Shabel Paper on (10 common Perfusion Problems) Prevention and treatment protocols

Question 1

How many perfusion accidents occur during CPB procedures?

How many end up in death or injury?

Answer 1

1 out of 300

1 out of 1000

Question 2

What percent of patients that undergo CPB will have at least transient neurological dysfunction ?

Answer 2

60 - 70%

Question 3

What percentage of perfusionist do not use protocols ?

Answer 3

> 50%

Question 4

What are the (2) number 1 causes of morbidity and mortality in bypass procedures?

Answer 4

Protamine Reaction

DIC

Question 5

An important step in developing protocols is to be able to apply the 4 steps of probelm solving theory. What are the 4 steps of problem solving theory ?

Answer 5

• Identification
• Evaluation
• Resolution
• Reassessment

Question 6

In what way can you approach identifying a particular perfusion problem ?

Answer 6

• Case Presentations

Question 7

After completing what 2 steps can you develop a protocol?

Answer 7

Identification

Evaluation

Question 8

What are variances ?

Answer 8

Failure to meet the standards required for a procedure or a task.

Question 9

Variances often occur when ?

Answer 9

Protocols are not used

Question 10

Protocols should be used to prevent variances of all types ?

Answer 10

Uncertainties
Unexpected events
Failures
Human Error

Question 11

Human error accounts for what percentage of variances ?

Answer 11

72%

Question 12

The purpose of this paper is to discuss 10 of the most common perfusion perfusion problems and give an outline for ____ and ____ of these problems.

Answer 12

Prevention

Treatment

Question 13

The purpose of this paper is to discuss 10 of the most common perfusion problems and give an
outline for what ?

Answer 13

Prevention and treatment

Question 14

The lack of a disciplined method of openly attacking problems ?

Answer 14

Breeds more problems

Question 15

Protocols are answers to what?

Answer 15

Problems

Question 16

Emergency protocols should be?

Answer 16

short, to the point, and limited to 1 page.

Question 17

How should protocols be written?

Answer 17

In a form that is easy to read, implement and follow.

Question 18

To ensure everyone has read and understands the existing protocol, __________ should be performed on
a regular basis.

Answer 18

drills

Question 19

What are the stated 4 benefits of practice drills?

Answer 19

• Educating the surgical team on new techniques and procedures.
• Shortening reaction time in emergencies
• Evaluating the existing protocol
• Enhancing communication between different members of the surgical team.

Question 20

What should be utilized prior to bypass.

Answer 20

Checklist

Question 21

Designing and implementing protocols should not be considered merely a legal issue
but also a ?

Answer 21

Ethical

Question 22

What do the authors contend are the first and one of the more important steps in making quality perfusion possible?

Answer 22

Doing the right thing the first time

Question 23

What period of time the Mejak Survey cover?

Answer 23

2 yrs

96-98

Question 24

Between the 1980 Stony survey and the 1986 Kurusz survey the was an increase in the use of what
device?

Answer 24

ALF

81.1 % to 98.5%

Question 25

How many perfusionists did Kurusz find to be using arterial line filters in 1986?

Answer 25

81%

Question 26

In Stony and Kurusz, what were the perfusion accident rates that resulted in serious injury of death?

Answer 26

1 : 1000

Question 27

In the Jenkins study, what was the incident rate? What was the rate of serious injury or death?

Answer 27

1 : 1288

Question 28

The Mejak Survey was divided into 4 sections, what were they ?

Answer 28

- Perfusionist info - Hospital Information - Equipment Info - Perfusion incident

Question 29

In the Mejak survey, What is the most commonly used safety device?

Answer 29

Hand Crank 99.2%

Question 30

In the Mejak survey, How many respondents cite the use of one-way pressure relief valves in the vent line?

Answer 30

83%

Question 31

In the Mejak survey, The most common perfusion incidents were ? This occured at a rate of ?

Answer 31

Coagulation disorders such as DIC 1 : 857

Question 32

In the Mejak survey, How was a protamine reaction defined?

Answer 32

1 : 871 Resulting in re-heparinizartion and restarting of CPB.

Question 33

In the Mejak survey, How many oxygenator failures were reported? Of these, how many required change-out?

Answer 33

273 144

Question 34

In the Mejak survey, How many medication errors were reported?

Answer 34

78

Question 35

How many incorrect blood units were reported? Any serious injury? Any deaths?

Answer 35

11 0 2

Question 36

Comparing this study with the 1986 Kurusz study, how have incident resulting in serious injury or death changed? To what may we attribute this decline?

Answer 36

Decreased Safety devices

Question 37

What was the overall incident rate of the Mejak study?

Answer 37

1 : 138 CPB procedures

Question 38

Because of the difficulty in predicting arterial related incidents in clinical practice, what do the authors recommend perfusionist do?

Answer 38

Prepare a plan of action for yourself and the operating room in case this occurs.