Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Methods II > Cardiac Surgery Concepts > Flashcards

Cardiac Surgery Concepts Flashcards

1
Q

the name of the procedure that restores normal blood flow to an area of the heart by creating new routes around obstructive coronary arteries

A

coronary artery bypass graft (CABG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 3 blood vessels that can be harvested from the body for a CABG?

A
  1. Left internal mammary artery (LIMA)
  2. saphenous vein
  3. radial artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where is the graft for the CABG sewn in relationship to the atherosclerotic coronary artery?

A

Proximal and distal to the atherosclerotic coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is the proximal anastomosis of the CABG graft located?

A

on the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the distal anastomosis of the CABG graft located?

A

on the coronary artery; distal to the obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

in a triple bypass, how many distal anastomoses and proximal anastomoses will there be?

A

3 distal and one proximal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

in a CABG, the amount of distal anastomoses will always be _____ (higher/lower) than the amount of proximal anastomoses

A

higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

in a CABG procedure, which anastomoses does the surgeon usually sew on first?
proximal or distal

A

distal; so when the surgeon is done sewing the distal anastomoses the procedure will be done soon because there are usually less proximals to do

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

which vessel is the most commonly used graft for CABG?

A

LIMA ( Left Internal Mammary Artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which vessel is the LIMA most commonly anastomosed with?

A

LAD ( left anterior descending)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

During CABG (arterial/venous) grafts are preferred over (arterial/venous) grafts.

Why?

A

arterial
venous
- the grafted vessel has to carry arterial blood and not venous blood
-coronary arterial pressure will damage the saphenous endothelium more quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

LIMA patency rates are 90%, saphenous patency rates are 60%, and radial artery patency rates are lower than LIMA over a period of 10 years. Why does LIMA have the highest?

A

LIMA is a “live” graft which means that its proximal origin from the subclavian is left intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does the acronym PCI stand for?

A

Percutaneous Coronary Intervention

-Balloon Angioplasty and Cardiac Stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What procedure is used as an alternative to CABG, is less invasive, and is used for less severe cases of coronary artery disease?

A

Cardiac stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

(CABG/Cardiac stenting) tends to show better 5 year survival and patency rates?

A

CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

(CABG/ Cardiac stenting) carries a higher risk of stroke after 5 years

A

CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Newer stents are called “____- ______” stents

What do these stents do?

A

drug-eluting

-they slowly release a drug in order to slow the narrowing process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A cardiopulmonary bypass machine (CBM) functions as both the _____ and ______

A

heart

lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 4 ways the cardiopulmonary bypass machine acts as the heart and lungs?

A
  1. drains deoxygenated blood from the body
  2. Oxygenates the blood
  3. Removes the CO2
  4. Pumps oxygenated blood back into the body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 2 primary reasons a surgeon would use the cardiopulmonary bypass machine?

A
  1. Stop the heart
    - so the surgeon can work on a heart that isn’t moving
  2. Drain the blood out of the heart
    - so the patient will not bleed out as the heart is opened
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name a surgery where the heart would need to be drained of blood and cardiopulmonary bypass would have to be used

A

open valve repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is it mandatory for the heart to be arrested during cardiac surgery?

A

no
-some operations do not require it, however surgeons will do it anyway because it is easier to operate on a non-moving target

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Is it mandatory for the heart to be arrested during cardiopulmonary bypass?

A

no

-it is most common, however it is possible for the heart to remain beating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what solution do surgeons inject into the heart to arrest the heart?

A

Cardioplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Cardioplegia made up of?

A

potassium rich solution

-can contain additives such as glucose, magnesium, calcium, bicarb, buffers, and free radical scavengers ( mannitol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is another way cardioplegia can be administered

A

mixed and injected with blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

the most common way of arresting the heart is to inject cardioplegia into the _____ ______ through the ______ ______

A 
coronary arteries
coronary ostia (os)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When cardioplegia is injected into the coronary arteries, it is referred to as “_______ ______”

A

antegrade cardioplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

most commonly antegrade cardioplegia is injected into the _____ ______

A

aortic root through a cardioplegia cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is necessary to put on the ascending aorta during antegrade cardioplegia?
What is its purpose?

A

cross clamp

prevents the cardioplegia from washing out into the body and contains it in the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the least common method of antegrade cardioplegia?

A

direct cannulation of the coronary os (coronary artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The cross clamp keeps cardioplegia in the coronary arteries, but prevents the heart from being perfused.
How is the heart perfused while its arrested and has the cross clamp on it?

A

the cardioplegia cannula can also infuse blood into the coronary arteries so that the heart can receive oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the only way the heart can get sufficient oxygen in cases where:

  1. the ascending aortic cross clamp must be placed
  2. the heart needs to be arrested
A

Cardioplegia cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

the cardioplegia cannula provides sufficient oxygen to the heart in which two circumstances?

A
  1. the ascending aortic cross clamp must be placed

2. the heart needs to be arrested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Where is “retrograde” cardioplegia injected?

A

retrograde through the coronary sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

when cardioplegia is injected through the coronary sinus it is referred to as “_____” cardioplegia

A

retrograde

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Why does the surgeon have to be careful with pressure when injecting retrograde cardioplegia?

A

because the coronary sinus is a vein and is more likely to rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What does the AA do in order to prevent coronary sinus damage during retrograde cardioplegia?

A

measures the pressure within the coronary sinus as cardioplegia is injected via a non-compliant transducer tubing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the 3 steps of monitoring retrograde cardioplegia?

