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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
Q

why must transfusion filters be used when adding blood products

A
  • bank blood may contain clots or debris

- helps reduce risk of clogging cariotimy reservoir

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26
Q

what must you never add to a circuit under any circumstances

A

platelets

because it can activate platelets and can clot off CPB circuit

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27
Q

what is an orange pall filter

A

blood products filter

40 um

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28
Q

blue pall filters are used when?

A

in north because it is a combo filter

40 um

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29
Q

yellow pall filters are used when

A

used a lot in pediatrics
used on crystalloid cardioplegia solutions
.2 um

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30
Q

what do leukocyte filters remove

A

removes leukocytes, fat globules, and micro aggregates

-may be used for washed blood

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31
Q

where are the leukocyte filters

A

in arterial filter

in blood cardioplegia filter

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32
Q

when are leukocyte filters used

A

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

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33
Q

what are the cons of leukocyte filters?

A

clot off really easily

hard to debubble

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34
Q

how big are cardioplegia filters

A

.2 microns

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35
Q

what do cardioplegia filter remove

A
  • filters crystalloid part of cardioplegia fluid
  • removes particulate matter from solution
  • removes particles resulting from mixing of drugs that may precipitate
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36
Q

how big are gas filters?

A

.2 microns

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37
Q

what do gas filters removes

A

-removes particulate matter from gas source such as wall system of hospital or tanks

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38
Q

gas sources are not ____

A

sterile

39
Q

you never want to hook up an oxygenator to a gas source without a

A

filter

40
Q

when should you replace a tank for gas source?

A

when pressure reaches 500psi or less due to more particles and debris at bottom of tank

41
Q

what do hydrophobic filters remove

A

air from a blood path

42
Q

where are hydrophobic filters usually at?

A

cardioplegia device

43
Q

what are some conderations when choosing a filter?

A
  • flow rates or restriction
  • priming volume
  • pore size
  • air handling capability
  • inlet and outlet size
  • holder or bracket
  • cost
  • disposable is best
44
Q

in general: what do oxygenators do?

A

act as a lung

45
Q

job of oxygenator (4)

A
  • oxygenates blood
  • removes CO2
  • introduces anesthetic gases
  • removes anesthetic gases
46
Q

is anesthetic gas able to permeate the membrane of oxygenators?

A

yes

47
Q

what is another part of an oxygenator?

A

integrated heat exchanger

48
Q

what do integrated heat exchangers help

A
  • cooling of patient for lower metabolic needs

- warming of patient to normal temp

49
Q

oxygenator membranes have no ____ to gas interface

A

no direct blood to gas interface

50
Q

oxygenator membranes gas transfer mimic what?

A

lungs

51
Q

what are the type of membrane oxygenation

A
  • rolled flat plate
  • flat plate
  • hollow fiber-polypropylene
  • hollow fiber- polymethyl pentene
52
Q

what is the most common type of oxygenation type that is used in the heart lung machine

A

hollow fiber polypropylene

53
Q

what is gas transfer from gas to blood driven by?

A

diffusion that is determined by partial pressure of gas

54
Q

at 1 ATM partial pressure of all gases equal

A

760 mmHg

55
Q

molecules of diffusing gas move from what to what

A

high to low concentrations

56
Q

FiO2 controls what?

A

pO2

57
Q

Sweep controls what

A

the pCO2

58
Q

what does Fick’s law describe

A

rate of diffusion

-rate of diffusion is proportional to partial pressure gradient of the gas in the direction of diffusion

59
Q

the greater the concentration difference, the ________

A

greater the diffusion

60
Q

gas transfer across membrane due to what?

A

permeability of the membrane to the gas and the driving pressure of the gas

61
Q

driving pressure of gas is the difference between what

A

difference in pressures of specific gas and independent of other gases

62
Q

the rate of exchange determined by what?

A

pressure differential of the gas on either side of membrane and the permeability of the membrane to that gas

63
Q

the greater the differential, the greater the

A

rate of exchange

64
Q

the greater the permeability, the greater the

A

rate

65
Q

each membrane has what?

A

rated pressure drop

66
Q

where do you measure the membrane

A

inlet and outlet pressure

67
Q

impact on pressure in CPB circuit?

A
  • high flow
  • high viscosity
  • high hemoglobin and hematocrit
  • low temperature
68
Q

why does a smaller membrane take longer to warm back up bigger patient

A

smaller membrane = smaller surface area = small heat exchanger = longer to warm back up bigger patient

69
Q

what makes an ideal oxygenator?

A
  • type of gas transfer material
  • pressure drop
  • prime volume
  • gas transfer rating
  • heat exchange rating
  • GME and air handling
  • integrated arterial filtration
  • biocompatibility
70
Q

small

A

5 flow
144 prime volume
chase with 500

71
Q

large

A

7 flow
260 prime volume
chase with 700

72
Q

what are cardiotomy reservoirs used on?

A

for CPB and for cell savers

73
Q

what is hardshell venous reservoirs (open) used on

A

for CPB

74
Q

what is soft-shell venous reservoir (closed)

A

for CPB

75
Q

what will a cardiotomy may or mayn’t have

A

integrated filter

76
Q

Cardiotomy is used to collet and hold what?

A

blood salvaged from operative site in CPB and cell saver cases

77
Q

where does the cardiotomy calibrate?

A

on outer shell

78
Q

what coats the cardiotomy filter?

A

de-foaming agent which lowers surface tension of bubbles

79
Q

the filtered areas in the cardiotomy reservoir filter out what?

A

clots, blood cell aggregates, fat globules, tissue

-help defame suction blood

80
Q

Never allow ____ to spill on device

A

isofluruane

81
Q

ports on Cardiotomy

A
  • 1/4 inch ports for suction inlets and quick prime inlet
  • 3/8 inch inlet and outlet
  • leur ports
  • vent ports
82
Q

ports on hardshell venous reservoir

A
  • 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
Q

adult venous reservoir bag ports

A
  • 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
Q

what is ultrafiltration

A

selective removal of plasma water and low molecular weight solutes from intravascular cellular components and plasma proteins of blood

85
Q

what is the driving force of ultrafiltration

A

hydrostatic pressure differential occurring across the semipermeable membrane

86
Q

formula for transmembrane pressure mmHg

A

TMP = (PA + PV) / 2 + (v)

TMP= transmembrane pressure
PA = arterial (inlet) pressure
PV = venous (outlet) pressure
V = absolute value of any applied suction

87
Q

transmembrane pressure should be in what range

A

100 - 500 mmHg

88
Q

facts affecting pressure

A

device resistance
hematocrit
temperature
blood flow rate through filter

89
Q

what are the types of hemoconcentration

A
  • ultrafiltration
  • MUF: modified ultrafiltration
  • ZBUF: zero balance ultrafiltration
  • CUF: continuous ultrafiltration
  • DUF: dilution ultrafiltration
90
Q

hemoconcentrators must have what kind of flow

A

must have positive pressure flow

91
Q

blood can be supplied to hemoconcetrator device from….

A
  • recirc line b/c pressure system is what runs pressure itself
  • arterial filter purge
  • venous purge
  • separate pump
92
Q

what does continuous ultrafiltration (CUF) correct?

A

corrects electrolyte imbalances and removes deleterious mediators

93
Q

blood from hemoconcentrator should be returned to

A

cardiotomy reservoir

hardshell venous reservoir

94
Q

blood should no be returned to

A
  • arterial line
  • direct to the oxygenator
  • direct to the patient due to possible air embolism

Perfusion Circuits (5 decks)

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