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CV- principles > CBP > Flashcards

CBP Flashcards

1
Q

what is a perfusionist?

A

a certified medical technician responsible for extracorporeal oxygenation and flow of the blood during open-heart surgery and for the operation and maintenance of equipment (such as a heart-lung machine) controlling it.

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2
Q

Perfusionists responsibilities

A

Setting up, operating and maintaining complex perfusion equipment
Monitoring circulation
Regulating the levels of oxygen and carbon dioxide in the blood
Regulating the body temperature
Measuring laboratory values such as arterial/venous blood gases
Administering medication and blood products via the bypass circuit under the supervision and direction of the anesthesiologist and surgeon

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3
Q

What are components of the circuit

A

♥ Oxygenator / Heat Exchange Unit
♥ Pump Head
♥ Venous Reservoir
♥ A-V Loop
♥ Arterial Filter
♥ Filtered Cardiotomy
♥ Cardioplegia Delivery System (MPS)
♥ Autologous Blood Conservation Technologies (Cell Saver)

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4
Q

What is the pump primed with?

A

♥ Normosol solution
♥ 10,000 units Heparin
♥ 200 cc 25% Mannitol
♥ 50 mEq’s Bicarb
♥ 200 mg Lidocaine
♥ 80 mEq’s K+
♥ 5 grams Magnesium

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5
Q

What is the AV-Loop?

A

the connection of the patient’s venous system to the patient’s arterial system with an extracorporeal circuit

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6
Q

What and where does the venous cannula drain

A

RA into the venous reservoir

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7
Q

Where is the arterial cannula inserted?

Where does it return blood to?

A

Inserted into the ascending aorta.

Delivers oxygenated blood to the body

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8
Q

Where does the basket in the mid cannula (venous) sit, and what part of the the body does it drain?

A

right atrium, drains upper body

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9
Q

where the basket that drains the lower body sit?

A

inferior vena cava

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10
Q

What does the venous reservoir act as?

A

Acts as the atrium of the heart-lung machine circuit

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11
Q

How is venous drainage achieved?

A

gravity and vacuum

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12
Q

why would vacuum of venous drainage be added?

A

to gain more patient volume & empty the heart if needed

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13
Q

What does the venous o2 saturation monitor measure?

A

constant measurement of venous o2 saturation & hct

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14
Q

What does the bubble detector do?

A

Safety mechanism that protects pts from receiving air embolus

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15
Q

where can the bubble detector be placed?

A

any portion of pump tubing

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16
Q

What is the E clamp?

A

a safety device that is attached to the arterial line.

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17
Q

What is the E clamps function?

A

to stop arterial flow to the patient when either air or low blood volume is detected

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18
Q

what can occur if air enters the venous line?

A

an airlock

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19
Q

What does a roller pump do?

A

compresses the blood tubing, which creates an occulsion point as it mechanically propels blood forward

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20
Q

What are the issues with the roller pump?

A

it’s traumatic to blood cells

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21
Q

the roller pump remains constant despite a patient’s ______

Why is this a problem/what can it lead to?

A

afterload

If the arterial inflow line is clamped the pimp continues to push blood forward which can rupture the arterial inflow tubing

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22
Q

If the venous reservoir runs dry, what is more likely to happen with a roller pump?

A

More likely to entrain air, which can lead to air embolism.

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23
Q

What does the pump do?

A

propels the blood through the patient’s circulation (replaces the heart)

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24
Q

how does the roller pump work?

A

positive displacement

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25
Q

How does the centrifugal pump work?

A

Non-occlusive constrained vortex– uses gravity and spins blood through a cone

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26
Q

what are benefits of the centrifugal pump?

A

less traumatic to blood cells
can’t produce excessive negative pressure= reduces risk of air embolus

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27
Q

the centrifugal pump flow decreases when it is confronted by excessive _____

A

afterload

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28
Q

What’s the disadvantage of the centrifugal pump?

A

It’s lack of occlusion point.

If there is an excessively high afterload, blood backs up towards the venous circulation, which reduces the pts circulating blood volume

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29
Q

What happens in the oxygenator?

A

gas exchange occurs (it replaces the lungs)

Primary function is the oxygenation & removal of CO2 from blood. This is the “ Lung”

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30
Q

Whats the secondary function of the oxygenator?

A

Secondary function is blood temperature management.

