Safety & Techniques part I Flashcards
Name 2 CPB related problems ?
- Prevention
- Treatment
What type of protein is Protamine ?
Polycationic
What type of molecule is Heparin ?
Polyanionic
What is a major protamine reaction ?
3 Risk Factors ?
- Catastrophic pulmonary vasoconstriction.
- Vasectomized males
- Hx of PPHN
- Seafood allergies
What would be the Classification of the following Protamine Reaction:
Hypotension from rapid administration.
Type I
What would be the Classification of the following Protamine Reaction:
Anaphylactic reaction
Type II a
What would be the Classification of the following Protamine Reaction:
Immediate Anaphylactic reaction
Type II b
What would be the Classification of the following Protamine Reaction:
Delayed Anaphylactic reaction
Type II c
What would be the Classification of the following Protamine Reaction:
Catastrophic vasoconstriction
Type III
Preventions/ preparations for Protamine Reaction.
- Slow Injection
- Give peripherially
- Careful history
- LV fx
- Vasectomized pts.
- Redo’s
- Fish allergies
- Keep circuit intact
Treatment / Response to a Protamine Reaction.
- Administer Fluids
- Administer O2, Steroids, Epi
- Positive Pressure Ventilation
- Alpha vasopressor
- Dopamine
- If unresponsive:
- Give Heparin
- Reinstituted CPB
Prevention / Preparation for an AIR EMBOLISM
- Careful priming
- Flush CO2
- Level sensor
- Bubble sensor
- Arterial filter
- Pre-CPB checklist
- Verify before infusion
- Limit traffic
Treatment / response
for an AIR EMBOLISM
- Automatic pump shut down, if possible
- Protocol for massive air embolism during CPB
- Retrograde cerebral perfusion
Prevention / Preparation for Oxygenator Failure
- Preform Drills
- Diagnosis algorithm
- Check all gas connections
- To oxygenator
- vaporizer
- Correct source
- Kink free
- Size oxygenator to patient
- Check oxygenator for leaks
- Pre-CPB
Treatment / response
for an Oxygenator Failure.
- Assuming all optimizing steps have failed:
- Communicate
- Consider cooling
- Change-out membrane
- Pre-primed if poss.
Prevention / Preparation for Electrical Failure
- Be familiar w/institution
- Inspect cords and plugs pre-CPB
- Check flashlight
- Hand cranks accessible
Treatment / response
for Electrical Failure
- Clamp venous line to avoid exsaungination
- If necessary, illuminate reservoir
- Shut off pump, hand crank to previous level and resistance
- Have assistant hand crank vent, sucker, CP as needed
Prevention / Preparation for Hypoperfusion
- Assess volume status; add as needed to maintain flow
- Scan venous line for air
- Set occlusion before every case
- Centrifugal pump users; scan flows frequently
- Monitor venous saturations
- Watch line pressure to insure proper cannulation
- Does calculated flow rate make sense?
Treatment / response
for Hypoperfusion
- Increase flow, add fluids
- Walk air lock out and increase flow
- Modify cannulation
Prevention / Preparation for Drug Errors
- Label/date/conc/initial all syringes
- Have back-up verify drug
- Document all drugs and dosages administered
- Communicate w/surgeon and anesthesia regarding use of non-protocol drugs
Treatment / response
for Drug Errors
Consult anesthesia and/or surgeon
Prevention / Preparation for Clots in circuit
- Add heparin to prime
- Monitor ACT’s closely
- Keep [hep] .300u/kg
- Use hep bonded components
- Shut off pump suction before/early in protamine admin.
- Careful history for coaguable states
Treatment / response
for Clots in circuit
- Add heparin
- Communicate w/surgeon
Discontinue CPB ASAP - Monitor circuit pressures
- Monitor oxygenator function
- Change out circuit
Prevention / Preparation for Line Separation
- Check all circuit connectors tie band - Monitor line pressure closely servoregulate - Visually check arterial line Safety drills
Treatment / response
for Line Separation
- Stop pump clamp AV lines
- Make necessary connections, fill lines w/fluid
- Aspirate air from arterial line and resume CPB
Prevention / Preparation for Transfusion Error
- Document pt’s ID # and blood type on pump record prior to bypass
- 2 person check on blood products
- Final check before adding to circuit
Treatment / response
for Transfusion Error
- Stop transfusion immediately
- Notify appropriate personnel
- Recheck all labels
- Obtain urine specimen
Prevention / Preparation of Gross Circuit Contamination
- Use sterile technique when cutting into circuit
- Do not allow wet set-up to sit extended periods of time
- Limit traffic around pump
- Do not remove lines from field until chest is closed
- Verify package intergrity before opening
Treatment / response
for Gross Circuit Contamination
- Antibiotics
- cultures
