Bypass CLP competancy exam Flashcards
S: How’s your Bypass ?
- 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
- Anesthesia, you can stop ventilating the patient!
- Can I cool the patient? Drift down to 34
S: Are you ready to cross clamp?
- Bypass is good.
- Proper Solution
- Proper Temperature
- Primed to the field
P: Yes, we’re ready to cross clamp.
S: Put some volume in the Heart!
• Clamp the Venous line until ABP is pulsatile.
ANOUNCE!
- ABP = Pulsatile
- Systolic = X
- CVP = X
S: Applying the cross clamp!
7
- 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
Induction Antegrade delivery!
5
- Cold 500 until fibrillation)
- Pressure = 180 – 220 mmHg ALP
- Flow = 200 – 300
- Vent OFF
- Report Changes in EKG and Volume Delivered
Induction Retrograde Delivery!
5
- Cold 500 until Asystole)
- Pressure = 35 – 45 mmHg (P4)
- Flow = 250 – 400
- Vent ON
- Report Changes in EKG and Volume Delivered
S: Turn Cardioplegia OFF, let me know in 2 minutes.
5
- Switch from Induction bag to Maintenance bag.
- Obtain ABG’s
- Obtain VBG’s
- Keep up with ACT
- Keep up with ABP
Maintenance Dose:
2
- Predominantly Retrograde
- Deliver every 5 min
Vein Graft Delivery !
2
• Pressure = 150 Ed ALP
Pressure = 200 Bruce ALP
• Flow = 30 – 110
Hand Held Delivery!
2
• Pressure = 150 Ed ALP
Pressure = 200 Bruce ALP
• Flow = 100 – 200
Hot Shot Delivery preparation !
3
- Switch to reperfusate bag
- Rewarm the patient to 38 degrees
- Rewarm the cardioplegia to 38 degrees
Hot Shot re-perfusate Antegrade Delivery ?
5
- Delivery 100 in
- Pressure = 180 – 220 mmHg ALP
- Flow = 200 – 300
- Vent OFF
- Report Changes in EKG and Heart Temperature
Hot Shot Re-perfusate Retrograde Delivery ?
(5)
- 100 in
- Pressure = 35 – 45 mmHg (P4)
- Flow = 250 – 400
- Vent ON
- Report Changes in EKG and Heart Temperature
At 3 min Switch to whole blood !
Hot Shot Whole Blood Preparation ?
(2)
- Unclamp bridge
* Clamp Reperfusate Bag
Whole Blood Retrograde Delivery ?
5
- 100 in
- Pressure = 35 – 45 mmHg (P4)
- Flow = 250 – 400
- Vent ON
- Report Changes in EKG and Heart Temperature
Cardioplegia administration is over and were back to Normal Sinus Rhythm !
(5)
- Pump down!
- Cross Clamp is Off! X-Clamp Timer Off
- Pump Back Up!!
- Administer 100 mL Lidocane & 2g Mg+ Sulfate
- Cardioplegia pump OFF!
S: Are you ready to come off Bypass?
- EKG = NSR
- Electrolytes = Good / Ca2+: K:
- Ventilator = ON
- Vents = Out/OFF
- Temp = 35 – 37
- Hct = >24
- Volume = Enough to wean from bypass
- Give Calcium
Are you ready to go on bypass?
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!
How does your pressure look ?
- we have a pulsatile pressure
- resembles our patients ABP
Go ahead and test the line !
I GET UP AND INSPECT FOR AIR IN THE ARTERIAL CANNULA!!!