A
  1. surgeon throws over a sterile non-compliant tubing over the drape
    - other end is connected to the retrograde cardioplegia line
  2. The anesthetist hooks the other end of the tubing to either the CVP or PAP stopcock on the triple transducer
  3. When the heart is arrested, the stopcock will be turned on to the retrograde line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Are CVP and PAP monitored during bypass?

A

no

cannot simultaneously monitor retrograde cardioplegia and CVP/ PAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When the heart Is arrested during retrograde cardioplegia, the stopcock at the transducer is turned (on/off) to the patient, and (on/off) to the retrograde line

A

off

on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When the stopcock is turned to the side (normal) during retrograde cardioplegia, what pressure is measured?

A

CVP and PAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When the stopcock is up (to the patient) during retrograde cardioplegia, what pressure is been measured?

A

retrograde cardioplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

List 2 indications for retrograde cardioplegia

A
  1. helps arrest areas of the heart distal to high grade obstructions
  2. helps arrest the heart in situations where antegrade cardioplegia would wash out
    - when the ascending aorta is opened
    - – ascending aorta repair
    - –open aortic valve repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

The 6 steps of how the Cardiopulmonary Bypass Machine works

A
  1. De-oxygenated blood is drawn away from the heart using a venous cannula
  2. the venous blood is stored in a venous reservoir
  3. the venous blood is sent through an oxygenator, heat exchanger, and arterial filter
  4. oxygenated blood is re-infused into the body via a “main pump”
  5. the “main pump” pumps the blood into the aorta through an “arterial cannula”
  6. an aortic cross clamp is placed on the ascending aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

how is deoxygenated blood drawn away from the heart on a cardiopulmonary bypass machine?

A

through a venous cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Where is the most common venous cannulation usually placed to drain blood away from the heart during cardiopulmonary bypass?

A

right atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Name the 3 other locations the venous cannula can be placed to draw blood away from the heart during cardiopulmonary bypass?

A
  1. SVC
  2. IVC
  3. femoral vein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the 2 purposes of the venous reservoir on the cardiopulmonary bypass machine?

A
  1. stores a surplus of blood
    - 1 to 3 Liters
    - serves as the circuits holding tank and acts as a buffer for imbalances between venous return and arterial flow
  2. help to remove any air that entered the bypass circuit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what are the 4 purposes of the oxygenator, heat exchanger, and arterial filter on the cardiopulmonary bypass machine?

A
  1. fat globules/ air particles are filtered
  2. temperature of the blood is controlled
  3. the blood is oxygenated
  4. CO2 is removed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the 2 purposes for the aortic cross clamp during cardiopulmonary bypass?

A
  1. prevent blood from the arterial cannula from backing up into the heart
  2. allows the heart to stay arrested by keeping the injected cardioplegia in the heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

When is the only situation a right atrium venous cannulation would not work?

A

during right sided heart operations

-blood would gush out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

if we need to do a traditional open right sided heart operation; where would the venous cannula be placed?

A

the inferior and superior vena cavas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

where would the venous cannula be placed in situations where the chest does not need to be opened?

A

through the femoral vein and threaded up into the right atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Where would an arterial cannula be placed in situations where the chest does not need to be opened?

A

through the femoral artery and threaded into the aorta to perfuse the entire body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

When cardiopulmonary bypass must be issued emergently, where should the venous and arterial cannulations be placed?

A

the femoral vein and artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

The _____ pump pumps blood to the body via the arterial cannula and has the option of pulsatile flow or non-pulsatile flow

A

main pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

This type of flow is more common through the main pump and uses a “centrifugal pump”

A

non-pulsatile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

This type of flow is a newer technique and is less common through the main pump and uses a “roller” pump or “diagonal pump”

A

pulsatile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what type of pump does non-pulsatile flow through the main pump use?

A

centrifugal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what type of pump does pulsatile flow use through the main pump?

A

roller or diagonal pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Two advantages of using pulsatile flow through the main pump

A
  1. better diastolic run-off

2. stimulation of the endothelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Perfusion is (better/worse) with pulsatile flow through the main pump

A

better; more physiologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

2 disadvantages to pulsatile blood flow through the main pump

A
  1. achieving pulsatile flow through a non-compliant cardiopulmonary bypass machine is difficult
  2. high flows and shear stress can result in more damage to blood elements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

This element of the cardiopulmonary bypass machine COOLS and HEATS the blood and allows the perfusionist to control the patient’s temperature during cardiopulmonary bypass

A

heat exchanger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what temperature is implemented while the patient is on cardiopulmonary bypass for organ protection?

A

modest hypothermia ~ 34 degrees Celsius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

List 2 advantages of modest hypothermia during cardiopulmonary bypass

A
  1. decreases oxygen requirements
  2. decreases anesthetic requirements
    - hypothermia acts as an anesthetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

a decrease in body temperature by 1 degree Celsius will decrease cerebral O2 consumption by _____%

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

a decrease in body temperature by 10 degrees Celsius will decrease cerebral O2 consumption by _____%

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

List 2 disadvantages to modest hypothermia during cardiopulmonary bypass

A
  1. increases the chances of coagulopathy
    - increases the bleeding risk
  2. increases blood viscosity, which can decrease perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

list the 3 functions of the oxygenator on the cardiopulmonary bypass machine

A
  1. oxygenates the blood
  2. removes CO2
  3. site of volatile agent into the bypass machine
    - controlled by the perfusionist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

List the 2 types of oxygenators

A
  1. Bubble oxygenator

2. membrane oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

this type of oxygenator is more simple and is of lower cost

A

bubble oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

this type of oxygenator causes more trauma to the blood

A

bubble oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

this type of oxygenator is rarely used in the current era

A

bubble oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

this type of oxygenator is associated with less blood trauma

A

membrane oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

this type of oxygenator has increased complexity and is higher in cost

A

membrane oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

this type of oxygenator is the standard used today

A

membrane oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what is the main problem with the oxygenator?

