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perfusion > Perfusion Tech > Flashcards

Perfusion Tech Flashcards

1
Q

According to Mora, hypothermia is defined as a body temperature below __ degrees C.

A

35

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2
Q

Cold is sensed by thermoregulators in the skin. This causes the hypothalamus to trigger a strong sympathetic nerve response. Therefore, __ the skin vessels.
a. Vasoconstricts
b. Vasodilates
c. Both
d. Does nothing to

A

a. Vasoconstricts

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3
Q

Name and define the 4 categories of hypothermia.

A

-Mild: 32-35 degrees
-Moderate: 26-31 degrees
-Deep: 20-25 degrees
-Profound: <20 degrees

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4
Q

Name 3 rationales for hypothermia on CPB.

A

-reduced metabolic rate
-reduced O2 consumption
-lower pump flows
-less blood trauma
-CNS protection

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5
Q

True or False: Hypothermia Q10 concept states that each 10 degree C drop in body temperature will decrease metabolic process by 30%. Why?

A

False
50% drop

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6
Q

True or False: A decrease in temperature causes a decrease in metabolism. Therefore, increases CO2 production. Why?

A

False
Decreases CO2 production

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7
Q

__(organ) experience the largest proportional decrease in blood flow while on hypothermic CPB.

A

Kidneys

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8
Q

In hyperglycemic patients __ administration is less effective in patients who are hypothermic.

A

Insulin

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9
Q

__ lengthens the period of tolerated ischemia.

A

Hypothermia

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10
Q

During DHCA, the __ is the organ at greatest risk for injury.

A

brain

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11
Q

Name 5 temperature monitoring sites best suited for a DHCA case.

A

-nasopharyngeal
-tympanic
-arterial
-venous
-bladder
-PA
-esophagus
-jugular bulb

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12
Q

Typically, __ is administered to combat acidosis during the warming phase after DHCA.

A

NaHCO3

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13
Q

True or False: According to the special report, the venous output temperature is recommended to be utilized for cerebral temperature measurement during CPB. Why?

A

False
Arterial outlet

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14
Q

True or False: Temperature gradients between arterial outlet & venous inflow on the oxygenator during cooling should not exceed 10 degrees C. Why?

A
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15
Q

According to the lecture, name the 2 favored sites of temperature monitoring reasonable for weaning & post bypass measurement.

A

-nasopharyngeal
-PA

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16
Q

According to the lecture, name 3 conditions in which the myocardium can be damaged during CPB.

A

-inadequate cardioplegia delivery
-prolonged aortic x-clamp
-reoperations
-operations during acute coronary ischemia
-impaired ventricular fxn
-concomitant valve or aortic surgery w/ CPB

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17
Q

Match it up … as it pertains to cardioplegia solutions
Potassium Magnesium Calcium
a) kept in low concentration to maintain cell membrane integrity
b) ion responsible to stop contractile activity
c) helps stabilize the myocardial membrane

A

a) calcium
b) potassium
c) magnesium

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18
Q

Which cardioplegic solution uses A…B…and C protocol?
a. Plegisol
b. Buckberg
c. delNido
d. Microplegia

A

b. Buckberg

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19
Q

Which cardioplegia solution was initially designed for pediatrics?
a. Plegisol
b. Buckberg
c. delNido
d. Microplegia

A

c. delNido

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20
Q

Which cardioplegic solution uses all blood with arresting components added with a drug pump?
a. Plegisol
b. Buckberg
c. delNido
d. Microplegia

A

d. Microplegia

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21
Q

__ is the mildest form of ischemia and reperfusion injury and given time may completely recover.

A

Myocardial stunning

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22
Q

What is the purpose of cardioplegia? Name 3 points

A

-myocardial protection
-bloodless field
-ease of operation
-stop the heart
-reduce energy requirements

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23
Q

Most common vessel to cannulate to vent the left ventricle?

A

right superior pulmonary vein

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24
Q

When administering cold cardioplegia solution, what should the water temperature be set at?

A

4 degrees C

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25
Q

Retrograde CPS should be administered at a pressure of __.

A

40mmHg

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26
Q

Name 3 benefits of hemodilution.

