CABG 3A Flashcards
WHY IS INSERTION OF RETROGRADE CARDIOPLEGIA LINE A CRITICAL TIME AND WHAT SHOULD YOU BE DOING?
TO INSERT THE LINE THEY NEED TO PICK UP HEART. THE PT MAY NOT TOLERATE THIS. THEY MIGHT NEED VOLUME AND/OR NEO.
WHEN SHOULD THE HEPARIN BE ADMINISTERED DURING CABG?
PRIOR TO CANNULATION. THIS IS AFTER LEG VEIN OUT, STITCHES AND PURSE STING IN PLACE. ANNOUNCE AND CONFIRM HEPARIN DOSE. GIVE IN CENTRAL VEIN, DRAW BACK BLOOD AND DOCUMENT.
WHAT IS THE TYPICAL ORDER OF CANNULATION?
AT THIS TIME LINES ARE INSERTED FLUSHED AND CLAMPED.
- AORTA. POSSIBLE BLOOD LOSS, LOOK FOR BUBBLES IN LINE.
- RETROGRADE CARDIOPLEGIA. POSSIBLE HYPOTENSION.
- VENOUS. EXAMINE FACE TO RULE OUT SVC OBSTRUCTION. MAY SEE ATRIAL ARRYTHMIAS. CVP MEASURED ABOVE THE CANNULA.
- ANTERIOGRADE CARDIOPLEGIA LINE.
WHAT IS RAP? WHAT MAY THE PATIENT NEED WHILE RAP TAKING PLACE?
RETROGRADE AUTOLOGOUS PRIME IS WHEN PERFUSIONIST DRAWS OFF AROUND 500CC PTS BLOOD TO PRIME CPB CIRCUIT INSTEAD OF USING CRYSTALLOID PRIME.
PT MAY REQUIRE PRESSORS, NOT VOLUME.
WHAT SHOULD THE AORTIC CANNULATION PRESSURE LOOK LIKE? AND WHY?
PUSITILE! THAT CORRELATES WITH RADIAL ART LINE.
THIS RULES OUT THAT THE AORTIC CANNULA IS IN A FALSE LUMEN WHICH WOULD CAUSE AN AORTIC DISSECTION.
WHAT CAN BE ADMINISTERED IN PATIENT RESISTANT TO HEPARIN IE LOW ACT DESPITE ADDITIONAL HEPARIN DOSES ?
2 UNITS FFP (PROVIDES SUBSTRATE FOR HEPARIN TO WORK)
OR THROMBATE
WHEN IS CARDIOPLEGIA SOLUTION GIVEN?
AFTER AORTA CROSS CLAMP IS APPLIED…..YOU WANT CARDIOPLEGIA ONLY IN THE HEART.
WHEN ARE HEART AND LUNGS STOPPED?
WHEN “ON BYPASS” IS CONFIRMED BY PERFUSIONIST. THEN TURN OFF VENT.
WHERE IS CARDIOPLEGIA GOING WHEN ITS GIVEN ANTEGRADE VERSUS RETROGRADE?
ANTEGRADE CARDIOPLEGIA LINE IS LOCATED BETWEEN THE CROSS CLAMP AND THE AORTIC VALVE….IT ENTERS THE AORTA.
RETROGRADE CARDIOPLEGIA ENTERS THROUGH THE CORONARY SINUS.
WHAT IS THE NORMAL ORDER OF GRAFT APPLICATION?
DISTAL, LIMA, THEN PROXIMALS. PROXIMALS ARE ON THE AORTA.
AFTER GRAFTS ARE ON WHAT CAN YOU DO TO HELP “MEASURE “ GRAFTS?
INFLATE LUNGS. PERFUSION WILL BE PINCHING THE VENOUS LINE TO REROUTE BLOOD TO HEART (FILL THE HEART) TO EVALUATE GRAFT INTEGRITY.
WHAT TEMPERATURE DOES THE PT NEED TO GET TO IN ORDER TO BE OFF BYPASS?
37 C
WHILE ON BYPASS WEHRE WILL BP BE MAINTAINED AND HOW?
MAP 70-80 NON PULSITILE PRESSURE VIA LEVOPHED IN CBP MACHINE IF NECESSARY. IN ORDER TO MAINTAINED CARDIAC INDEX OF 2.2-2.5 THE ONLY GTT WE WILL BE RUNNING THROUGHOUT PROCEDURE IS INSULIN.
THE PAP AND CVP WILL BE 0 SINCE THE HEART IS EMPTY
WHEN THE PACING WIRES ARE HANDED TO YOU WHERE DOES THE WHITE LEAD GO?
VENTRICULAR.
BLUE GOES TO ATRIA
WHAT DOES PERFUSION DO TO BEGIN TAKING PT OFF PUMP?
SLOWLY CLAMP THE VENOUS LINE WHICH DIVERTS VENOUS BLOOD FROM PUMP TO HEART. THEN THE ATRIAL PUMP FLOW IS ALSO DECREASED AS PUMP RESERVOIR VOLUME EMPTIES INTO PATIENT. THESE ACTIONS MAKE HEART TAKE OVER.
WHAT ARE THE 3 THINGS THE PERFUSIONIST COMMUNICATES DURING WEANING?
- CURRENT FLOW RATE OF PUMP -INDICATES STAGE OF WEANING.
- VOLUME IN PUMP RESERVOIR- INDICATES AMT AVAILABLE FOR TRANSFUSION
- VENOUS O2 SAT- INDICATES PERIPHERAL PERFUSION
WHAT IS THE DEFINITION OF OPTIMAL PRELOAD?
THE LOWEST FILLING PRESSURE THAT PROVIDES ADEQUATE CARDIAC OUTPUT.
WHAT ARE SOME COMPLICATIONS THAT CAN OCCUR DURING CANNULATION AND WHEN ON CPB?
- AORTIC DISSECTION FROM AORTIC CANNULA BEING PLACED IN FLASE LUMEN. DIAGNOSE: INAPPROPRIATLY HIGH AORTIC BP OR NON PULSITILE, ISCHEMIA, PUPIL ASSYMETRY, OLIGURIA.
- CAROTID OR INNOMINATE ARTERY HYPERPERFUSION: ALL/MOST OF PUMP FLOW IS GOING TO CAROTID…USUALLY THE RIGHT SIDE. THIS IS WHY YOU NEED TO CHECK THE PULSES OF LAT CAROTIDS TO ENSURE NO THRILLS POST CANNULATION. LOOK FOR IPSILATERAL BLANCHING, PUPIL DILATION, CONJUNCTIVAL EDEMA.
WHAT WILL THE RADIAL BP LOOK LIKE IF RIGHT CAROTID IS HYPERPERFUSED DUE TO CANNULATION?
LEFT: LOW BP
RIGHT: HTN DUE TO INNOMINATE ARTERY HYPERPERFUSION
WHAT DO YOU DO IF YOU GET A MASSIVE AIR EMBOLUS?
COMPRESS BILAT CAROTIDS.