A

damages the blood

  • leukocyte activation, inflammatory response, organ dysfunction
  • decrease in circulating white blood cells and platelets and an increase in pulmonary artery pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the main function of the arterial filter in the cardiopulmonary bypass machine?

A

removes fat globules and air bubbles from the bypass circuit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what is the purpose of the ultrafilter on the cardiopulmonary bypass circuit?

A

aka hemoconcentrator, removes excess water and electrolytes from the circulating volume and concentrates the blood in a patient with a low hematocrit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

List the two types of suction used in cardiopulmonary bypass

A
  1. Standard
    - regular operating room suction
  2. Blood salvage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

List the 3 types of blood salvage suction used in cardiopulmonary bypass during cardiac surgery

A
  1. cardiotomy suction
  2. cell saver suction
  3. left ventricular vent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

this type of suction refers to suctioned blood that will eventually be returned to the patient ; a blood preservation technique that decreases the chances of the patient needing a donor transfusion

A

blood salvage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

this type of suction takes blood from the field and returns it to the cardiotomy reservoir before eventually ending up into the venous reservoir

A

cardiotomy suction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

will blood from cardiotomy suction run through the bypass machine?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

cardiotomy suction and left ventricular vent suction is used (before/after) the patient is heparinized and (should/ should not) be used after the patient comes off bypass

A

after

should not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the main advantage of cardiotomy and left ventricular vent suction?

A
  1. it is WHOLE blood which includes clotting factors, platelets, and PRBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are the 2 disadvantages of cardiotomy AND left ventricular vent suction?

A
  1. the blood going through cardiotomy suction is damaged by the bypass machine
    - associated with a more pronounced systemic inflammatory response and resulting coagulopathy
  2. significant contributor to hemolysis and particulate emboli that occur during bypass
    - room air is aspirated with the blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

this type of suction the blood from the field is washed and then centrifuged, which separates PRBCs from the plasma, platelets, and particulate matter
The RBCs are then moved to an infusion bag and transferred back to the patient

A

cell saver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what is the hematocrit of cell saver blood

A

50-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

List 2 advantages of cell saver blood

A
  1. Particles such as fat, air, and tissue are filtered out o the blood
  2. since the blood does not run through the bypass machine it is less damaged when it gets returned to the patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

does cell saver suction blood run through the bypass machine?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

list 2 disadvantages to cell saver suction

A
  1. it is NOT whole blood
    - only PRBCs
  2. takes longer before it can be reinfused into the patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

left ventricular vent suction is inserted into the left ventricle through the ______ vein

A

pulmonary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

this type of suction removes all the venous blood that was not picked up by the venous reservoir (blood that comes from bronchial and thespian veins) and returns it to the venous reservoir to prevent left ventricular distention

A

left ventricular vent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the risk of using left ventricular vent suction?

A

risk of introducing air into the left heart leading to an air embolism
-need to use TEE to assess air before taking the clamp off the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

in left ventricular vent suction, does the blood go through the bypass machine?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Where should the aortic cross clamp be placed in relation to the arterial cannula?
why?

A

proximal

-the only way perfusion to the head and the rest of the body is possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Where should the aortic cross clamp be placed in order for the arterial cannula to perfuse all 3 aortic arch vessels?

A

the ascending aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What are the 3 steps in sequence to arresting the heart and placing a patient on bypass

A
  1. drain the blood from the heart via the venous cannula
  2. place the aortic cross clamp while the heart is still beating
  3. arrest the heart by injecting cardioplegia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

when is it OK for the aortic cross clamp to be placed while the heart is beating?

A

ONLY when the heart is drained of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

List 2 ways the heart can be arrested without an aortic cross clamp

A
  1. retrograde cardioplegia

2. direct cannulation of the coronary arteries for cardioplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

List 3 advantages of the aortic cross clamp

A
  1. It is easier to arrest the heart
    - keeps cardioplegia in the heart and prevents it from washing out to the rest of the body
  2. prevents air inside the heart from entering the circulation
    - air can enter the heart when the aorta or hear is opened (valve repair)
  3. prevents re-infused blood from (from the arterial cannula) from backing up into the heart
105
Q

what are 2 disadvantages to the aortic cross clamp?

A
  1. physiologic perfusion to the heart is not possible

2. increases the risk of stroke from a possible dislodging of emboli

106
Q

how does the heart get perfused during bypass with the aortic cross clamp placed?

A

the bypass machine through the cardioplegia cannula proximal to the clamp
-usually non-pulsatile

107
Q

what is the purpose of a partial aortic cross clamp?

A

allows a hole to be made in order for a graft to be sewn into the aorta without blood shooting everywhere
-once the graft is sewn in, the clamp can be removed

“think of pinching of a balloon to create a hole without it popping”

108
Q

what is the disadvantage of partial aortic cross clamp?

