Concepts of CPB Flashcards
CPB circuit components
Oxygenator / heat exchange unit, pump head, venous reservoir, A-V loop, Arterial filter, filtered cardiotomy, cardioplegia delivery system, autologus blood conservation technologies
The oxygenator is the ______ portion of the unit
lung
The is pumps the blood to the patient
pump head
Arterial-venous connecction to the machine
A-V loop
The filtered cardiotomy is the another ______ tank or reservoir
holding
How we stop the heart
cardioplegia deilvery system
Autologous bloo dconsercation technologies AKA
Cell saver
What is used to prime the pump
Normosol, 10,000 units heparin, 200 cc 25% Mannitol, 50 mEq’s Bicarb, 200 mg lidocaine, 80 mEq’s K+, 5 grams Magnesium
Cannulation placement - The venous cannula goes into the _____ _______ and drains via GRAVITY from the IVC and SVC. Some blood flow will work its way through the heart and the onlu way to prevent this is to have two separate cannulas that are _____ together. The cardioplegia goes into the the ________ vessels causing the heart to stop.
right atrium / Y’ed / coronary
The second purpose of the cardioplegia line is to _____ the blood from the heart to the machine so the _______ ventricle does not overdistend or overstretch.
vent / left
The other way to give cardioplegia is to give it in the ______ _______ which would be RETROGRADE
coronary sinus
They will always harvest the ______ prior to going on pump.
LIMA
The LIMA is usually bypassed to the _____
LAD
When surgery is dones and coming off bypass and you are filling the lungs with air, look over the drap to make sure you don’t _______.
overinflate
A-V LOOP - The venous cannula drains the RA into the ______ ______. The arterial line returns FILTERED blood through cannula which is inserted into the _______.
venous reservoir / aorta
The venous reservoir acts as the ______ of the heart lung machine
atrium
There are closed and open systems when it comes to the venous reservoir. What are some of the components?
Defoamer, nylon sock, filtration media and screens
For venous drainage, a 2-stage cannula is inserted into the right atrium and connected to ___ inch pump tubing. Drainage achieved by GRAVITY.
1/2 inch
Can you add vacuum to the venous drainage if needed?
YES
The Venous 02 saturation monitor is a constant in-line monitor that can give you measurement of venous 02 saturation and _______. It is good way to tell whether adequate ______ is being achieved.
Hct / perfusion
While on pump you want your SV02 around ____%. Say it’s in the 40-50% range, what should you do?
70% / may need to turn flows up. Look at Hct, if it’s low you may need to give blood or diurese
Can the bubble detector be placed on any portion of the pump?
YES
Where would an air emobli go and what would it cause?
Brain / stroke
There are two types of pumps, what are they?
Roller pump and Centrifugal pump
The ______ pump is a bad pump for blood because it is pushing against the tubing and can damage the _____ ______
roller / blood cells
The ______ pump looks like a cone, no rollers, gentler on the blood cells and does the job of propelling the blood ________. This type of pump reduces _________.
centrifugal / forward/ hemolysis
Regardless of pump type, the longer the pump run the more likely will have _____
hemolysis
The pump console is considered the ________. It allows for adjustments in raising or lowering blood ________. In other words, it manages the patient’s cardiac ______.
heart / flow / output
On the pump console, the RPM translates into ______. 3000 RPMs is equivalent to about ___ to _____ liters of flow
flow / 3.5-4
The pump maintains _______ circulation
systemic
A hollow fiber membrane unit with a stainless steel blellows heat exchange unit
oxygenator - heat exchanger
The primary function of the oxygenator - heat exchanger is _______ and removal of _______ from the blood. This is considered the _______ of the machine.
oxygenation / C02 / Lung
Secondary function of the oxygnator-heat exchanger is ______ ________ management
blood temperature
The heater cooler attaches to the heat exchanger on bottom of oxygenator. This cools and warms the patient via blood circulation. Lowering 1 degree celsius reduces metabolic rate by ___%
7%
What mimics the ventilator?
Sechrist 02 blender
The 02 blender allows the perfusionist to control the ____ and the delivery speed of the oxygen air mixture to the _________
Fi02 / oxygenator
The desflurane vaporizer provides continuous and easily titrateable level of anesthesia. What are some of the benefits?
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
The arterial line includes a __ micron filter that removes air micro and macro bubbles via _____ line.
20 / purge
For the arterial filter the blood enters at the ______ and exits out the ______
top / bottom
What is the last safety device before blood enters the patient
arterial filter
What provides a direct measurement of circuit line pressure, serves as a 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?
