13 cc

1300 rpm

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29
Q

Boot diameter of 3/8”= ______ stroke vol/revolution and ______ max RPM’s

A

27 cc

2700 rpm

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30
Q

Boot diameter of ½””= ______ stroke vol/revolution and ______ max RPM’s

A

45 cc

4500 rpm

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31
Q

Ohms law and its hydraulic analogy?

A

VIR

PQR

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32
Q

Reynolds Number= [formula]

A

(VelocityDensityDiameter) / Viscosity

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33
Q

Poiseuilles Law= [formula]

A

Flow = (ΔP x πr4) / (Length x Viscosity x 8)

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34
Q

Reynolds number for blood flow is

A

2000

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35
Q

When selecting a cannula, what do you look for?

A

Look for high flow – low pressure drops

36
Q

What type of cannula give us good flow with a lower pressure drop?

A

Thin walled reinforced and thin wall metal cannula

37
Q

It’s all about the __(for us) and the __ (for surgeons)

A

It’s all about the ID (for us) and the OD (for surgeons)

38
Q

When selecting an arterial cannula, what is the goal

A

utilize the smallest cannula w/ the highest flow rate

39
Q

When selecting an venous cannula, what is the goal

A

drain the patient with the smallest cannulas

40
Q

Do not exceed a pressure drop of ____ for arterial cannulas

A

> 100 mmHg

41
Q

Do not exceed a pressure drop of ____ for venous cannulas

A

-30 to -40 range

42
Q

For arterial cannula’s, when is critical velocity reached?

A
  • when laminar flow becomes turbulent (Reynolds #)

- Higher pressures = higher sheer stress = hemolysis = bad

43
Q

Vacuum Assist Venous Drainage (VAVD) may help but at what cost

A

micro-emboli

44
Q

When selecting the arterial cannula, what should you anticipate?

A

Anticipate larger flow needs when warming

Anticipate viscosity changes

45
Q

If given a french size, how do you convert to ml

A

divide by 3

46
Q

What is the #1 type of arterial peds cannula

A

DLP wire reinforced

47
Q

DLP wire reinforced cannula:

8F= _____ max flow at 100mmHg press gradient

A

750 ml/min

48
Q

DLP wire reinforced cannula:

10F= _____ max flow at 100mmHg press gradient

A

1300 ml/min

49
Q

DLP wire reinforced cannula:

12F= _____ max flow at 100mmHg press gradient

A

2200 ml/min

50
Q

DLP wire reinforced cannula:

14F= _____ max flow at 100mmHg press gradient

A

2900 ml/min

51
Q

DLP wire reinforced cannula:

16F= _____ max flow at 100mmHg press gradient

A

4000 ml/min

52
Q

A tubing diameter of 1/8= ____ max flow with a prime volume of ___

A

Max arterial flow= 700 ml/min

Prime volume= 2.5 ml/ft

53
Q

A tubing diameter of 3/16= ____ max flow with a prime volume of ___

A

Max arterial flow= 1100 ml/min

Prime volume= 7 ml/ft

54
Q

A tubing diameter of 1/4= ____ max flow with a prime volume of ___

A

Max arterial flow= 2000 ml/min

Prime volume= 9.65 ml/ft

55
Q

A tubing diameter of 3/8= ____ max flow with a prime volume of ___

A

Max arterial flow= 6500 ml/min

Prime volume= 21.7 ml/ft

56
Q

A tubing diameter of 1/2= ____ max flow with a prime volume of ___

A

Max arterial flow= ——-

Prime volume= 38.6 ml/ft

57
Q

When determining venous cannulas, what 2 do we utilize?

A

Bicaval or Single Atrial

58
Q

When determining venous cannulas, what should we anticipate?

A

Anticipate larger flow needs when warming

Anticipate viscosity changes

59
Q

If you double the length of the cannula, what happens

A

blood flow is cut in ½

60
Q

If you double the viscosity within the cannula, what happens?