A

associated with air emboli and stroke

109
Q

list 2 advantages to the cardiopulmonary bypass machine

A
  1. the surgery is “easier” for the surgeon

2. more hemodynamic stability

110
Q

list 7 disadvantages to the cardiopulmonary bypass machine

A
  1. the priming fluid causes hemodilution ( hematocrit decreases)
  2. an aortic cross clamp must be placed
  3. there may be difficulty coming off the pump
    - re-establishing an effective heart beat and contractility
  4. pulmonary complications are more likely
    - pulmonary edema
    - reduces the effects of natural surfactant
  5. Tissue perfusion is less effective
    - non-pulsatile
    - renal and hepatic perfusion is decreased and drugs are not cleared well
  6. the patient’s blood is damaged from the bypass machine
    - hemolysis
    - platelet and clotting factors are reduced
    - intense inflammatory response occurs
  7. large volume shifts can occur with possible cerebral edema
111
Q

how many mL of fluid is the bypass machine primed with? What percent of hemodilutional bolus does this usually equate to a patient’s circulating blood volume?

A

2,000 mL

50-70%

112
Q

in pediatrics, what is the bypass machine usually primed with in order to prevent hemodilution?

A

blood

113
Q

What two types of bypass systems are there depending on the type of venous reservoir used

A

open or closed

114
Q

the more common type of bypass system where the venous drainage flows freely by gravity into a venous reservoir that is open to the atmosphere

A

open aka “hard-shell reservoir”

-air is vented but blood is in direct contact to the air

115
Q

type of bypass system where the venous reservoir has been removed from the system, or is in the system but closed to the atmosphere

A

closed aka “collapsible bag”

116
Q

the advantage of an open bypass system

A

it is easier to manage for the perfusionist

-more precise monitoring of the venous reservoir (air is automatically purged)

117
Q

the disadvantage of an open bypass system

A

there is more blood-air contact resulting in more blood damage

118
Q

2 advantages of a closed bypass system

A
  1. less blood damage
    - less air-blood contact
    - decreased inflammatory response
  2. less hemodilution
    - smaller priming volume
119
Q

3 disadvantages of a closed bypass system

A
  1. less precise visual monitoring of venous return
  2. the venous reservoir is harder to manage for the perfusionist
    - requires an additional system to purge the air
    - more distracting for the perfusionist
  3. has less filters and may lead to more microemboli exiting the reservoir
120
Q

minimal extracorporeal circulation ( mini ECC) is a type of ____ _____ bypass

A

mini-cardiopulmonary

121
Q

what is the main advantage of mini-ECC?

A

the reduction of tubing length/ priming length

122
Q

what is the priming tube length of mini-ECC?

A

600 mL

123
Q

is the mini-ECC a closed or open bypass system?

A

closed

-limits blood-air contact

124
Q

what are the 4 components of a mini-cardiopulmonary bypass system?

A
  1. pump
  2. oxygenator
  3. reduced tubing length
  4. an arterial filter
125
Q

what are the 3 components that a mini-cardiopulmonary bypass system does NOT have

A
  1. heat exchanger
  2. venous reservoir
  3. cardiotomy suction
126
Q

what are 4 advantages of mini-cardiopulmonary bypass system

A
  1. all the advantages of a closed bypass system
  2. improves myocardial protection
    - less defibrillation to restore normal sinus rhythm
    - less post-op atrial fibrillation
    - consistent coronary blood flow
  3. less blood transfusion
    - lower priming volume and less hemodilution
  4. earlier recovery times and reduced ICU and total hospitalization time
127
Q

disadvantage to mini-cardiopulmonary bypass

A

demanding for the perfusionist

  • cell salvage which delays the return of blood to the circuclation
  • air entrapment stops the flow of blood and must be removed by the perfusionist
128
Q

What is the benefit of “off pump” heart surgery and how does it work?

A

the patient will not be exposed to all the negative effects of the bypass machine
- suction cups are applied to the heart to limit the the amount of motion while the heart is beating and being operated on

129
Q

what is the main complication with “off pump” heart surgery?

A

significant hypotension and arrhythmias due to the suction cups on the heart that reduce cardiac output

130
Q

this type of bypass refers to only draining a portion of the venous blood from the patient’s body, while the rest of the blood stays in the heart and travels to the body

A

partial cardiopulmonary bypass

131
Q

With partial bypass (some/all) the blood is removed from the ____ _____ via the venous cannula. This blood travels through the bypass machine and perfuses the body through the _____ _____

A

some
right atrium
arterial cannula

132
Q

with partial bypass (some/all) the blood stays in the heart and goes to the lungs before being pumped into the left ventricle and out of the aorta

A

some

133
Q

When a surgeon attempts to do a heart surgery “off pump” but the patient cannot tolerate it- the hypotension is too severe- the surgeon has what 2 options?

A
  1. place the patient on full bypass; the heart will be arrested and perfusion will be non-physiologic
  2. place the patient on partial cardiopulmonary bypass; the heart can still beat and perfusion can stay physiologic
134
Q

why would the surgeon consider a partial pulmonary bypass technique?

A

When the patient cannot tolerate an “off pump” a partial bypass technique allows the surgeon to keep the heart beating without the patient getting hypotensive

135
Q

List 3 surgical considerations of partial bypass?

A
  1. the heart must stay beating
  2. the patient will need to be ventilated and the anesthetist will need to deliver volatile agent
  3. an ascending aortic clamp does not need to be placed
136
Q

with left heart partial bypass, blood travels through the (right/left) heart and lungs as normal

A

right

137
Q

in left heart partial bypass, how is the blood removed from the left atrium and where does it travel?

