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Pediatrics > test 1 part 2 > Flashcards

test 1 part 2 Flashcards

1
Q

Neonates and pediatric overview

A

 Many pediatric organ systems are immature / vulnerable
 Neonates have higher metabolic demands
 Neonates have IMMATURE MYOCARDIUM (matures 3-12 months)
 Neonates utilize GLUCOSE OXIDATION
 Immature myocardium prone to “stretch injury”
 Utilize alpha-stat and pH-stat blood gas management

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2
Q

adults overview

A

 Adult circuits tend to be “one size fits all”
 Many adult organ systems have acquired disease
 Some organ systems have failed
 Adults utilize FATTY ACID DEPENDENT energy source
 Not affected as much by prime volume dilution
 Mature clotting cascade and organ systems
 Utilize mostly alpha-stat and some pH-stat blood gas management

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3
Q 
estimating blood volumes:
Weight (kg):
<10
11-20
21-30
31-40
>40
A 
Blood volume (cc/kg)
< 10 = 85
11-20 = 80
21-30 = 75
31-40 = 70
> 40 = 65
- used for calculating post dilutional hematocrit
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4
Q 
Circuits are commonly called:
3/16” x ¼”
¼” x ¼” 
¼” x 3/8” 
3/8” x 3/8”
3/8” x ½”
A 
 3/16” x ¼” = Neonatal Pack
 ¼” x ¼” = Infant Pack
 ¼” x 3/8” = Pediatric/Small Adult Pack
 3/8” x 3/8” = Adult Pack
 3/8” x ½” = Large Adult Pack
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5
Q

Sequence to choosing an appropriate pediatric CPB circuit

A
  1. Determine BSA (kg weight may suffice)
  2. Determine maximum flow rate (KG weight based or BSA based)
  3. Choose oxygenator
    4.Choose appropriate pump boot
  4. Determine arterial line size
  5. Determine venous line size
     *Packs (1/8” x 3/16”, 3/16”x3/16”, 3/16”x¼”, ¼” x ¼”, ¼”x3/8”, 3/8”x3/8”, 3/8”x½”)
  6. Pick arterial cannula
  7. Pick venous cannula
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6
Q 
Kg weight - based flows
Weight (kg)
0-3
3-10
10-15 
15-30
>30
>55
A 
 0-3 = 200 cc/kg
 3-10 = 150 cc/kg
 10-15 = 125 cc/kg
 15-30 = 100 cc/kg
 >30 = 75 cc/kg
 >55 = 65 cc/kg
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7
Q

Terumo Baby RX05 (Max Flow and Prime volume)

A

Max Flow: 1.5 L/min (in red)

Prime volume: 43 cc (in red)

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8
Q

Terumo RX10

A

Max Flow: 4 L/min
Prime volume: 135 cc
-used for bigger kids

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9
Q

Terumo RX15

A

Max Flow: 5 L/min
Prime volume: 135 cc
-used for bigger kids

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10
Q

Sorin Kids D100

A

Max Flow: 0.7 L/min

Prime volume: 31 cc (in red)

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11
Q

Sorin Kids D101

A

Max Flow: 2.5 L/min

Prime volume: 87 cc

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12
Q 
Stroke volume/ revolution for boot diameter:
3/16”
¼”
3/8”
½”
A

 3/16” = 7 cc
 ¼” = 13 cc
 3/8” = 27 cc
 ½” = 45 cc

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13
Q

do NOT exceed how many RPM’s for maximum tubing flows

A

100 RPM’s

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14
Q 
Max tubing flows for:
3/16”
¼”
3/8”
½”
A

 3/16” 7 cc => (x 100 =700 cc)
 ¼” 13 cc => (x 100= 1300 cc)
 3/8” 27 cc => (x 100= 2700 cc)
 ½” 45 cc => (x 100= 4500 cc)

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15
Q

Reynolds number

A

Reynolds number = (velocity of fluid x density of fluid x diameter of pipe) / viscosity of fluid

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16
Q

Poisueille’s law

A
  • total volume that flows through a tube
    Flow = (change in pressure x pi x radius^4) / (length of tube x viscosity of fluid x 8)
  • radius is the only thing that changes
17
Q

how does turbulent flow effect the critical velocity

A
  • Turbulence decreases flow at any given perfusion pressure
  • turbulence increases the perfusion pressure required for a given flow
  • there is a “critical reynolds number” that when it is exceeded, there is a difference between turbulent flow and laminar flow
18
Q 
Choosing arterial tubing size base on max blood flow and how much prime it contains
1/8 
3/16”
¼”
3/8”
A

