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Perfusion Circuits > Filters, Oxygenators, Reservoirs, Hemoconcentrators > Flashcards

Filters, Oxygenators, Reservoirs, Hemoconcentrators Flashcards

1
Q

What are some filter desirable characteristics? (7)

A
  1. ability to remove particulate matter
  2. ability to remove micro air-emboli
  3. negligible resistance to blood flow
  4. minimal blood trauma
  5. large surface area
  6. ease of priming and de-airing
  7. translucency
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2
Q

what does negligible resistance to air flow mean

A

want it to have minimum resistance to flow

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3
Q

filters are used to remove ____ and ____

A

remove particulate matter and micro-air emboli

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4
Q

what can particulate matter include?

A
  • debris from circuit
  • debris from solutions
  • platelet aggregates
  • fat globules
  • bone chips
  • tissue
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5
Q

what are sources of micro air

A
  • air in venous line from cannulation site
  • air in venous line from insertion of retrograde cannula
  • high flows from cardiotomy reservoir
  • turbulence of blood
  • warming blood too quickly
  • draining venous reservoir
  • allowing level to get too low with high flows
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6
Q

high flow with low level creates what

A

less reaction time

create suction vortex which could let in air

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7
Q

what are the different types of filters

A
  • screen filters
  • depth filters
  • combination filters
  • blood filters
  • non blood filters
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8
Q

what do the depth combination filters deplete?

A

leukocyte

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9
Q

what do non blood filters filter out

A

something smaller then blood red cells

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10
Q

what do hydrophobic filters not like

A

does not like water

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11
Q

what are the blood filters

A
  • arterial line filter
  • cardiotomy filter
  • transfusion filter
  • leukocyte depleting filter
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12
Q

what are the non-blood filters

A
  • pre bypass filter
  • cardioplegida filter
  • gas filter
  • hydrophobic filter
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13
Q

how big is the arterial line filter

A

20-40 um filter

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14
Q

housing design affects ____

A

function

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15
Q

arterial line filters is designed to act as a bubble trap using what?

A

a purge line with one-way valve

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16
Q

what does a purge line help in arterial filters

A

allows ease of priming and air removal

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17
Q

where are the cardiotomy filters placed?

A

filter can be separate or integrate into cardiotomy reservoir

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18
Q

what type of filter is a cardiotomy filter?

A

usually a combination of filter type

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19
Q

what do cardiotomy filters remove?

A

removes particulate matter during surgery

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20
Q

what feature does cardiotomy filter have?

A

coated with antifoam and/or defaming agent to reduce air/bubbles due to turbulence of suction blood

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21
Q

how many microns is a filtered cardiotomy

A

20-40

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22
Q

how many microns is an unfiltered cardiotomy

A

70-180

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23
Q

what type of filter is used at THI and how big of microns?

A

pall filter

40 microns

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24
Q

when are transfusion filters used

A

must be used when adding blood products to circuit or patient (PRBC or FFP)