Arterial line manometer
Following systemic heparinization, pump suckers can be turned on and blood is scavenged into this filtered reservoir known as the ____ ________
filtered cardiotomy
In open systems, the cardiotomy is integrated as a part of the venous reservoir instead of the ________ bag
collapsible
For the cardiotomy, You will have two sucker lines on the field to clear blood away as they’re working. This gets blood back to the pump so there is a minimal ____ _____ as possible
blood loss
Cardiotomy characteristics
received blood from the surgical field via a pump suctions, acts as a backup reservoir when excessive volume is reached, receives volume when vents are put into the heart
During bypass the aorta is cross clamped. Blood does manage to go through pulmonary circulation with stage 2 cannulation. If proper _______ does not occur then LV distention results. What is responsible for this?
venting / aortic root vent
The Left ventricular-pulmonary vent is used on _____ ________ cases. It mimics the same duties as the aortic root vent in limiting ____ distention
valve replacement / LV
How Is cardiac arrest achieved?
K+ infusion via the aortic root, coronary sinus (retrograde), vein grafts, coronary ostia
Antegrade delivery is through vein grafts and ______ ______
coronary ostia
High K+ infusion has significant _________ effect. Magnesium helps membrane ___________.
vasodilatory / stability
Quest Microplegia system allows for ___ ___ ___ adjustments
on the fly
Is there a built in heat exchanger to regulate temperature of perfusate with the cardioplegia delivery system?
YES
What allows you to maintain cardioplegia after each graft?
cardioplegia deilvery system
For the Quest Microplegia system, ______ is used as delivery solution instesad of crystalloid solution which helps reduced ______ significantly
blood / hemodilution
Prior to patient being put on pump, _________ heparizination must be reached. Levels are measured every ______ or necessary to maintain an ACT of ____ sec
systemic / 30 minutes / >480
With cell saver, the blood is ________ as it is suctioned from the operative field. The suctioned blood is collected and filtered in a reservoir. It is then centrifuged and washed with __________.
heparinzed / saline
With the cell saver washing, what is washed off?
protein / plasma / clotting factors
With cell saver, washed RBCs in normal saline is concentrated to a Hct around ___ to ___.
50-75%
What does a large amount of cell saver blood indicate
large plasma loss
Disadvantages of cell saver blood
loss of clotting factors
The magellan-platelet gel machine concnetrates ______ _______ to stimulate soft tissue and bone healing. This is usually placed on the _________. You can only use this if you have a normal or _______ platelet count.
growth factor / sternum / higher
Protocol summary
Minimum Hct for cold is 21% for warm is 24%, MAP 60-90 mmHg, urine 1-2 cc/kg/hr, temperature drift to 32 degrees celsius, ABGs q 30min, document flows and UOP q 15 min, dose cardioplegia q 15 min, heparin/protamine assays q30 min, cell saver for all cases
The retrograge autologus prime (RAP) procedure ocmes with risk of _______, so you may have to give some neo. The retrograge cardioplegia monitoring has a pressure line that will be connected to the _____ line, it is really key that stop cocks are both pointing UP (two thumbs up). Only want a pressure of _____ mmHg to the coronary sinus.
hypotension / CVP / 40
Want to keep glucose around _____
150
What can produce an overwhelming and systemic activation of the inflammatory cascade?
Blood contact Activation (from blood coming in contact with foreigns substances like metal and plastic)
The lungs are very susceptible to the inflammatory process. Activated WBCs are deposited or sequestered in the lungs where they release superoxides and lysosomal enzymes, which produce endothelial damage and in turn results in the accumulation of extravascular water. This AKA as ________ _______
pump lung
Severe hemodynamic compromise can result from a particularly vigorous complement response following _______ _______. (C3a, C4a, C5a)
protamine administration (PROTAMINE REACTION)
Air to blood interface causes the inflammatory response and triggers ______ _______ activation. This is a primary rationale for the switch from bubble oxygenators to ________ oxygenators
blood contact / membrane
Mechanisms to reduce blood activation
closed venous reservoirs, bio-compatible surfaces, judicious use of suction, cell savers, vents, doseing proper amount of heparin and protamine, microcircuitry
Benefits of closed venous reservoirs
eliminates the majority of air/blood interface, better flow dynamics, reduces 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
Benefits of Bio-compatible surfaces
heparin bonded coatings tip to tip, preserves platelet function, reduced complement activation, reduced post-op bleeding, improved post-op lung function, unfortunately it’s only limitation is $$$$