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31
Q

Lowering 1 degree celsius reduces_____

A

metabolic rate by 7%

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32
Q

What are the 3 types of hypothermia?

A

mild, moderate, profound

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33
Q

What does the O2 blender do?

A

controls the FIO2 and the delivery speed of the oxygen-air mixture to the oxygenator

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34
Q

What gases does the perfusionist use?

A

desflurane and isoflurane

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35
Q

Why are those gases used?

A

♥ Provides continuous and
easily titrateable level of
anesthesia
♥ Lowers chance of recall
♥ Allows heart to survive a
longer period of time before
injury due to ischemia.
“Anesthesia Preconditioning”
♥ Quick On-Off properties due
to its low blood gas
solubility makes it very
manageable to control BP

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36
Q

What is the last safety device before blood enters pt?

A

Arterial filter

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37
Q

what does the arterial filter do?

A

Removes air micro- and macro-bubbles via purge line

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38
Q

What does the arterial line manometer measure?

A

circuit line pressure

♥ Provides safety mechanism
for the heart lung machine
by verifying proper
placement of aortic cannula
and assuring that over
pressurization of the circuit
does not occur

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38
Q

What does the arterial line manometer measure?

A

circuit line pressure

♥ Provides safety mechanism
for the heart lung machine
by verifying proper
placement of aortic cannula
and assuring that over
pressurization of the circuit
does not occur

39
Q

What is the function of the cardiotomy?

A

♥ Receives blood from
surgical field via pump
suctions
♥ Acts as backup
reservoir when
excessive volume is
reached
♥ Receives volume when
vents are put into the
heart

40
Q

What is the function of the cardiotomy?

A

♥ Receives blood from
surgical field via pump
suctions
♥ Acts as backup
reservoir when
excessive volume is
reached
♥ Receives volume when
vents are put into the
heart

41
Q

What does the Aortic Root vent do?

A

prevents LV distention when the blood does get through the pulm circulation w 2 stage cannulation

42
Q

When is the left ventricular pulmonary vent used?

A

valve replacement cases

43
Q

what does the left ventricular pulmonary vent do?

A

♥ Mimics the same duties
of the aortic root vent in
limiting LV distention.
“Starlings Curve”

44
Q

How is cardiac arrest achieved?

A

High K+ infusion

(has significant vasodilatory effect)

45
Q

via what routes is cardioplegia administered?

A

-aortic root (antegrade)
-coronary sinus (retrograde)
-vein grafts
-coronary ostia

46
Q

What effects does the high K+ infusion have?

A

vasodilatory effects

47
Q

what is magnesium used for?

A

membrane stability

48
Q

what lab values does the blood analyzer produce?

A

PH, PCo2, PO2, Na+, K+,
Ca++, Glu, Lac, Hct, HCO3,
BE, SO2

49
Q

What ACT must be maintained and how often is it measured?

A

> 480 every 30 mins

50
Q

What ACT must be maintained and how often is it measured?

A

> 480 every 30 mins

51
Q

what are RBCs washed in for cell saver?

A

NS–> concentrated at hct 50 (75%)

52
Q

what does large amounts of cell saver blood indicate?

A

large plasma loss

53
Q

what is the major disadvantage of cell saver?

A

elements of the patient’s blood are “washed” off especially clotting factors.

End result potential bleeding problems with massive blood loss

54
Q

what is the major disadvantage of cell saver?

A

elements of the patient’s blood are “washed” off especially clotting factors.

End result potential bleeding problems with massive blood loss

55
Q

what does AGF stand for?

A

Autologous Growth Factor

56
Q

What does platelet rich contain?

A

> 1,000,000 plts/ul
7 growth factors

57
Q

what does platelet rich do?

A

stimulate and accelerate bone and soft tissue healing

58
Q

what is added to the platelet rich?

A

Calcium & Thrombin added to produce gel formation

59
Q

what does plt poor contain?

A

mostly plasma w few plts

60
Q

what is plt poor recommended for ?

A

use in plt aggregation

61
Q

when is plt poor used?

A

Applied on top of “RICH” to hold it in place like a bandage

62
Q

minimum hct cold

A

21%

63
Q

minimum hct warm

A

24%

64
Q

minimum hct warm

A

24%

65
Q

what MAP should be maintained?

A

60-90 mmHg

66
Q

how much urine output should be maintained?

A

1-2cc/kg/hr

67
Q

what temp do you want to maintain?

