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Perf Tech > test 7 > Flashcards

test 7 Flashcards

1
Q

Normal right ventricle blood return

A
  • systemic venous return
  • coronary sinus drainage
  • +/- small cardiac vein(s)
  • cardioplegia
  • thebesian veins
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2
Q

Normal left ventricle blood return

A
  • bronchial circulation
  • cardioplegia
  • thebesian veins
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3
Q

Abnormal right ventricle blood return

A

-persistent left superior vena
cava (LSVC)
-atrial / ventricular septal
defects

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4
Q

Abnormal left ventricle blood return

A

-patent ductus arteriosus (PDA)
-systemic-to-pulmonary artery shunt
-anomalous systemic venous drainage to left heart
-aortic insufficiency
-atrial / ventricular septal
defects

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5
Q

bronchial circulation

A
  • provides nutritional flow to lungs
  • 1-3% of CO
  • can go as high as 10% CO with lung problems
  • bronchial veins empty into pulmonary veins
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6
Q

small cardiac veins

A
  • usually empty into coronary sinus

- might empty into RA, middle cardiac vein, or never develop

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7
Q

Cardioplegia antegrade

A
  • left coronary drains into coronary sinus and the right atrium
  • right coronary drains into RA by small cardiac veins
  • some flow return to all chambers by thebesian veins
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8
Q

cardioplegia retrograde

A
  • most empties into artic root via left coronary ostia

- really bad job of protecting the heart

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9
Q

Persistent left superior vena cava

A
  • normally drains into right coronary sinus

- occurence: 0.3% to 0.5% of general population and 2-10% of patients with congenital heart disease

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10
Q

problems associated with LSVC

A
  • procedures requiring opening of right heart and use of bicaval cannulation with tapes
  • delivery of retrograde cardioplegia: proper position of balloon in coronary sinus, delivery of solution up LSVC rather than coronary sinus, and dilution of solution by LSVC return
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11
Q

LSVC results from

A

1) Failure of the L. brachiocephalic vein to fully develop

2) Failure of the left common cardinal vein to disappear during development

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12
Q

systemic to pulmonary artery shunts

A
  • Blalock-Taussig shunt= transected right subclavian artery connected to right pulmonary artery
  • Waterston= posterior ascending aorta connected to anterior right pulmonary artery
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13
Q

aortic insufficiency

A

-Not a problem as long as heart beating
-Placement of cross-clamp stops regurgitation
from arterial cannula
-Can occur during cardioplegia delivery: indicated by low delivery pressure into aortic root
-Can result in significant left ventricular
distension in fibrillating or arrested heart

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14
Q

Ventricular venting: purpose

A 
-Prevent ventricular distension (and all the “bad” that
goes with it!)
-Improve surgical exposure
-Aid in myocardial protection
-Remove air
-Prevent pulmonary venous hypertension
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15
Q

myocardial protection by decompression

A

-Accounts for approximately 40% of myocardial protection
-Reduces wall tension and myocardial stretch – reduces RESTING oxygen
consumption

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16
Q

myocardial protection by increased subendocardial perfusion

A

-Normal coronary perfusion pressure (CPP) = mean arterial (MAP) minus left
ventricular end diastolic (LVEDP)
-With cross-clamp applied and antegrade delivery of cardioplegia CPP = aortic root pressure – LVEDP
-with left ventricle empty LV coronary perfusion is optimal

17
Q

myocardial protection by preventing myocardial rewarming

A
  • Hypothermia accounts for approximately 10% of myocardial protection
  • By removing systemic return to heart, heart stays cool
18
Q

air removal

A

-Large quantities may arise during intracardiac
operations
-Venting aids de-airing upon closure of incision
into heart but before cross-clamp removal
-Small amounts may be introduced during
coronary bypass procedures

19
Q

concerns with venous cannulation and blood return

A
  • Venous cannulation must collect all return from: superior vena cava, inferior vena cava, coronary sinus
  • Bicaval cannulation with snares/tapes- cannot collect coronary sinus return
  • Improper placement of cannula
  • Inadequate cannula size
  • Inadequate height (siphon) gradient (∆P)
20
Q

vent locations

A
  • aortic root
  • right superior pulmonary vein
  • main pulmonary artery
  • apex of left ventricle: very dangerous (not used much to at all anymore)
21
Q

venting aortic root description

A

-Small bore catheter direct into the aorta
-May be wyed into catheter along with antegrade cardioplegia
delivery line

