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Perf Tech 3 > 7. Embolic Events- Exam 2 > Flashcards

7. Embolic Events- Exam 2 Flashcards

1
Q

What is the incidence of clinically obvious strokes post CPB

A

1-5%

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2
Q

MRI suggests that there could be new infarcts in what % of those same patients

A

30%

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3
Q

is the source of strokes necessarily from CPB

A

nope

-patients are a major contributor

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4
Q

what % of CABG patients experienced cerebral infarct prior to surgery

A

50%

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5
Q

what are the 3 types of infection

A
  1. Biologic (bloodborne)
  2. Foreign Material (Circuit/Manufacturing)
  3. Gaseous
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6
Q

Micro vessels are the main target for emboli. What are their diameter

A

3-500 micrometers in diameter

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7
Q

what is the greatest period of risk for emboli

A
  1. Insertion of arterial cannula
  2. Initiation of bypass (hypotension)
  3. Cross-clamp application/removal
  4. Use of centrifugal pump (any time you have a decrease in flow)
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8
Q

trauma to the aorta can contribute to brain infarctions for how long

A

up to 1 month

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9
Q

what organ is at the greatest risk for emboli

A

brain

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10
Q

Formation of biologic emboli: homologous transfused blood- risk increases with what

A

storage time

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11
Q

Formation of biologic emboli: inadequate anticoagulation with contact with what

A

foreign surface

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12
Q

Formation of biologic emboli: areas at risk from inadequate anticoagulation-contact with foreign surface

A 
minimal flow
stagnant areas
turbulence
cavitation
rough areas
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13
Q

Formation of biologic emboli: areas of the circuit at risk from inadequate anticoagulation-contact with foreign surface

A 
connectors
bubble oxygenators
ALF
cardiotomy rservoirs
intraluminal projections
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14
Q

Formation of biologic emboli: Trauma to ____ cells of epicardium and trauma to ____ of the surgical wound

A

fat

tissue

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15
Q

Formation of biologic emboli: do you need CPB to produce fat emboli? what other sources are there?

A

No
Median sternotomy
Thoracotomy

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16
Q

Formation of biologic emboli: how much fat within a circuit comes from cardiotomy suction

A

2/3

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17
Q

Formation of biologic emboli: fat emboli can be large particles of how many microns

A

4 - 200 microns

18
Q

Formation of biologic emboli: what organs can fat emboli be found in post bypass

A 
kidney
lungs
heart
brain
liver
spleen
19
Q

Formation of biologic emboli: complement activation sue to what

A

surface contact- activation process

20
Q

Formation of biologic emboli: complement activation from surface contact includes what

A

platelets and neutrophils

21
Q

platelet counts drop what % with initiation of bypass

A

30-50%

-also drop in # of functional platelets

22
Q

describe platelets role with decreased #

A

post-op bleeding
neurologic dysfunction
release of histamine (membrane permeability)
release of serotonin/thromboxane (vasoconstriction)

23
Q

name some examples of foreign particle emboli

A 
cotton fibers
plastic particles
 filter material
spallation
bone wax
24
Q

name 4 sources of gaseous microemboli

A

bubble oxygenators
temp gradients
surgical air
pump/circuit problems

25
Q

bubble oxygenators can produce what size emboli thats associated with CPB mortality and morbidity

A

35 - 40 micrometers

  • mainly oxygen
  • solution was to transition to membrane oxygenators
26
Q

name 3 ways to create surgical air

A
  1. heart contracts before chambers are completely de-aired
  2. surgeon cuts into chamber of beating heart
  3. placement of arterial, venous or LV vent cannulae
27
Q

how long is surgical air present in the heart post CPB

A

30 to 40 min

28
Q

what is a solution to correct surgical air

A

flush with CO2… 86% of buubles gone within 1 minute

29
Q

name 5 ways to pump air

A
  1. inattention to level in VR
  2. reversed roller pump
  3. retrograde flow through centrifugal pumo
  4. drug injections into circuit
  5. inadequate debubbling of ALF
    - –more on slide 15
30
Q

what % of air is pumped due to inattention to VR level

A

37%

31
Q

what % of air is pumped due to aortic root air during plegia administration

A

29%

32
Q

what % of air is pumped due to unexpected heart beat

A

10%

33
Q

what % of air is pumped due to reversed LV vent line

A

9%

34
Q

what % of air is pumped due to pressurized cardiotomy

A

5%

35
Q

what % of air is pumped due to ruptures arterial pumphead tubing

A

5%

36
Q

what % of air is pumped due to unnoticed rotation of arterial pump head

A

5%

37
Q

what are the top 2 ways to pump air (from bar graph)

A
  1. Drug 50%

2. Blood sample 30%

38
Q

name 5 results of blood-bubble interactions

A
  1. denaturation of plasma proteins
  2. adsorption of phospholipids/fibrinogen
  3. complement activation
  4. microthrombi production
  5. endothelial wall damage
39
Q

name 4 safety devices to prevent emboli

A
  1. low level alarm
  2. air bubble detector
  3. ALF/Cardiotomy filter
  4. one-way valve in arterial line & vent line
  5. use of prebypass checklist
40
Q

name 5 ways you can minimize biologic emboli know

A
  1. use transfusion filters
  2. adequately anticoagulate
  3. minimize surface area of circuit
  4. use membrane oxygenator
  5. minimize complement, platelet and neutrophil activation
41
Q

name 3 ways you can minimize induction of foreign paticles know

A
  1. circulate crystalloid solution through entire circuit
  2. dont use silicone tubing in arterial pump head
  3. use medical grade tubing
42
Q

name 5 ways you can minimize formation of gaseous microemboli know

A
  1. check all equipment for proper operation
  2. ensure tubing connections are secure
  3. proper use of all safety devices
  4. avoid air in venous line
  5. flush circuit with CO2 prior to priming

Perf Tech 3 (15 decks)

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