A

Drift to 32 degrees celsius

68
Q

how often should you do abgs?

A

30 mins

69
Q

how often do you document flows and UOP?

A

Q15

70
Q

how often is cardioplegia administered?Q

A

Q15-20 mins

71
Q

how often is cardioplegia administered?Q

A

Q15-20 mins

72
Q

how often should you do heparin/protamine assays?

A

Q30 mins

73
Q

when do you use cell saver?

A

all cases

74
Q

What is contact activation?

A

(Inflammation) - a series of host-defense mechanisms designed to attack foreign substances or tissue injury.

results from blood coming in contact with plastic tubing, filters, connectors, stainless steel heat exchangers, and blood to gas interfaces

Produces an overwhelming and systemic activation of the inflammatory cascade. (Systemic Inflammatory Response Syndrome: SIRS)

75
Q

how does the complement system affect the lungs?

A

Activated WBC’s are deposited or sequestered in the lungs; where they release superoxides and lysosomal enzymes, which produce endothelial damage & in turn results in the accumulation of extravascular water. “PUMP LUNG”

76
Q

what is the heparin -protamine complex associated with?

A

activation of the classic pathway and production of C3a,C4a and C5a.

77
Q

how should protamine be administered?

A

SLOWLY

78
Q

how should protamine be administered?

A

SLOWLY

79
Q

what does the air to interface inflammatory response do?

A

♥ Formation of gaseous microemboli.
♥ These gaseous microemboli disrupt
microcirculation by producing tissue & organ ischemia.

80
Q

what does the air to interface inflammatory response do?

A

♥ Formation of gaseous microemboli.
♥ These gaseous microemboli disrupt
microcirculation by producing tissue & organ ischemia.

81
Q

mechanisms to reduce blood activation

A

♥ Closed venous reservoirs
♥ Bio-compatible surfaces
♥ Judicious use of suction, cell savers, vents
♥ Dosing the proper amount of heparin & protamine
♥“Microcircuitry” (Smaller Compact Circuits)

82
Q

benefits of closed venous reservoirs

A

♥ Eliminates the majority of air/blood interface.
♥ Better flow dynamics, reduced areas of stasis.
♥ No defoaming agents, no nylon filter sock..
♥ Reduced complement activation.
♥ Preserves platelet function
♥ Reduced post-op bleeding.
♥ Improved post-op lung function.

83
Q

why are pts on CPB rendered hypothermic?

A

reduce metabolic rate

84
Q

why are pts on CPB rendered hypothermic?

A

reduce metabolic rate

85
Q

priming with anything other than blood produces:

A

Hemodilution:
-decreased hematocrit
-decreased o2-carrying capacity
-decreased blood viscosity (good if hypothermia is used)
-decreased plasma concentration of drugs and plasma proteins
-increased microvascular flow (d/t reduced viscosity)
-

86
Q

priming the CPB machine with a balanced salt solution reduces all of the following EXCEPT:
-microvascular flow
-plasma drug concentration
-oxygen-carrying capacity
-blood viscosity

A

microvascular flow

87
Q

When is awareness MOST likely to occur during CABG surgery on pump?
-induction of anesthesia
-aortic cannulation
-rewarming
-sternotomy

A

sternotomy (d/t intense surgical stimulation

next most common: rewarming

88
Q

what can be used if the pt has a heparin allergy?

A

bivalirudin, hirudin, or another factor 10 inhibitor

89
Q

whats the ideal range of SBP during aortic cannulation?

A

90-100 mmhg or MAP <70mmHg

90
Q

what is used to reduce bleeding risks?

A

antifibrinolytics: aminocaproic acid or TXA or cell saver

91
Q

does cardioplegia arrest heart is systole or diastole?

A

diastole

K+ increases resting membrane potential which locks the voltage-gated Na+ channels in the closed-inactive state

91
Q

does cardioplegia arrest heart is systole or diastole?

A

diastole

K+ increases resting membrane potential which locks the voltage-gated Na+ channels in the closed-inactive state

92
Q

how is the heart restarted?

A

infusint the coronary circulation with warm, normokalemic blood

93
Q

where is antegrade cardioplegia administered?

A

aortic root where it enters the coronary arteries

94
Q

where retrograde is cardioplegia administered

A

through cannula placed in the coronary sinus

CV- principles (8 decks)

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