Bypass CLP competancy exam

Question 1

S: How’s your Bypass ?

Answer 1

• Non-pulsatile ABP
• CVP = 0
• ALP is within range = (150 – 250)
• We’ve met our top flow / CI: 2.4
• PaO2 / FiO2 relationship looks great
• SVO2 > 70
• Cerebral sats look great

1. Anesthesia, you can stop ventilating the patient!
2. Can I cool the patient? Drift down to 34

Question 2

S: Are you ready to cross clamp?

Answer 2

• Bypass is good.
• Proper Solution
• Proper Temperature
• Primed to the field

P: Yes, we’re ready to cross clamp.

Question 3

S: Put some volume in the Heart!

Answer 3

• Clamp the Venous line until ABP is pulsatile.

ANOUNCE!

• ABP = Pulsatile
• Systolic = X
• CVP = X

Question 4

S: Applying the cross clamp!

7

Answer 4

• Pump is down!
• Cross clamp is on!
• Pump back up!

• X Clamp Timer is On

• Vent ON
• Plegia ON!
• Vent OFF
• Start Counting Plegia. Were now delivering Antegrade

Question 5

Induction Antegrade delivery!

5

Answer 5

• Cold 500 until fibrillation)
• Pressure = 180 – 220 mmHg ALP
• Flow = 200 – 300
• Vent OFF
• Report Changes in EKG and Volume Delivered

Question 6

Induction Retrograde Delivery!

5

Answer 6

• Cold 500 until Asystole)
• Pressure = 35 – 45 mmHg (P4)
• Flow = 250 – 400
• Vent ON
• Report Changes in EKG and Volume Delivered

Question 7

S: Turn Cardioplegia OFF, let me know in 2 minutes.

5

Answer 7

• Switch from Induction bag to Maintenance bag.
• Obtain ABG’s
• Obtain VBG’s
• Keep up with ACT
• Keep up with ABP

Question 8

Maintenance Dose:

2

Answer 8

• Predominantly Retrograde

- Deliver every 5 min

Question 9

Vein Graft Delivery !

2

Answer 9

• Pressure = 150 Ed ALP
Pressure = 200 Bruce ALP
• Flow = 30 – 110

Question 10

Hand Held Delivery!

2

Answer 10

• Pressure = 150 Ed ALP
Pressure = 200 Bruce ALP
• Flow = 100 – 200

Question 11

Hot Shot Delivery preparation !

3

Answer 11

• Switch to reperfusate bag
• Rewarm the patient to 38 degrees
• Rewarm the cardioplegia to 38 degrees

Question 12

Hot Shot re-perfusate Antegrade Delivery ?

5

Answer 12

• Delivery 100 in
• Pressure = 180 – 220 mmHg ALP
• Flow = 200 – 300
• Vent OFF
• Report Changes in EKG and Heart Temperature

Question 13

Hot Shot Re-perfusate Retrograde Delivery ?

(5)

Answer 13

• 100 in
• Pressure = 35 – 45 mmHg (P4)
• Flow = 250 – 400
• Vent ON
• Report Changes in EKG and Heart Temperature

Question 14

At 3 min Switch to whole blood !
Hot Shot Whole Blood Preparation ?

(2)

Answer 14

• Unclamp bridge

* Clamp Reperfusate Bag

Question 15

Whole Blood Retrograde Delivery ?

5

Answer 15

• 100 in
• Pressure = 35 – 45 mmHg (P4)
• Flow = 250 – 400
• Vent ON
• Report Changes in EKG and Heart Temperature

Question 16

Cardioplegia administration is over and were back to Normal Sinus Rhythm !

(5)

Answer 16

• Pump down!
• Cross Clamp is Off! X-Clamp Timer Off
• Pump Back Up!!
• Administer 100 mL Lidocane & 2g Mg+ Sulfate
• Cardioplegia pump OFF!

Question 17

S: Are you ready to come off Bypass?

Answer 17

• EKG = NSR
• Electrolytes = Good / Ca2+: K:
• Ventilator = ON
• Vents = Out/OFF
• Temp = 35 – 37
• Hct = >24
• Volume = Enough to wean from bypass
• Give Calcium

Question 18

Are you ready to go on bypass?

Answer 18

Bypass check list was completed
Arterial cannula is patent / No air in it
Venous cannula is connected and unclamped

We are ready for bypass!

Turn ON Forane (0.8 - 1.0%)
Turn ON FiO2 (60-80%)
Turn ON timer

Go on bypass!

Question 19

How does your pressure look ?

Answer 19

• we have a pulsatile pressure

- resembles our patients ABP

Question 20

Go ahead and test the line !

Answer 20

I GET UP AND INSPECT FOR AIR IN THE ARTERIAL CANNULA!!!