A

-reduce strain on hospital blood bank
-allow for emergency CPB capability
-allows for possible avoidance of blood transfusion
-improved capillary blood flow
-decreased viscosity of blood

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27
Q

Name 3 complications of hemodilution.

A

-hypotension
-pulmonary & renal dysfunction
-anemia
-edema
-dilution of clotting factors & catecholamines
-increased need for blood products
-increased incidence of stroke

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28
Q

Name two perfusion techniques to reduce hemodilution.

A

-RAP
-MUF
-CUF
-pre-CPB blood sequestration

29
Q

Name 3 factors that affect the patient’s hematocrit during CPB.

A

-blood volume status
-prime volume
-blood loss
-addition of crystalloid
-pre-bypass Hgb

30
Q

Name a crystalloid priming solution that needs no buffering.
a. Plasmalyte
b. 0.9% NaCl
c. Lactated Ringers
d. Saline
e. All of the above

A

a. Plasmalyte

31
Q

31) Name the most popular colloid added to the prime.

A

Albumin

32
Q

True or False: Mannitol is a loop diuretic that is often used in the prime. Why?

A

False
Osmotic diuretic

33
Q

True or False: Osmitrol prevents tissue edema but is known to cause transient hypotension. Why?

A
34
Q

True or False: Amicar & Transexamic Acid are 2 antifibrinolytic agents that are usually administered before, during, and after CPB to reduce bleeding. Why?

A
35
Q

Heparin prevents the conversion of prothrombin to __.

A

thrombin

36
Q

Heparin’s peak effect is within __.

A

1 minute

37
Q

True or False: The half life of heparin is generally 30-60 minutes and decreases with temperature. Why?

A

False
Heparin is being metabolized slower w/ decreased temperature so 1/2 life increases.

38
Q

Name 2 factors that affect the ACT other than heparin.

A

-CPB (hypothermia, hemodilution, prime)
-coumadin
-technical errors
-disease state
-factor deficiencies
-temperature

39
Q

True or False: Heparin may be added to the prime. Why or why not?

A

True
Helps to coat the pump in case initial heparin dose is inadequate or patient metabolizes it quicker than normal.

40
Q

Name 2 signs of a protamine reaction.

A

-systemic hypotension
-pulmonary hypertension
-acute RV failure
-bronchospasms

41
Q

When using a 4 to 1 cardioplegia set how much blood/cardioplegia solution is delivered when giving a 1000cc dose of cardioplegia?
a. 700cc blood and 300cc cardioplegia solution
b. 800cc blood and 200cc cardioplegia solution
c. 1000cc blood and 200cc cardioplegia solution
d. 500cc blood and 500cc cardioplegia solution

A

b. 800cc blood and 200cc cardioplegia solution

42
Q

The difference between traditional Buckberg type (4:1) cardioplegia and Del Nido cardioplegia is:
a. Less crystalloid is used with Del Nido cardioplegia
b. Del Nido is given at a ratio of 1:4
c. Del Nido cardioplegia solution must be given every 20 minutes
d. Buckburg solution is becoming more popular in pediatric CV surgery

A

b. Del Nido is given at a ratio of 1:4

43
Q

What effect does severe aortic insufficiency have on cardioplegia delivery?
a. Increases aortic root pressure between the aortic cross clamp and the aortic valve
b. Decreases aortic root pressure between the aortic cross clamp and the aortic valve
c. Reduces the amount of cardioplegia solution in the left ventricle
d. Eliminates the need for direct ostial cannulation

A

b. Decreases aortic root pressure between the aortic cross clamp and the aortic valve

44
Q

What pressure should be monitored when giving retrograde cardioplegia?
a. Aortic root
b. Coronary sinus
c. Pulmonary artery
d. Central venous pressure

A

b. Coronary sinus

45
Q

Coronary artery bypass graft procedures are performed on patients with:
a. Severe aortic valve insufficiency
b. Mitral valve stenosis
c. Ischemic heart disease
d. Endocarditis

A

c. Ischemic heart disease

46
Q

What affect does severe aortic insufficiency have on antegrade cardioplegia delivered into the aortic root?
a. Improves distribution
b. Impairs cardioplegia delivery
c. Causes high aortic root pressures
d. Facilitates a swift arrest

