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561 - Perfusion Technology > Exam 5 - Filters & Arterial Cannulas > Flashcards

Exam 5 - Filters & Arterial Cannulas Flashcards

1
Q

What is floating around in system?

A
  • Fat aggregates
  • Platelets
  • Microbubbles
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2
Q

Why do we use filters

A
  • GME
  • Other microparticles
    - Can cause transient to detectable microembolic events
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3
Q

ECC post-op dysfunction

A
  • Alter blood components
    - Platelet aggregation and compliment activation
  • Alter efficiency of the body systems
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4
Q

Sources of emboli

A
  • Platelet / Leukocyte (MAJOR source)
  • Denatured proteins
  • Particulates from ECC manufacturing
  • Fat microemboli
  • Microbubbles
  • Fibrin
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5
Q

Causes of GME

A
  • Repositioning / Insertion of cannula (can’t control)
  • Adding volume to reservoir
  • Rapid bonus injection
  • Excessive venous line negative pressure
    - can control last 3
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6
Q

Sources of Platelet / Leukocyte Aggregates

A
  • Blood trauma
  • Bank blood
  • Rxn between donor / patient blood
  • Hypotension / Trauma
  • Contact with foreign surface
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7
Q

Screen filters

A
  • made of woven mesh (polyester)
  • filters via direct interception
  • mesh pore size determines what can filter
  • pressure drop depends on:
    - fluid viscosity, flow, and filter design
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8
Q

Bubble Point Pressure

A
  • Ease at which bubble can pass through filter

- If BPP is exceeded by pressure gradient, bubble will pass through

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9
Q

Depth filters

A
  • Made of packed filter material (poly foam, nylon, glass wool)
  • Filtration depends on adsorption of emboli
  • Particle removal depends on:
    - amount of surface available and pathway traveled in filter
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10
Q

Pre-CBP filter

A
  • placed before reservoir inlet
  • 0.2 microns
  • Used during priming / recirculation of crystalloid
  • Cut out after recirculation BEFORE adding blood
    - NEVER leave in with blood products
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11
Q

Venous reservoir / cardiotomy filter

A
  • Removes aggregates picked up from suction trauma
  • Low resistance (cannot impede gravity drainage)
  • 20 - 40 microns
  • Filter integrated into reservoir
    - Can have both screen and depth filters (depth then screen)
  • Source of emboli due to suction
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12
Q

Arterial line filter (ALF)

A
  • located in arterial line
  • 20-40 microns
  • Must be able to:
    • easy prime, high flow rate, continuous pressure monitoring, purge trapped air, add bypass line, low prime volume
  • In 2013, AmSECT made it standard to use in ECC
  • Great big bubble traps (need purge line w/ one way valve to remove micro bubbles)
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13
Q

ALF disadvantages

A
  • add to cost
  • can obstruct flow
  • possible source of GME….hard to de-air
  • can cause hemolysis and compliment activation
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14
Q

Self-venting ALF

A
  • Have hydrophobic membrane on top
  • can vent micro bubbles w/o purge line
  • still recommended to use a purge line with them
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15
Q

Integrated ALF / membrane oxygenator

A
  • no external filter
  • reduces prime volume
  • easier set up and priming
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16
Q

Leukocyte Depleting filters (LD)

A
  • Located in ALF or cardioplegia line
  • 40 microns
  • drops leukocyte levels
  • non-woven polyester fibers w/ polysaccharide surface
    - selectively grabs leukocyte and leaves other blood components
17
Q

Why do we remove Leukocytes from ECC

A
  • Release cytokines when activated

- cytokines contribute to SIRS and other organ injury

18
Q

LD disadvantages

A
  • Effects line pressure
  • high resistance as filter becomes saturated
  • less effective over time
  • WBC selective
  • studies of efficacy show mixed results
19
Q

LD for ECC vs Bank blood

A
  • Should be used on Bank blood due to patient condition or surgeon request
  • ECC and bank LD filters look different….pay attention
20
Q

Cardioplegia Filters

A
  • located in Cardioplegia line system
  • blood = >40 microns
  • crystalloid = 0.2 microns
  • removes particulates, endotoxins, bacteria
21
Q

Gas line filter

A
  • located between gas source (blender) and oxygenator
  • 0.2 microns
  • removes 99.999% of bacteria
  • minimizes cross contamination between equipment and patient
22
Q

Blood transfusion filters

A
  • use when transfusing blood into pump
  • use when administering processed, washed RBC
  • lots of microaggregates in bank blood
  • AABB recommends use of lipid filter too when transfusing blood
23
Q

3 Common cannulation sites

A
  • Ascending Aorta
  • Femoral artery
  • Axillary / subclavian artery
24
Q

Cannulation site determination

A
  • surgeon preference
  • operation planned
  • type of cannula used
  • quality of aorta
  • previous conditions
25
Q

Arterial cannula

A
  • made of plastic (can be wire reinforced)
  • various tip formations (want thin tip….best ID:OD ratio)
  • narrowest part of ECC
  • keep pressure gradient less than 100 mmHg
26
Q

Cannula size

A
  • usually measured in French (Fr)
  • adults are 20 and above
  • can be measured with external diameter
27
Q

Reynolds number

A
  • determines if flow is laminar or not
  • > 2500 flow is turbulent
  • <2000 flow is laminar
28
Q

Jetting effects

A
  • velocity of blood leaving cannula tip
  • jetting velocities can be 5-10x more than systolic velocity
  • can change jetting velocities with different tips
  • too high jet effect causes:
    • sandblasting, aortic dissection, hemolysis, protein denature
29
Q

Diagnosis of cannula tip in head vessel

A
  • High arterial line pressure of ECC
  • High radial pressure
  • Asymmetric cooling of neck
  • Unilateral hyperemia, edema, and petechia
    - Petechia = little blood spots under skin due to hemorrhage
30
Q

Diagnosis of aortic dissection

A
  • Sudden decrease in venous return and arterial pressure
  • excessive loss of perfusate
  • increased circuit arterial line pressure
  • decreased organ perfusion
  • blue color in aortic root due to adventitial hematoma
31
Q

Special purpose arterial cannulas

A
  • Embol-X : has extra filter to capture particulates

- Triumph : soft occlusion aortic cannula (instead of x-clamp)

32
Q

Aortic arch vs. Femoral artery

A

Accessibility: easy of AA….hard for FA
Direction: AA is antegrade….FA is retrograde
Leg ischemia: AA is not possible….FA is possible

33
Q

Femoral artery advantages

A
  • allows peripheral cannulation
  • allows cannulation for high risk patients
  • may be only option
34
Q

Femoral artery disadvantages

A
  • limited flow due to size
  • FA trauma (dissections most serious)
  • bleeding
  • leg ischemia
  • infection
35
Q

Axillary/Subclavian cannulation

A
  • Can be direct or via 8mm graft
  • Right axillary favored
  • allows selective antegrade cerebral perfusion
  • less malperfusion during aortic dissection surgery
  • less risk of cerebral atheroembolism
36
Q

Axillary cannulation complications

A
  • Axillary injury
  • brachial plexus injury
  • limp ischemia in arm
37
Q

4 types of integrated filters

A
  • Terumo FX
  • Sorin synthesis
  • Medtronic Affinity Fusion
  • Quadrox-I

561 - Perfusion Technology (12 decks)

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