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25
why must transfusion filters be used when adding blood products
- bank blood may contain clots or debris | - helps reduce risk of clogging cariotimy reservoir
26
what must you never add to a circuit under any circumstances
platelets | because it can activate platelets and can clot off CPB circuit
27
what is an orange pall filter
blood products filter | 40 um
28
blue pall filters are used when?
in north because it is a combo filter | 40 um
29
yellow pall filters are used when
used a lot in pediatrics used on crystalloid cardioplegia solutions .2 um
30
what do leukocyte filters remove
removes leukocytes, fat globules, and micro aggregates | -may be used for washed blood
31
where are the leukocyte filters
in arterial filter | in blood cardioplegia filter
32
when are leukocyte filters used
sometimes used on transplant patients and sometimes used as external arterial line filter during rewarming sometimes used in cardioplegia systems sometimes used in auto transfusion
33
what are the cons of leukocyte filters?
clot off really easily | hard to debubble
34
how big are cardioplegia filters
.2 microns
35
what do cardioplegia filter remove
- filters crystalloid part of cardioplegia fluid - removes particulate matter from solution - removes particles resulting from mixing of drugs that may precipitate
36
how big are gas filters?
.2 microns
37
what do gas filters removes
-removes particulate matter from gas source such as wall system of hospital or tanks
38
gas sources are not ____
sterile
39
you never want to hook up an oxygenator to a gas source without a
filter
40
when should you replace a tank for gas source?
when pressure reaches 500psi or less due to more particles and debris at bottom of tank
41
what do hydrophobic filters remove
air from a blood path
42
where are hydrophobic filters usually at?
cardioplegia device
43
what are some conderations when choosing a filter?
- flow rates or restriction - priming volume - pore size - air handling capability - inlet and outlet size - holder or bracket - cost - disposable is best
44
in general: what do oxygenators do?
act as a lung
45
job of oxygenator (4)
- oxygenates blood - removes CO2 - introduces anesthetic gases - removes anesthetic gases
46
is anesthetic gas able to permeate the membrane of oxygenators?
yes
47
what is another part of an oxygenator?
integrated heat exchanger
48
what do integrated heat exchangers help
- cooling of patient for lower metabolic needs | - warming of patient to normal temp
49
oxygenator membranes have no ____ to gas interface
no direct blood to gas interface
50
oxygenator membranes gas transfer mimic what?
lungs
51
what are the type of membrane oxygenation
- rolled flat plate - flat plate - hollow fiber-polypropylene - hollow fiber- polymethyl pentene
52
what is the most common type of oxygenation type that is used in the heart lung machine
hollow fiber polypropylene
53
what is gas transfer from gas to blood driven by?
diffusion that is determined by partial pressure of gas
54
at 1 ATM partial pressure of all gases equal
760 mmHg
55
molecules of diffusing gas move from what to what
high to low concentrations
56
FiO2 controls what?
pO2
57
Sweep controls what
the pCO2
58
what does Fick's law describe
rate of diffusion | -rate of diffusion is proportional to partial pressure gradient of the gas in the direction of diffusion
59
the greater the concentration difference, the ________
greater the diffusion
60
gas transfer across membrane due to what?
permeability of the membrane to the gas and the driving pressure of the gas
61
driving pressure of gas is the difference between what
difference in pressures of specific gas and independent of other gases
62
the rate of exchange determined by what?
pressure differential of the gas on either side of membrane and the permeability of the membrane to that gas
63
the greater the differential, the greater the
rate of exchange
64
the greater the permeability, the greater the
rate
65
each membrane has what?
rated pressure drop
66
where do you measure the membrane
inlet and outlet pressure
67
impact on pressure in CPB circuit?
- high flow - high viscosity - high hemoglobin and hematocrit - low temperature
68
why does a smaller membrane take longer to warm back up bigger patient
smaller membrane = smaller surface area = small heat exchanger = longer to warm back up bigger patient
69
what makes an ideal oxygenator?
- type of gas transfer material - pressure drop - prime volume - gas transfer rating - heat exchange rating - GME and air handling - integrated arterial filtration - biocompatibility
70
small
5 flow 144 prime volume chase with 500
71
large
7 flow 260 prime volume chase with 700
72
what are cardiotomy reservoirs used on?
for CPB and for cell savers
73
what is hardshell venous reservoirs (open) used on
for CPB
74
what is soft-shell venous reservoir (closed)
for CPB
75
what will a cardiotomy may or mayn't have
integrated filter
76
Cardiotomy is used to collet and hold what?
blood salvaged from operative site in CPB and cell saver cases
77
where does the cardiotomy calibrate?
on outer shell
78
what coats the cardiotomy filter?
de-foaming agent which lowers surface tension of bubbles
79
the filtered areas in the cardiotomy reservoir filter out what?
clots, blood cell aggregates, fat globules, tissue | -help defame suction blood
80
Never allow ____ to spill on device
isofluruane
81
ports on Cardiotomy
- 1/4 inch ports for suction inlets and quick prime inlet - 3/8 inch inlet and outlet - leur ports - vent ports
82
ports on hardshell venous reservoir
- 1/4 inch ports for suction inlets and quickie prime inlet - 3/8 inch inlet for cardiotomy and outlets for venous blood pump line - 1/2 inch inlet for venous line - leur ports - vent
83
adult venous reservoir bag ports
- 1/2 in inlet for venous blood - 3/8 in inlet for cardiotomy and outlet for venous blood pump - may have 1/4 in recirc line - 1 or 2 leur connections on top for medication or air removal - no vent
84
what is ultrafiltration
selective removal of plasma water and low molecular weight solutes from intravascular cellular components and plasma proteins of blood
85
what is the driving force of ultrafiltration
hydrostatic pressure differential occurring across the semipermeable membrane
86
formula for transmembrane pressure mmHg
TMP = (PA + PV) / 2 + (v) TMP= transmembrane pressure PA = arterial (inlet) pressure PV = venous (outlet) pressure V = absolute value of any applied suction
87
transmembrane pressure should be in what range
100 - 500 mmHg
88
facts affecting pressure
device resistance hematocrit temperature blood flow rate through filter
89
what are the types of hemoconcentration
- ultrafiltration - MUF: modified ultrafiltration - ZBUF: zero balance ultrafiltration - CUF: continuous ultrafiltration - DUF: dilution ultrafiltration
90
hemoconcentrators must have what kind of flow
must have positive pressure flow
91
blood can be supplied to hemoconcetrator device from....
- recirc line b/c pressure system is what runs pressure itself - arterial filter purge - venous purge - separate pump
92
what does continuous ultrafiltration (CUF) correct?
corrects electrolyte imbalances and removes deleterious mediators
93
blood from hemoconcentrator should be returned to
cardiotomy reservoir | hardshell venous reservoir
94
blood should no be returned to
- arterial line - direct to the oxygenator - direct to the patient due to possible air embolism

Perfusion Circuits (5 decks)

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