A

b. Impairs cardioplegia delivery

47
Q

What is the most common arrest agent used in cardioplegia solutions?
a. Calcium
b. Lidocaine
c. Potassium
d. Glucose

A

c. Potassium

48
Q

After periods of ischemia what agent has been shown to facilitate reperfusion injury?
a. Glucose
b. Potassium
c. Magnesium
d. Calcium

A

d. Calcium

49
Q

Myocardial injury is caused by:
a. High blood flow
b. Ischemia
c. Low calcium
d. Low glucose

A

b. Ischemia

50
Q

What is the purpose(s) of giving a “Hot Shot” prior to removing the aortic cross clamp.
a. Addresses ischemia
b. Warms the myocardium
c. Replenishes cell energy
d. All of the above

A

d. All of the above

51
Q

If 1000cc’s of cardioplegia is administered and the heart still is not arrested what could be the possible cause?
a. Severe aortic valve stenosis
b. Severe aortic valve insufficiency
c. Severe mitral valve insufficiency
d. Severe tricuspid valve insufficiency

A

b. Severe aortic valve insufficiency

52
Q

How many surgical anastomosis’ are necessary for a cardiac transplant?
a. 1
b. 2
c. 3
d. 4

A

d. 4

53
Q

Once the native aortic valve is removed how can the surgeon administer antegrade cardioplegia?
a. Coronary sinus
b. Coronary ostia
c. Cardioplegia needle in the aortic root
d. None of the above

A

b. Coronary ostia

54
Q

What cannulation strategy is typically used for a CABG case?
a. Bi-caval cannulation
b. Dual stage cannula in the right atrium
c. Triple stage cannula in the right atrium
d. B and C

A

d. B and C

55
Q

What cannulation strategy is commonly used for a tricuspid valve repair?
a. Single stage cannula in the right atrium
b. Dual stage cannula in the right atrium
c. Triple stage cannula in the right atrium
d. Single stage cannula in the IVC and a single stage in the SVC

A

d. Single stage cannula in the IVC and a single stage in the SVC

56
Q

True or False: When using bi-caval cannulation can the IVC cannula be inserted through the femoral vein?

A

True

57
Q

When preparing a case report what patient data is necessary?
a. Height & weight
b. Diagnosis
c. Procedure
d. Complications
e. All of the above

A

e. All of the above

58
Q

Subclavian arterial cannulation is usually used for what type of procedure?
a. CABG
b. Aortic valve replacement
c. Mitral valve repair
d. Aortic reconstruction

A

d. Aortic reconstruction

59
Q

The lowest energy consumption state of the myocardium is:
a. Fibrilating heart
b. Beating working heart
c. Beating non-working (empty) heart
d. None of the above

A

c. Beating non-working (empty) heart

60
Q

True or False: Lowering the temperature of living tissue reduces the oxygen demand

A

True

61
Q

A hyperkalemic cardioplegia solution has:
a. High calcium
b. High potassium
c. High magnesium
d. Low calcium

A

b. High potassium

62
Q

True or False: Antegrade cardioplegia doesn’t address distal ischemia in patients with coronary artery disease.

A

True

63
Q

What pressure is monitored when giving retrograde cardioplegia?
a. Aortic root
b. CVP
c. Coronary sinus
d. LAP

A

c. Coronary sinus

64
Q

Cardioplegia dosing can be which of the following?
a. Time based
b. Volume based
c. Based on temperature change
d. All of the above

A

d. All of the above

65
Q

True or False: Hypothermia can cause vasoconstriction.

A

True

66
Q

Which crystalloid priming solution has the most physiologic pH?
a. 0.9% NaCl
b. Lactated Ringers
c. Plasmalyte
d. 5% Albumin

A

c. Plasmalyte

67
Q

Why does the surgeon cross clamp the aorta?
a. To create a bloodless field
b. To make the heart motionless
c. To facilitate complex cardiac repairs
d. All of the above

A

d. All of the above

68
Q

True or False: CABG patients tend to be volume overloaded prior to CPB?

A

False

69
Q

What venous cannulation strategy is used for a routine AVR?
a. 2 stage venous in the right atrium
b. 3 stage venous in the right atrium
c. Bi-caval cannulation
d. A and B

A

d. A and B

perfusion (11 decks)

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