A

blood flow is cut in ½

61
Q

Whats the big difference between Bicaval or Single Atrial venous cannulas

A

Bicaval= you get 66% return from the IVC ans 33% SVC

Single Atrial= you get 100% from the RA

62
Q

What is hold-up volume

A

Resistance in your reservoir can be a factor in venous return. Since your venous line goes into the sock, a certain amount of volume is “delayed” there. As your viscosity goes up - so may your holdup volume

63
Q

Terumo Capiox Baby RX05: Max flow____ Prime Vol ____

A

Max Flow= 1.5 L/m

Prime Vol= 43 cc

64
Q

Medos Hilite 1000: Max flow____ Prime Vol ____

A

Max Flow= 1.0 L/m

Prime Vol= 57 cc

65
Q

Sorin Kids D100: Max flow____ Prime Vol ____

A

Max Flow= 0.7 L/m

Prime Vol= 31 cc

66
Q

What are your choices for ped ALF?

A

Terumo AFX02
Medtronic affinity
Integral oxygenator filtration

67
Q

What are the 9 basic prime constituents for peds?

A 
Normosol
Solumedrol (methylprednisolone)
Antibiotic
25% Albumin
Mannitol
CaCl
NaHCO3
PRBC’s 
Heparin 100 units
68
Q

describe 25% Albumin (5 things)

A
  • Large molecule
  • Aids passification of tubing
  • Elevates C.O.P. and serum osmolarity
  • Good osmotic “pull” from tissues (1.3:1)
  • Be careful in recommendations (i.e X-coating calls for wetting with crystalloid 1st)
69
Q

Antibiotic dosage: Cefazolin (Kefzol, Ancef)

A

25 mg/kg (max dose = 1 g)

70
Q

Antibiotic dosage: Ampicillin

A

50 mg/kg (max dose = 1 g)

71
Q

Antibiotic dosage: Gentamicin

A

2 mg/kg (max dose = 80 mg)

72
Q

Antibiotic dosage: Nafcillin

A

25 mg/kg (max dose = 1 g)

73
Q

Antibiotic dosage: Vancomycin

A

10 -15 mg/kg (max dose = 1 g)

74
Q

What is special about vancomycin?

A

Vancomycin is titrated during CPB. All other of the antibiotics listed can be safely administered to the extra-corporeal circuit prior to the intiation of CPB.

75
Q

The pump prime may contain ___ mg/kg methylprednisolone (up to ___ mg) on ALL patients undergoing procedures requiring CPB.

A

30 mg/kg

500 mg

76
Q

Pediatric transplant patients receive ___ mg/kg methylprednisolone when the aortic crossclamp is released

A

30 mg/kg

77
Q

The prime should have a bicarbonate concentration of approximately __ mEq/L

A

24 mEq/L

78
Q

The amount of NaHCO3 necessary for a given amount of asanguineous volume may be calculated using what formula?

A

? mEq NaHCO3 = 0.025 * mL asanguineous volume

79
Q

If PRBC’s are added to the prime, then a sample should be taken, and NaHCO3 administered according to the following formula

A

? mEq NaHCO3 = 0.3(kg wt)(BE)

80
Q

describe mannitol (4 things)

A

Osmotic dieuretic
Elevates Osmolarity rapidly
Given over a range of medical disciplines
Oxygen radical scavenger

81
Q

How much mannitol os given in the prime? How much is given during AoXc removal?

A

0.25 g/kg in the prime

An additional 0.25 g/kg is given during AoXc removal

82
Q

Since mannitol is 25% solution, how do you determine the dose?

A

The amount of kg of the pt is the amount of ml’s of mannitol (EX 5.3 kg= 5.3 ml of mannitol)

83
Q

CaCl2 is not routinely added to the prime. However, an ionized Ca++ level of the perfusate should be measured shortly after the initiation of CPB and corrected upward to ____ mM/L, if necessary

A
  1. 7 - 0.8 mM/L
    - -This is imperative because a level of 0.7 to 0.8 mM/l would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution
84
Q

For neonates/infants < 5kg, ___ ml PRBC’s are added to the prime to avoid what?

A

100 ml

to avoid a prolonged period a asanguineous perfusion

85
Q

Always keep an idea of where your hematocrit will be:

CPB Hct = [formula]

A

(((IVBV x kg x (patient Hct / 100)) / ((IVBV x kg) + mL prime))) x 100

Peds (17 decks)

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