Cannulation for bypass Flashcards
Sequence of cannulation
1: aortic
2: venous
3: PA
During aortic cannulation have
systolic BP 90-100 (narcs, inhalation, NTG)
-prevents aortic tearing, shedding of ca deposits
during venous cannulation
- inserted via right atrial appendage
- often lots of heart manipulation at this point
during PA cannulation
preents RV & LV distention from blood return to the heart from thespian veins and coronary sinus
where does the coronary sinus receive blood and empty?
receives venous blood from the heart and empties into the right atrium
Tributaries of the coronary sinus
small cardiac vein and middle cardiac vein
What vein is a remnant of the embyonic left superior vena cava
oblique vein
what is cardioplegia
the intentional and temporary cessation of cardiac activity primarily for cardiac surgery
has cold substrates for the heart to use while it is not beating, delivered with two different cannulas
antegrade cardioplegia
b/w the aortic cross clamp and the aortic valve down the coronaries in the same direction as usual flow
retrograde cardioplegia
via coronary sinus, backwards to get past blockages
-area of myocardium distal to the blockages
what should you monitor with retrograde cardioplegia
perfusion pressures
correct cannula positioning makes for good flow
Prebypass checklist
- anticoagulation adequate
- check the head
- anesthesia adequate (isoflurane on pump)
- treat glucose
- cannula placement correct (check bounce, good flow on pump)
- fluids off
- disconnect ventilation once perfusionist is on full flow
- aortic cross clamp applied
Cross clamp time of
150 min
240 min
what to do on pump
- charting
- prepare antibiotics
- check drugs and pumps for off bypass
- run glucoses
- monitor and chart MAP, UOP and temp
Guidlines while on pump
perfusionist runs the show, gives isoflurane
temp 25-28c