22
Q

venting Right superior pulmonary vena cava description

A

-Can be Advanced across mitral valve into LV or left in LA

23
Q

venting Main pulmonary artery description

A

-Tends to interfere with the pulmonary artery monitoring catheter

24
Q

venting Apex of left ventricle description

A

-Problems associated with direct cannulation of the left ventricle
-Surgeon may insert a 27 gauge needle into apex for temporary
use to remove air stuck in the apical area

25
Q

Root vent with antegrade cardioplegia needle

A
  • Vent must be off during cardioplegia delivery
  • Able to remove some air in the ascending aorta prior to cross-clamp removal or even as air is ejected from the left ventricle (remember, air rises and the aorta’s a tube…)
26
Q

Left ventricular vent

A

Pliable with multiple fenestrations (openings) to aid blood removal and limit risk of sucking tissue into catheter

27
Q

mechanical drainage

A

-Via roller pump
-Always best to include one-way valve in return line to
minimize chance of pump air into heart
Can use higher pump RPMs if:
-Use a vacuum relief valve – opens if too much vacuum applied – prevents pulling ventricular tissue into catheter tip = “Endocardial hickies” (can be part of one-way valve or separate)
-Must use low pump RPMs if no relief value used
-Best to monitor LA pressure
-Always a good idea to “run
your CP to your vent”
ahead of time because you don’t want to send bubbles to aorta

28
Q

gravity drainage: “Y’ vent line into venous return line

A

Venous return blood passing opening of wye connector creates Venturi Effect

  • Usually done at the table – shorter line with less resistance to flow
  • Vent line needs to be primed to reduce chance of venous air lock
  • Surgeon controls vent (on versus off) at field)
29
Q

gravity drainage: normal vent line

A

-Procedure: fill vent line with couple turns of roller pump and remove line from pump to allow gravity pressure gradient to move fluid from
heart to the reservoir
-May not adequately drain heart if large amounts of return
-May need to use larger bore tubing for vent line

30
Q

cardiotomy/ pump suction

A

-Blood from the field that is returned to the CPB circuit during bypass, or an autotransfusion reservoir pre- and post-CPB
-Large amount of air-blood interface can will
lead to hemolysis and potential micro air
emboli: Use of separate cardiotomy filter has been shown to reduce # of air emboli.

31
Q

blood collected in chest

A
  • typically has elevated
    concentrations of activated humoral elements
    including”: Coagulation factors (tissue factor), Endotoxin, Complement, Interleukins
    -Profound drop in arterial blood pressure often seen
    when cardiotomy suction blood is directly infused into
    patient
32
Q

cardiotomy suction using cell saver

A
  • Reduction in post-operative bleeding when stagnant chest blood is washed and filtered prior to reinfusion
  • Reduction in cerebral fat emboli and stroke rate by eliminating chest blood return via pump suckers
33
Q

cell saver guidlines

A

-Use collection reservoir with a built-in 40 to 150 micron filter
-Vacuum attached to collection reservoir should not exceed -120 mmHg
-An anticoagulant drip must be used
-Washed product should be returned to the patient through a
transfusion filter
-Collected cells should be washed with AT LEAST 1,000 mLs of normal saline – wash effluent should be clear
-Washed product must be transferred to a separate
reinfusion bag (reduce chance of air emoli)
-don’t use pressure bag to speed reinfusion time

34
Q

Reinfusion bag should be properly labeled with four

things:

A

1) Patient name and ID#;
2) Expiration time (6 hours from collection time at room temperature);
3) Volume in bag;
4) Note stating “Autologous Use Only”

35
Q

quarterly testing should check

A
  • Product hematocrit greater than 40%
  • Product potassium less than 3.0 mEq/L
  • Product free hemoglobin concentration less than 100 mg/dL
  • Product heparin concentration less than 0.5 units per ml
36
Q

summary

A
  • Use of vent and pump suction should be minimal amount needed to expose operative field and protect the myocardium
  • Use of cell saver device in lieu of pump suction for pooled and/or stagnant blood

Perf Tech (6 decks)

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