A

blood is removed from the left atrium through a venous cannula
the blood then goes to the bypass machine and enters the arterial cannula where it perfuses the lower extremities

138
Q

in left heart partial bypass where does the blood that stays in the left atrium end up?

A

goes out the aorta to perfuse the head

139
Q

is the right side of the heart perfused and bypassed during left heart partial bypass?

A

no, ONLY the left side is bypassed

the right side of the heart and lungs are perfused and are NOT bypassed

140
Q

in left heart partial bypass, does the machine require an oxygenator?

A

no, all the blood flowing to the bypass machine is already oxygenated

141
Q

during left heart partial bypass, does the heart need to stay beating and lungs ventilated?

A

yes

the right side of the heart still needs to pump blood to the left side

142
Q

in left heart partial bypass, what are the 3 components that are NOT needed on the machine?

A
  1. oxygenator
  2. reservoir
  3. heat exchanger
143
Q

what is the only indication for left heart partial bypass repair?

A

open descending thoracic aorta aneurysm repair

-clamps are on the descending aorta

144
Q

in left heart bypass for descending aorta repair:
some blood is removed from the left atrium by a reservoir cannula and goes through the bypass machine and perfuses the ______ _______ through an arterial cannula (distal/proximal) to the clamp on the descending aorta

A

lower extremities

distal

145
Q

in left heart bypass for descending aorta repair:
some blood stays in the left atrium and is pumped into the aorta to perfuse the _____ and ______ ______ that is (distal/proximal) to the clamp on the descending aorta

A

head

upper extremities

proximal

146
Q

List 5 advantages to left heart partial bypass

A
  1. the heart stays beating and does not need to be restarted
    - physiologic perfusion
  2. lower circuit priming volume
    - less hemodilution
    - less blood damage from bypass circuit
    - less heparinization needed
  3. decreased chance of postoperative renal failure
    - only 4% incidence (9-11% with CBP and clamps)
  4. blood pressure can be controlled by the perfusionist
    - amount of blood flowing from left atrium to aorta can be controlled
  5. there is no direct blood-air contact in the circuit= less blood damage
    - no venous reservoir= closed circuit
147
Q

what is the target ACT for left heart partial bypass

A

150-200 seconds

148
Q

3 disadvantages to left heart bypass

A

a reservoir, heat exchanger, and oxygenator are not used

  1. no blood or fluid can be added to the bypass system
  2. the patient cannot be warmed or cooled by the bypass machine
  3. without the reservoir, systemic air embolization may be more likely
149
Q

with right heart bypass where are the venous cannulas placed?

A

in the superior and inferior vena cava

150
Q

with right heart bypass, venous cannulas remove (oxygenated/deoxygenated) blood from the (right/left) side of the heart and send it to the bypass machine

A

deoxygenated

right

151
Q

in right heart bypass, blood is re-infused into the ______ ______ through an arterial cannula

A

pulmonary artery

152
Q

the arterial cannula is placed (distal/proximal) to the aortic cross clamp on the pulmonary artery

A

distal

153
Q

is the aorta cross clamped during right heart bypass?

A

no; results in lower stroke risk

154
Q

in right heart bypass, only the (right/left) side of the heart is bypassed and the blood from the bypass machine goes to the _____

A

right

lungs

155
Q

is an oxygenator necessary in right heart bypass?

A

no; blood from the machine goes into the pulmonary artery and to the lungs

156
Q

is the heart arrested during right heart bypass?

A

no; the machine gets blood to the left side of the heart so the heart must stay beating and the lungs ventilated to pump blood to the rest of the body

157
Q

3 types of right sided heart operations that use right heart bypass

A
  1. tricuspid valve repair
  2. pulmonic valve repair
  3. right ventricular assist device (RVAD) placement
158
Q

What are 3 advantages of right heart bypass for the surgeon?

A
  1. the heart can stay beating
  2. the aorta does not need to be clamped
  3. the oxygenator does not need to be used on the bypass machine
159
Q

what are the only two ways that we can repair aneurysms on the ascending aorta or the aortic arch if the distal clamps need to be placed on the aortic arch or the descending aorta

A
  1. add another perfusion cannula
    - in addition to the regular arterial cannula
  2. make the patient so cold that their metabolic requirements would be low enough to allow them to survive a short period of time with no perfusion
160
Q

What are 3 options to protect the brain during the operation IF total body perfusion is not feasible with the arterial cannula due to the location of the clamps

A
  1. Deep hypothermic circulatory arrest (DHCA)
  2. retrograde cerebral perfusion with an additional perfusion cannula
  3. antegrade cerebral perfusion with an additional perfusion cannula

(these can be used in combo or in single)

161
Q

what is the name of the strategy where the perfusionist puts the patient on bypass, makes the patient profoundly hypothermic, and then turns the bypass machine off and stops circulation throughout the patients body

A

Deep Hypothermic Circulatory Arrest (DHCA)
-allows certain lesions to be repaired in situations where attempts at perfusion would have been unsafe or hard to achieve

162
Q

What does DHCA do to blood flow and oxygen requirements?