1/8 => 700 mls/min => 3 mls/ft
3/16 => 1100 mls/min => 7 mls/ft
1/4 => 2000 mls/min => 10 mls/ft
3/8 => 6500 mls/min => 20 mls/ft

19
Q

why is venous line normally larger

A
  • need a bigger line to drain more
20
Q 
Choosing arterial tubing size base on max blood flow and how much prime it contains
3/16”
¼”
3/8”
½”
A

3/16 => 1100 mls/min => 7 mls/ft
1/4 => 2000 mls/min => 10 mls/ft
3/8 => 6500 mls/min => 20 mls/ft
½ = > ———- => 40 mls/ft

21
Q

Resistance in the venous reservoir

A
  • We will not be dealing with a wide open venous line
  • Resistance in your reservoir can be a factor in venous return
    ◦ Since your venous line goes into the sock, a certain amount of volume is “delayed” there
    ◦ This is called “holdup volume”
    ◦ As your viscosity goes up - so may your holdup volume
22
Q

Pediatric Cannula Selection

A
  • Cannulation can be achieved in various vessels depending on the anomaly
  • Look for high flow – low pressure drops
  • Thin walled reinforced and thin wall metal cannula give good flow with lower pressure drops
  • It’s all about the ID (inner diameter) (for us) and the OD (outer diameter) (for surgeons)
23
Q

Pediatric Cannula Selection: arterial

A

 Aim: utilize the smallest cannula w/ the highest flow rate
 Do NOT exceed pressure drop > 100 mmHg
 Critical velocity is reached when laminar flow becomes turbulent (Reynolds #)
 Higher pressures = higher sheer stress = hemolysis = bad

24
Q

Pediatric Cannula Selection: venous

A

 Aim: drain the patient with the smallest cannulas
 Be aware if the cannulation is bicaval or single atrial cannula
 Pressure drop is in the -30 to -40 range (pressure-flow curve)
 Vacuum Assist Venous Drainage (VAVD) may help but at a cost (micro-emboli may be associated with VAVD)

25
Q

Determining arterial cannula

A

 Determine max flow:
 Cannulation may be aortic / femoral / neck
 Pressure drop should not exceed 100 mmHg
 Anticipate larger flow needs when warming
 Anticipate viscosity changes

26
Q

Main ascending aortic cannulae

A

DLP wire reinforced

27
Q

main femoral arterial cannulae

A

Biomedicus arterial cannulae

28
Q

Determining venous cannula

A

 Determine max flow
 Cannulation utilizes Bicaval or Single Atrial
 Pressure drop -30 to -40 mmHg
 ( MEASURE IT - its gravity!)
 Anticipate larger flow needs when warming
 Anticipate viscosity changes

29
Q

when choosing a cannula, it’s all about what

A
  • resitance
30
Q

priming with 25% albumin

A
  • Start with prime then take out the filter and put in your albumin. displace all of the prime and all that is left in there is pretty much albumin
     Aids passification of tubing
     Elevates C.O.P. and serum osmolarity
     Good osmotic “pull” from tissues
  • make sure tubing isn’t coated with X-coating which calls for priming with crystalloid first
31
Q

Cefazolin (Kefzol, Ancef) dose

A

 25 mg/kg (max dose = 1 g)

32
Q

Pump prime may contain how much solumedrol (methylprednixolone)

A

30 mg/kg up to 500mg

33
Q

bicarbonate equation

A

0.3(kg wt)(BE) = NaHCO3 mEq

34
Q

Mannitol calculation

A

0.25 g/kg in prime

35
Q

CaCl

A

 If priming with blood, a good rule of thumb is to use 1 mg CaCl per 1 mL of blood product

36
Q

for neonates/infants < 5kg

A
  • 100 ml PRBC’s are added to the prime to avoid a prolonged period a asanguineous perfusion.
37
Q

calculate the PDHCT

A
  • practice
38
Q

hemochron vs hepcon (ACT)

A
  • hemochron gives you abnormally high values compared to the hepcon
  • could result in having clotting problems in the circuit
39
Q

Platelet works

A

 Assesses platelet function and compares functional and nonfunctional platelets by percentage (%)
- does not tell you a platelet count

Pediatrics (37 decks)

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