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CVP 611 > Cannulation Techniques > Flashcards

Cannulation Techniques Flashcards

1
Q

Types of venous cannulas

A

*Single stage
*Two stage (atriocaval/cavoatrial)
(Two stage usually has a wider portion (basket) that sits in the right atrium and a narrower tip with holes that sits in the IVC

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2
Q

Numbers associated with cannulas. What does the higher number mean?

A
  • 36/46
  • 34/46
  • 29/37
  • The higher the number, the larger the cannula
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3
Q

What are 6 ways cannulas are chosen?

A
  • Flow characteristics
  • Pressure drop across the cannula
  • Size of the patient
  • Calculated flows
  • Procedure being performed
  • Resistance to flow (SVR, vessel diameter)
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4
Q

How does venous blood enter the circuit?

A

Venous blood enters the circuit by gravity or siphon drainage into the reservoir placed 40-70 cm below the level of the heart.

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5
Q

How is the amount of blood drained in venous drainage determined?

A
  • CVP
  • Intravascular volume
  • Venous compliance
  • Medications
  • Anesthesia (depth of anesthesia)

*Resistance in cannulas, tubing, connectors

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6
Q

Characteristics of cannuals

A
  • Wire reinforced to prevent kinking (venous cannula is reinforced)
  • Thin walled to permit higher flow
  • Straight, angled, low profile designs(low profile design provides clear operative field ideal for minimal incision approaches)
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7
Q

Too much siphon drainage may create ______ pressure in a collapsible atrium.

How is this corrected?

A

Negative.
(This can lead to collapse of the vessel walls around the cannula causing “chattering” in venous line. So much venous pressure that it is jumping back and forth “chattering”)

*Corrected by adding volume by “retarding the venous return”

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8
Q

The venous line must be ___________ of blood. If there is air in the venous line, it can cause an _______ and the return will cease.

A
  • Full

* Air lock

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9
Q

If a cannula is too small what can happen?

A

*Will cause blood to flow around the baskets in the cannula, decrease return and fill the heart.

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10
Q

What are 4 measures you can take to reduce obstruction of flow?

A
  • VAVR (vacuum assisted venous return)
  • KAVR (kinetic assisted venous return)
  • Baskets and fluted tipped venous cannulas
  • Raising the table to improve return to the venous reservoir
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11
Q

Pediatric cannula sizes range from ___________

A

12 to 18 Fr (french)

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12
Q

Adults cannula sizes range from ___________

A

20-40 Fr (french)

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13
Q

Factors to determine the size of venous cannulae

A
  • Patient requirements (size)
  • Anticipated flow rate
  • Index of catheter flow indices
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14
Q

What are the different kinds of tips on cannulae?

A
  • Straight or angled

* Made from rigid plastic or metal

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15
Q

Venous cannulae are made out of _________ and may or may not have __________

A
  • Flexible plastic

* wire reinforcement

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16
Q

Caval tapes are placed around the cannulas to isolate venous return to the heart this is _______

A

Total CPB

17
Q

Negative pressure risks:

A
  • Aspiration of gross or microscopic air causing cerebral injury
  • Hemolysis
  • Air aspiration into the blood compartment of membrane oxygenator
  • Venous reservoir imploding
18
Q

Femoral or iliac vein is used in __________

A

Peripheral venous cannulation

19
Q

Indications for peripheral venous cannulation include:

A
  • Unstable patients for emergent CPB prior to sternotomy or anesthesia induction
  • Reoperations: to provide controlled conditions during sternotomy and exposure of the heart
  • Aortic surgery
  • Minimally invasive access surgery
  • ECMO
20
Q

Femoral cannulation-lead to ischemia (Presentation-5 P’s)

A
  • Pain/swelling
  • Pain with passive stretching
  • Pallor
  • Pressure measurement
  • Pulselessness (may be misleading)
21
Q

Sites of arterial cannulation

A
  • Proximal aorta
  • Innominate artery
  • Distal aortic arch
  • Femoral
  • Axillary
  • Subclavian
22
Q

Choice of site for arterial cannulation is influenced by:

A
  • The planned operation

* The distribution of atherosclerotic plaque

23
Q

How soon before cannulation is Heparin given?

A

5 mins before

24
Q

Activated clotting time must be _______ prior to cannulation

A

Extended

25
Q

Normal non-heparinized ACT = __ - ___ seconds

A

90-120

26
Q

What is the cannulation Act?

A

> 200 seconds

27
Q

During arterial cannulation BP is lowered to _____

A

60-80

28
Q

Proper placement of the arterial cannula is confirmed by ___________

A

pulsatility and pressure

29
Q

Single stage cannulas are used for ___________ one cannula in the SVC and one in the IVC

A

Dual cannulation

30
Q

Whenever the right heart is opened a ________ is required

A

Single stage cannula

31
Q

________ may also be used for femoral venous cannulation

A

Single stage

CVP 611 (3 decks)

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