A

stops the blood flow through the surgical site which allows the surgeon to complete the operation
AND
oxygen requirements are lowered from the intense hypothermia so the patient can survive a short period of time of having no perfusion

163
Q

2 of the most common indications for DHCA

A
  1. ascending aortic repair

2. aortic arch repair

164
Q

2 other indications for DHCA

A
  1. descending aorta repair

2. clipping of certain complex brain aneurysms

165
Q

List the 4 steps of placing the patient on DHCA

A
  1. the patient is put on cardiopulmonary bypass
  2. the heat exchanger from the bypass machine profoundly decreases the patients temperature
  3. the heart is arrested, and circulation through the bypass machine is slowed to a near standstill
  4. the profound decrease in oxygen consumption allows the patient to survive the operation with minimal blood flowing through the body
166
Q

where is the arterial cannula usually placed during DHCA?

what is the other option?

A

femoral artery

axillary artery

167
Q

what can you do to help speed up the patient’s cooling process and further protect the brain during DHCA?

A

ice packs on the head

-can delay brain re-warming and increase ischemic tolerance

168
Q

What is the typical temperature just prior to circulatory arrest?

A

15-17 degrees celsius

-the longer the operations takes, the colder the patient will need to be

169
Q

what are 2 sensors that can be used to monitor the depth of hypothermia and ensure electrical silence during DHCA?

A
  1. BIS monitor

2. EEG

170
Q

at what temperature does the EEG become isoelectric?

A

between 15-20 degrees celsius at the nasopharyngeal temperature

171
Q

how long after the EEG becomes isoelectric must you wait before DHCA is initiated?

A

10 more minutes of cooling to ensure adequate homogeneous cooling of the brain

172
Q

what is the safe amount of time that DHCA can be performed?

A

30-45 minutes

173
Q

DHCA should not be performed for longer than ___ minutes

A

60

174
Q

DHCA of less than ___ minutes shows no neurologic complications

A

30

175
Q

DHCA of greater than ___ minutes shows an increased incidence of brain injury

A

40

176
Q

DHCA of greater than ___ minutes commonly results from some irreversible brain injury

A

60

177
Q

what patient population can tolerate LONGER periods of circulatory arrest?

A

neonates and children

178
Q

List 3 complications of DHCA

A
  1. any general complications of hypothermia
    - coagulopathy and profuse bleeding are the biggest
  2. potential neurologic complications
    - from bypass, aortic cross clamp, or lack of perfusion time during circulatory arrest
  3. neurologic complications from cooling or warming the patient too rapidly
179
Q

What timeframe is considered rapid cooling and what does it do to the brain

A

<20 minutes

lower neurodevelopmental outcome scores

180
Q

what 4 things does rapid warming after DHCA do to the patient?

A
  1. promotes systemic gas bubble formation
    - solubility of gas in a liquid decreases as the liquid temperature increases
  2. cerebral oxygen desaturation
  3. uneven warming
  4. organ damage
181
Q

Rewarming should not exceed ___ degree(s) celsius core temperature rise per ___ minutes of bypass time

A

1

3

182
Q

termination of rewarming should occur when the nasopharyngeal temperature reaches ____ degrees celsius

A

35

183
Q

which type of temperature probe should be used in all DHCA cases?

A

nasal

184
Q

why is a nasopharyngeal temperature probe used during hypothalamic cardiac arrest procedures?

A

provides an accurate reflection of brain temperature during cardiopulmonary bypass

185
Q

what are 5 additional intervention for brain protection from DHCA?

A
  1. preoperative steroids
  2. hyper oxygenation before DHCA
  3. allow at least 20 minutes for cooling
  4. packing the head in ice
  5. intermittent cerebral perfusion between 15 and 20 minute periods of DHCA
186
Q

the name of the technique where the surgeon places an EXTRA perfusion line in the SVC in order to deliver cold blood to the head during circulatory arrest

A

retrograde cerebral perfusion

187
Q

retrograde cerebral perfusion allows the perfusionist to deliver cold blood to the head through the (veins/arteries) instead of the (veins/arteries)

A

veins

arteries

188
Q

what is the purpose of retrograde cerebral perfusion during circulatory arrest?

A

to provide some blood flow to the head and keep the head cold and oxygenated

189
Q

when would you use retrograde cerebral perfusion?

A

during circulatory arrest

190
Q

the name of the technique where the surgeon places an EXTRA perfusion line in the right axillary artery to perfuse the head and lower extremities during ascending aorta and aortic arch repair

A

Normothermic Antegrade cerebral perfusion

191
Q

in retrograde cerebral perfusion, where is the extra perfusion line placed?

A

SVC

192
Q

in normothermic antegrade cerebral perfusion, where is the extra perfusion line placed?

A

right axillary artery

193
Q

in what circumstance is a normothermic antegrade cerebral perfusion technique used?

A

during ascending aorta and aortic arch repairs

194
Q

in normothermic antegrade cerebral perfusion, the perfusionist can can perfuse both the ____ _____ with the regular arterial cannula, and the _____ with the extra perfusion line

A

lower extremities

head

195
Q

what does “normothermia” refer to in antegrade cerebral perfusion?

A

we can repair the ascending aorta and aortic arch under NORMOTHERMIA= without hypothermic circulatory arrest

196
Q

can antegrade cerebral perfusion be used in conjunction with circulatory arrest?

A

yes, can provide some head perfusion just like with retrograde cerebral perfusion

197
Q

what is the disadvantage of using normothermic antegrade perfusion vs. hypothermic circulatory arrest?

