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AP Final Exam > CPB > Flashcards

CPB Flashcards

1
Q

What is CPB

A

Blood bypasses the heart and lungs

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2
Q

Explain the physical steps of CPS

A

Venous blood flows into the reservoir via gravity drainage
Blood flows through an oxygenator and a filter
Blood is pumped back into the aorta via the aortic cannula
A heat exchanger allows heating and cooling

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3
Q

Left heart bypass

A

Used for defending aorta surgery
Blood flows from the left atrium and is pumped back into the femoral artery
No oxygenator; May have heater/cooler

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4
Q

Extracorporeal Membrane Oxygenation (ECMO) Types

A

Veno-atrial (VA) and Veno-venous (VV)

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5
Q

VA vs. VV

A

VA: Post surgical patients, cardiac support
VV: Clears CO2 better than it adds O2, background ventilation needed
Both: Require systemic heparinization and ICU care

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6
Q

CPB Monitoring

A

ECG, arterial pressure, temperature, perfusion, volume

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7
Q

CPB Anticoagulation

A

Heparin, ACT

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8
Q

CPB Cannulas

A

Arterial, venous, vent, tack

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9
Q

CPB ECG Monitoring

A

Confirm asystole after cardioplegia and while the cross clamp is on
ST changes can occur due to air or ischemia

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10
Q

CPB Arterial Pressure Monitoring

A

Necessary because arterial pressure will not be pulsatile and therefore NIBP monitoring won’t work

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11
Q

Right radial arterial line issue during CPB

A

May not be accurate when right axillary is cannulated

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12
Q

Left radial arterial line issue during CPB

A

May be lost during high clamp in defending procedures

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13
Q

CPB Temperature Monitoring

A

Hypothermia is utilized to improve tolerance of non-pulsatile flow and decrease ischemic injury to brain, heart, and kidneys

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14
Q

CPB Target Temperature

A

Related to expected duration of the procedure

Mild/tepid 34-36, moderate 30-34, DHCA 18

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15
Q

What part of the body is most sensitive to ischemic insult?

A

CNS

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16
Q

CPB Profusion Monitoring

A

BIS/cerebral oximetry, ECG/filling pressures, Urine output, MVO2, Labs!

17
Q

Best way to assess volume status during CPB?

A

Reservoir volume

18
Q

Ultrafiltration

A

Removes excess volume and some electrolytes (like dialysis)

19
Q

How does CPB effect anticoagulation?

A

It generates contact activation

20
Q

Heparin works how?

A

It inhibits thrombin via antithrombin III

21
Q

Anticoagulation options for patients with HIT

A

LMWH, danaparoid, lepirudin, ancrod, argatroban

22
Q

Heparin Resistance

A

ATIII deficiency

Requires therapy for CPB

23
Q

Normal ACT

A

100-140

24
Q

ACT adequate to go on CPB

A

380-480

25
Q

ACT in impacted by…

A

Temperature, platelet function and hemodilution

26
Q

CPB Arterial Cannulas

A

Blood is pumped back in to the arterial system after being oxygenated and cleared of CO2

27
Q

CPB Arterial Cannulas: Common Placement

A

Ascending aorta, dital to the pulmonary artery

Alternatives: Axillary or femoral artery

28
Q

CPB Venous Cannulas

A

Placed in a large vein and allowed to drain into the CPB reservoir via gravity drainage

29
Q

CPB Venous Cannulas: Common Placement

A

Sternotomy

Dual or tri stage venous: Cannula placed through the right atrial appendage and down in to the IVC, drains RA and IVC

30
Q

Bicaval cannulation

A

Separate cannulas in SVC and IVC

Maximal drainage of the heart

31
Q

SVC cannula

A

Placed by anesthesiology via RIJ

32
Q

Vent

A

Catheter placed in the RUPV and in the left atrium to remove blood that accumulates in the heart in order to prevent injury

33
Q

Tack

A

A small catheter placed in the assenting aorta to facilitate clearance of intracardiac air

34
Q

Retrograde cardioplegia

A

A catheter is placed by the surgeon into the coronary sinus directly, or sometimes percutaneously by anesthesiologist via the RIJ with TEE guidance
The infusion pressure is measured in order to prevent injury to the sinus

35
Q

Antegrade vs. Retrograde cardioplegia

A

Antegrade - follows path of normal blood flow
Retrograde - flows from the sinuses to the coronary veins and out of the aorta
Choice between the two depends on the surgical procedure and on the ventricular function status

36
Q

Axillary Cannulation

A

Used for major aortic surgical procedures

MUST have an a-line

37
Q

Protamine

A

Used to reverse heparin
Will clot the CPB circuit!
Never give until the surgeon asks and always tell the perfusionist

38
Q

Protamine Reactions

A

Rare, but can be fatal

Pulmonary HTN/systemic hypotension

39
Q

What blood products can be given during CPB?

A

PRBCs and FFP

AP Final Exam (4 decks)

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