Expected pressures/Random CPB questions

Question 1

Antegrade cardioplegia expected flow and pressures. Vent on/off?

Answer 1

Flows 400-500
Pressure 200-250 mmHg
Vent off
(cannula is in the aortic root)

Question 2

Retrograde cardioplegia expected flow and pressures. Vent on/off?

Answer 2

Expect flows between 180-200
Pressure 35-50 mmHg in coronary sinus
Vent is on

Question 3

Ostial cardioplegia expected flow and pressures. Vent on/off? Where is it given?

Answer 3

Flows between 150-200
Pressure under 200 mmHg
Vent (depends)
Ostial cardioplegia given directly into the left or right coronaries

Question 4

If the retrograde pressure is too HIGH what might this mean/what should the surgeon consider doing?

Answer 4

May need to reposition cannula or remove some of the fluid in the balloon

Question 5

If the retrograde pressure is too LOW what might this mean/what should the surgeon consider doing?

Answer 5

May need to reposition or add some fluid to the balloon

Question 6

List 10 things you should look at when doing your ‘sweep’ as a perfusionist.

Answer 6

Volume in your reservoir, blood pressure, CVP (depending on where you are in the case), cardioplegia pressures, time since cardioplegia, time since last lab or ACT, what your anesthetic gas is set at, temperatures, flows, line pressure, cerebral sats, cell saver and where surgeon is in the case

Question 7

List 10 things you need to chart.

Answer 7

Time on bypass, time off bypass, clamp on, clamp off, flows, FiO2, sweep, anesthetic gas, if vacuum is on and how high, labs, ACTs, cell saver blood given and processed, cardioplegia, line pressure, any directions given by surgeon, any drugs given, who the perfusionist is

Question 8

List 5 things you should look at to access if you are ready to come off bypass and why it is important to look at each of these.

Answer 8

Blood pressure- needs to be adequate to come off bypass or you need to make changes to get it adequate (give drugs, leave more volume in patient, resolve bleeding issues, ect)
CVP is around 12-15 so you know that the patient has enough volume in them
Patient temperature is 36-37 degrees Celsius
EKG looks good
Labs and ACT look good (For example..if HCT is low can affect blood pressure and sats or if potassium is high it can cause arrhythmias)

Question 9

How do you know that the patient is full enough when coming down and off pump?

Answer 9

CVP is 12-15 or adequate for patient, the arterial waveform has a good waveform and you can always ask the surgeon if the heart is full enough or if he wants more volume since he is looking at the heart

Question 10

What two things do you want off before weaning that can affect the volume in your reservoir?

Answer 10

Want the vacuum and hemoconcentrator to be off before weaning if possible since both of these will affect your volume in reservoir if you do this after started weaning. Hemoconcentrator is a large shunt and vacuum is helping with drainage.

Question 11

At what point do you want to turn off your suckers after you are off bypass?

Answer 11

Once protamine is given (some hospitals you turn it off as protamine is started, some when a test dose is in, some when 50 mg is in, and some when half the protamine dose is in). The key is you do not want to clot off your circuit.

Question 12

What are some ways you can give back the blood from your reservoir once you are off bypass?

Answer 12

Hemoconcentrate and put the heparinized whole blood into a bag to give to anesthesia or through the cell saver

Question 13

Zero Balance Ultrafiltration

Answer 13

Done during a case
Reduces the potassium level of the patient
Add normal saline or 0K dialysate solution to the reservoir (usually 200 ml at a time in adults) and then remove the same amount of volume through the hemoconcentrator (hence zero balance)

Question 14

Modified Ultra Filtration (MUF)

Answer 14

Done after you are off pump
Allows you to give back the patients whole blood (contains heparin), including all the clotting factors that would be lost in the cell saver, to the patient
Used primarily in pediatrics, but can also be used in adults
 This is accomplished by pulling blood down the arterial line out of the patient through a roller head pump to a hemoconcentrator and returning to the patient through the venous line
 While you are doing this you are removing free plasma water from the hemoconcentrator and therefore removing volume from the patient
 YOU NEED TO WATCH THE CVP AND THE BLOOD PRESSURE
 As you remove the volume the CVP and blood pressure drops you can give back the volume left in your reservoir
 This volume goes up the arterial line to the patient (so you temporarily are not flowing backwards down the arterial line during this infusion)
 You also want to make sure the patient is not too full… so keep an eye on your CVP

Question 15

Normal PAP (Pulmonary artery pressure) what is normal PAP on bypass?

Answer 15

_____

Normal on bypass is like 0 or -5 or something? B/C PA is empty (we are the heart)

Question 16

CVP should be around _____ when coming off bypass, what does this assess?

Answer 16

12-15, assesses the patient is full enough/has enough volume

Question 17

Normal BP?

Answer 17

120/80

Question 18

Normal MAP?

Answer 18

60-90 on bypass if low could increase flows or give Neo

Question 19

Come down the vein (define it)
Pressure wanted
Flow wanted

Answer 19

Filling the vessel, and checking the anestamosis. (called a dribble or drip too)
Pressure of about 100? (double check)
Flow of about 80cc (double check)

Question 20

Vent on till __________ is in

Answer 20

Protamine

Question 21

Draw a blood gas/ACT right before ______

Answer 21

Going off pump

Question 22

Low venous return could do ______?

Answer 22

Vacuum