A

placement of the extra perfusion line and manipulations of the arch-vessel cannulation may increase the incidence of stroke

198
Q

the name of a monitoring device straps to the head and uses “near-infrared spectroscopy” (NIRS) technology to measure oxygen saturation in cerebral vessels

A

cerebral oximeter

199
Q

instead of SpO2, a cerebral oximeter displays the saturation of oxygen in the head as ____

A

rSO2

regional cerebral oxygenation

200
Q

what is a normal cerebral oxygenation saturation (rSO2) value?

A

60-80%

the cerebral vascular bed is 75% venous and 25% arterial

201
Q

what does cerebral oximetry ultimately indicate?

A

cerebral perfusion

202
Q

if cerebral blood flow decreases, cerebral oxygen saturation will ( increase/decrease)

A

decrease

-there will be less arterial/oxygenated blood in the head

203
Q

a low rSO2 value indicates that cerebral perfusion has (increased/decreased)

A

decreased

-anesthetist need to increase blood flow and oxygen to the head

204
Q

What are 2 circumstances where an anesthetist would use a cerebral oximeter?

A
  1. Heart surgery
    - carries a high risk of stroke intraoperativly and this would alert the anesthetist immediately if cerebral perfusion is disrupted
  2. sitting position/ beach chair surgery
    - BP in the head can be uncertain
205
Q

Triggering points for when an anesthetist should intervene with rSO2 monitoring:

  1. an rSO2 value less than ____%
  2. a greater than _____% drop from the individual baseline rSO2
  3. a difference of ____% from the left and right hemispheres
A
  1. rSO2 value less than 50%
  2. a greater than 20% drop from the individual baseline rSO2
  3. a different of >30% from the left and right hemispheres
206
Q

4 factors that can decrease rSO2 values

A
  1. decrease in cerebral blood flow
    - hypotension/ decreased cardiac output
    - hyperventilation (hypocarbia)
  2. hypoxemia
    - decreased SaO2
  3. anemia
    - when there are less RBCs, a higher portion of oxygen will be taken off of each RBC= lower rSO2
  4. mechanical disturbances
    - vascular occlusion or compression, embolic events, clamping dissection, malposition of cannulas or balloon pump, clamping
207
Q

6 ways to increase cerebral SpO2

A
  1. increase cerebral perfusion pressure
    • increase MAP if patient is hypotensive
      - fluids, pressers, trendelenburg
    • decrease ICP
      - mannitol: decreases CSF production
      - placement of a lumbar drain
  2. increase cerebral blood flow (cerebral dilation)
    • increase PaCO2 (decrease patient’s minute vent.)
    • Nitroglycerin
  3. increase FiO2
  4. Increase cardiac output
  5. increase hematocrit
  6. decrease cerebral metabolism
    • increase the anesthetic or decrease temperature
208
Q

the three tests for standard anticoagulation tests

A

PTT, PT, INR

209
Q

this anticoagulation test examines the extrinsic pathway of the coagulation cascade

A

PT (prothrombin time)

210
Q

normal value of a PT test

A

12-15 seconds

211
Q

the anticoagulation test that examines the intrinsic pathway of the coagulation cascade

A

PTT (partial thromboplastin time)

212
Q

normal value of a PTT test

A

25-40 seconds

213
Q

normal value of INR

A

0.9-1.1

214
Q

a “standardized” PT result that corrects for variations in PT from different labs

A

international normalized ratio (INR)

215
Q

this drug works by binding and enhancing the activity of antithrombin III 1000 fold

A

unfractioned heparin

216
Q

heparin more readily affects the (intrinsic/extrinsic) coagulation pathway and effects the (PTT, PT, INR) coagulation test

A

intrinsic

PTT

217
Q

the effects of heparin can be reversed by a drug called _____

A

protamine

218
Q

in what type of line should heparin only be given in?

A

central line

219
Q

the standard anticoagulant drug used during cardiac surgery and the drug of choice for anticoagulation prior to cardiac surgery

A

heparin

-prevents blood from clotting in the bypass machine

220
Q

what is the heparin dose for standard cardiopulmonary bypass cases and when is it dosed?

A

300-400 units/kg

dosed just prior to aortic cannulation

221
Q

a clotting time test (obtained from a blood sample) that is used to assess coagulation in the cardiac operating room whenever heparin is given

A

ACT ( Activated Clotting Time)

222
Q

a normal ACT time

A

100-150 seconds

223
Q

the goal ACT required prior to going on pump for cardiac surgery

A

> 450 seconds

224
Q

occurs when a patient’s immune system develops antibodies against heparin

A

Heparin Induced Thrombocytopenia (HIT)

  • thrombocytopenia (low platelet count)
  • thrombosis

usually occurs with standard heparin

225
Q

When a patient has a hx of heparin induced thrombocytopenia and needs to have cardiac surgery, what drug can be used as a direct thrombin inhibitor for anticoagulation?

A

argatroban

-dosing guidelines are unclear and it is more difficult to control post-op bleeding

226
Q

patients with this deficiency will show resistance to heparin

A

antithrombin III

- deficiency can be inherited or acquired from previous heparin administration

227
Q

2 ways to manage antithrombin III deficiency

A
  1. Replace the antithrombin III
    - concentrates are available and pre-operative replacement should be 100% before cardiac surgery
  2. Administer FFP
    - if antithrombin III concentrates are not available, transfusion of plasma will replace antithrombin III but has a higher degree of viral transmission
228
Q

what is the most common version of low molecular weight or fractioned heparin?

A

lovenox (enoxaparin)

229
Q

4 ways fractioned (LMW) heparin is different from standard heparin

A
  1. it is dosed subcutaneously
  2. longer lasting (12-24 hours)
  3. Doesn’t prolong PTT as much
  4. not reversed as reliably with protamine

Standard heparin:

  • only administered IV
  • has a half life of 1 hour
230
Q

what is the better anticoagulation test that is used for lovenox?

A

anti-Xa assay

231
Q

a vitamin K antagonist that effects the extrinsic coagulation pathway

A

Coumadin (warfarin)

232
Q

Coumadin (warfarin) is dosed (PO/IV) and affects the ____ and ____ coagulation tests

A

PT and INR

233
Q

2 ways the effects of Coumadin can be reversed

A
  1. FFP

2. vitamin K

234
Q

a PO antiplatelet drug similar to aspirin

A

Plavix (clopidogrel)

235
Q

how long does Plavix last and how is it reversed?

A

5-7 days

platelet transfusion. Half life of plavix is long so platelets need to be administer over a prolonged period of time

236
Q

how long should aspirin be discontinued prior to elective surgeries?

A

7 days

237
Q

patients who have recently had a coronary balloon angioplasty and/or stent are at risk for coronary thrombosis and are commonly treated with 2 antiplatelet drugs known as?
what are the 2 drugs used?

A

Dual antiplatelet therapy

aspirin and plavix

238
Q

if a patient needs to have surgery but is on dual antiplatelet therapy, why is it a risk to discontinue the antiplatelet agents?

A

coronary occulution

239
Q

if a patient needs to have surgery but is on dual antiplatelet therapy, why is it a risk to continue the antiplatelet agents?

A

major intraoperative bleeding that could lead to fatality

240
Q

Managing Dual antiplatelet therapy in surgery:

patient underwent balloon angioplasty; dual antiplatelet therapy is required for _____

A

14 days

241
Q

Managing Dual antiplatelet therapy in surgery:

Patient received a bare metal stent, non-urgently;
dual antiplatelet therapy is required for _____

elective surgery should be delayed for _____

A

one month

one month

242
Q

Managing Dual antiplatelet therapy in surgery:

patient received a bare metal stent, urgently (acute coronary syndrome);
dual antiplatelet therapy is required for _____

elective surgery should be delayed for ____

A

one year

one year

243
Q

Managing Dual antiplatelet therapy in surgery:

a patient received a drug-eluting stent, non-urgently;
dual antiplatelet therapy is required for _____

elective surgery should be delayed ____

A

6 months

one month

244
Q

Managing Dual antiplatelet therapy in surgery:

patient received a drug-eluting stent, urgently (acute coronary syndrome)
dual antiplatelet therapy is required for _____

elective surgery should be delayed _____

A

one year

one year

245
Q

Managing Dual antiplatelet therapy in surgery:

urgent surgery may be continued with (aspirin/plavix) but not (aspirin/ plavix)

A

aspirin

plavix

246
Q

2 drugs that are direct factor Xa inhibitors

A

Xarelto (rivaroxiban) : taken PO

Eliquis (Apixaban)

247
Q

how long should Xarelto be discontinued prior to surgery?

A

24 hours

248
Q

the drug that is an inactivated from of Xa and binds to Xarelto and Eliquis to inhibit their activity

A

Andexxa

249
Q

how long should Eliquis (Apixaban) be discontinued prior to surgery?

A

48 hours

250
Q

patients that have had a thrombolytic agent (rtPA, streptokinase, urokinase) should not have elective surgery for at least ______

A

10 days

251
Q

this drug is derived from salmon sperm and reverses anticoagulation caused by heparin (brings the patient’s ACT back to normal)

A

Protamine

252
Q

when is Protamine dosed in cardiac surgery?

A

After the patient is taken off cardiopulmonary bypass

-give slowly peripherally

253
Q

what is the Protamine dose

A

1 mg Protamine per 100 units Heparin

254
Q

what is the mechanism of Protmamine

A

binds to Heparin directly and heparin is no longer able to work by binding antithrombin III
-Protamine has anticoagulation properties and excess protamine may therefore potentially increase bleeding

255
Q

3 adverse affects of Protamine

A
  1. Hypotension
    - more likely with rapid/central administration
  2. anaphylactoid reactions
    - more likely with rapid/central administration, prior exposure to Protamine, patient’s allergic to fish, male patients who have had a vasectomy, and diabetics exposed to Protamine through insulin
  3. possible catastrophic pulmonary vasoconstriction
256
Q

a concentrated extract from fresh-frozen plasma (factors are at 25 fold higher concentration than FFP) and can be given as part of a massive hemorrhage protocol in replacement of FFP

contains the vitamin K dependent clotting factors (II, VII, IX, and X), is used to treat life threatening hemorrhagein unstable patients onanticoagulants, and can be used to reverse the effects of Vitamin K antagonists

A

Prothrombin Complex Concentrates (PCC)

257
Q

4 advantages of PCC

A
  1. 2X as fast as FFP in coagulopathy reversal
  2. single dose every 24 hours (less volume required)
  3. half the adverse effects (transfusion reactions) as FFP
  4. Faster prep time than FFP (does not require thawing)
258
Q

2 disadvantages of PCC

A
  1. up to 20X more expensive than FFP

2. shorter acting than FFP (lasts for less than a day)

259
Q

what vitamin should PCC be concurrently administered with because of it short acting nature

A

vitamin K

Methods II (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions