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Pediatrics > topic 2 > Flashcards

topic 2 Flashcards

1
Q

Neonatal:

A

less than 30 days

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2
Q

pediatrics

A

up to 18 yrs

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3
Q

Neonates have immature

A

myocardium

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4
Q

Neonates utilize _______ for energy

A

glucose

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5
Q

Immature myocardium prone to

A

stretch injury

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6
Q

Adult circuits tend to be

A

one size fits all”

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7
Q

blood volume for < 10 (kg)

A

85 cc/kg

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8
Q

blood volume for 11-20 kg

A

80 cc/kg

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9
Q

blood volume for 21-30 kg

A

75 cc/kg

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10
Q

blood volume for 31-40 kg

A

70 cc/kg

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11
Q

blood volume for >40 kg

A

65 cc/kg

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12
Q

A 1100 gram child has how much BV

A

93.5 mL

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13
Q

Adult circuit characteristics

A

3/8” arterial line 3/8”, 1⁄2” venous line Large oxygenators Larger priming volume

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14
Q

pediatric circuit cicuits

A

1/8”, 3/16”, 1⁄4”, 3/8” arterial line 3/16” 1⁄4”, 3/8”, 1⁄2” venous line Small/Med/Large Oxygenators Smaller Priming Volumes

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15
Q

Neonatal Pack

A

3/16” x 1⁄4”

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16
Q

infant pack

A

1⁄4” x 1⁄4”

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17
Q

pediatric pack

A

1⁄4” x 3/8”

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18
Q

small adult pack

A

3/8” x 3/8”

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19
Q

adult pack

A

3/8” x 1⁄2”

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20
Q

sequence to determine appropriate pediatric circuit

A

It is Imperative to ascertain kg weight prior to choosing  1. Determine BSA (kg weight may suffice)  2. Determine maximum flow rate (KG weight based or BSA based)  3.Choose appropriate pump boot  4. Pick arterial cannula  5. Determine arterial line size  6. Pick venous cannula  7. Determine venous line size

*Packs (1/8” x 3/16”, 3/16”x3/16”, 3/16”x1⁄4”, 1⁄4” x 1⁄4”, 1⁄4”x3/8”, 3/8”x3/8”, 3/8”x1⁄2”)
 8. Choose oxygenator  9. Choose arterial filter

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21
Q

CPB normothermic flows for 0-3 kg

A

200 cc/kg

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22
Q

CPB normothermic flows for 3-10 kg

A

150 cc/kg

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23
Q

CPB normothermic flows for 10-15 kg

A

125 cc/kg 1

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24
Q

CPB normothermic flows for 15-30 kg

A

100 cc/kg

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25
Q

CPB normothermic flows for >30kg

A

75cc/kg

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26
Q

CPB normothermic flows for >55kg

A

65cc/kg

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27
Q

kg weight x cc/kg/min flow =

A

max flow 5.3 kg x 150 cc/kg/min = 795 cc/min or 0.795 L/min

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28
Q

Normothermic CPB flows :  1. BSA:

A

1.8 l/m/m2 up to 2.4 l/m/m2  2.4 l/m/m2 X 2.00 m2 BSA = 4.8 L/m

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29
Q

Normothermic CPB flows .KG:

A

50-75 cc/kg/min  75 cc/kg/min x 70 kg = 5.25 L/m

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30
Q

SV FOR Rollerpump Callibration Chart: Boot Diameter 3/16

A

7 CC x 100 rpm =700 ml/monn

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31
Q

SV FORRollerpump Callibration Chart: Boot Diameter 1/4

A

13 CC x 100 rpm = 1300 ml/min

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32
Q

SV FOR Rollerpump Callibration Chart: Boot Diameter 3/8

A

27 CC x 100 rpm = 2700 ml/min

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33
Q

SV FOR Rollerpump Callibration Chart: Boot Diameter 1/2

A

45 CC x 100 rpm =4500 ml/min

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34
Q

Do NOT exceed ______ RPM for max tubing flow

A

100

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35
Q

reynolds # equals

A

(velocity of fluid)(density)(diameter)/viscosity

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36
Q

Poiseuille’s law

A

Flow = (ΔP x πr4)/( Lx V x 8)

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37
Q

pediatric arterial cannula selection aim:

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

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38
Q

pediatric venous cannula selection aim:

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)

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39
Q

tubing pack selection for single atrial cannula neonatal

A

3/16,1/4 <800ml/min

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40
Q

tubing pack selection for single atrial cannula infant

A

1/4,1/4 800-1278 ml/min

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41
Q

tubing pack selection for single atrial cannula peds

A

1/4,3/8 1278-2898 ml/min

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42
Q

tubing pack selection for single atrial cannula small adult

A

3/8,3/8 2898-3500 ml/min

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43
Q

tubing pack selection for single atrial cannula adult

A

3/8,1/2 >3500 ml/min

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44
Q

tubing pack selection for bicaval atrial cannula neonatal

A

3/16,1/4 < 800 ml/min.

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45
Q

tubing pack selection for bi caval atrial cannula infant

A

1/4,1/4 800-1566 ml/min

46
Q

tubing pack selection for bi caval atrial cannula peds

A

1/4,3/8 1566-3000 ml/min

47
Q

tubing pack selection for bi caval atrial cannula small adult

A

3/8,3/8 3000-3500 ml/min

48
Q

tubing pack selection for bi caval atrial cannula adult

A

3/8,1/2 > 3500 ml/min

49
Q

PED ALFs

A

Terumo AFX02 Medtronic affinity Integral oxygenator filtration

50
Q

the new integral filter oxgenators _______is currently

changing the landscape

51
Q

Pediatric CannulaSelection: Arterial PROCESS

A

 Determinemaxflow:  Cannulation may be aortic / femoral / neck  Pressure drop should not exceed 100 mmHg  Anticipate larger flow needs when warming  Anticipateviscositychanges

52
Q

Pediatric CannulaSelection: venous PROCESS

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

53
Q

bicaval cannulation max flow 12/12

54
Q

bicaval cannulation max flow 12/14

55
Q

bicaval cannulation max flow 12/16

56
Q

bicaval cannulation max flow 14/14

57
Q

bicaval cannulation max flow 14/16

58
Q

bicaval cannulation max flow 16/16

59
Q

bicaval cannulation max flow 16/18

60
Q

bicaval cannulation max flow 18/18

61
Q

venous 3/16” MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

62
Q

venous 1/4” MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

63
Q

venous 3/8” MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

64
Q

venous 1/2” MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

A

—–,38.6

65
Q

capiox infant ALF flow range

A

< 2500 ml/min

66
Q

intersect pediatric ALF flow range

A

2500-3000 ml/min

67
Q

GISH ALF flow range >3000 ml/min

A

> 3000 ml/min

68
Q

pall leuco guard 3 max flow

A

3000 ml/min

69
Q

pall leuco guard 6 flow range

A

3000-6000 ml/min

70
Q

basic prime constituents adults

A

 Normosol Hetastarch/Albumin  Antibiotic  NaHCO3  Mannitol Heparin 10 K units

71
Q

basic prime constituents peds

A

 Normosol25% Albumin  Antibiotic  Solumedrol  NaHCO3 Heparin 100 units  Mannitol  CaCl  PRBC’s

72
Q

25% albumin purpose

A

 Largemolecule  Aids passification of tubing  Elevates C.O.P. and serum osmolarity  Good osmotic “pull” from tissues (1.3:1)  Be careful in recommendations  (i.e X-coating calls for wetting with crystalloid 1st)

73
Q

Cefazolin(Kefzol,Ancef) dosage

A

25 mg/kg (max dose = 1 g)

74
Q

Ampicillin dosage

A

 50 mg/kg (max dose = 1 g)

75
Q

gentamicin dosage

A

2 mg/kg (max dose = 80 mg)

76
Q

nafcilliin dosage

A

25 mg/kg (max dose = 1 g)

77
Q

vancomycin dosage

A

0 -15 mg/kg (max dose = 1 g)
 Vancomycin is titrated during CPB. All other of the antibiotics listed can be safely administered to the extra-corporeal circuit prior to the intiation of CPB.

78
Q

solumedrol dosage pump prime

A

The pump prime may contain 30mg/kg. methylprednisolone (up to 500 mg) on all to patients undergoing procedures requiring CPB.

79
Q

Pediatric transplant patients receive ______methylprednisolone when the aortic crossclamp is released.

80
Q

The prime should have a bicarbonate concentration of approximately

81
Q

formula for he amount of NaHCO3 necessary for a given amount of asanguineous volume

A

x = 0.025V

82
Q

f PRBC’s are added to the prime, then a sample should be taken, and NaHCO3 administered according to the following formula:

A

? mEq NaHCO3 = 0.3(kg wt)(BE)

83
Q

mannitol purpose

A

 Osmoticdieuretic
 ElevatesOsmolarityrapidly
 Given over a range of medical disciplines
 Oxygen radical scavenger

84
Q

mannitol dosage

A

0.25g/kgintheprime
 An additional 0.25 g/kg is administered on the release of the aortic cross-clamp.
 Since mannitol is 25% solution (5.3 kg x .25 = 1.325 g) And that is 5.3 cc

85
Q

CaCl2 is not

A

routinely added to the prime.

86
Q

perfusate level of CaCL2 should be_______ because_______

A

0.7 - 0.8 mM/L, if necessary. would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution

87
Q

PRBCS patient kg weight range intravascular BV index <10KG

88
Q

PRBCS patient kg weight range intravascular BV index 10-20 KG

89
Q

PRBCS patient kg weight range intravascular BV index 20-30KG

90
Q

PRBCS patient kg weight range intravascular BV index 30-40 KG

91
Q

PRBCS patient kg weight range intravascular BV index >40KG

92
Q

PRBCS patient kg weight range intravascular BV index For neonates/infants < 5kg

A

100 ml PRBC’s are added to the prime

to avoid a prolonged period of asanguineous perfusion.

93
Q

CPB Hct =

A

(((IVBV x kg x (patient Hct / 100)) / ((IVBV x kg) + mL prime))) x 100

94
Q

TEG use in PEDS

A

 Sporatic use in Or/Perfusion labs  Takes a long time to finalize (takes patience)  Looks at the larger spectrum

95
Q

TEG Viscoelastic test on whole blood – rotates specimen in cuvette

A

10 seconds

96
Q

platelet works

A

 Assesses plateletn function and compares functional and non-functional platelets by percentage (%)
 More useful due to looks at function, not number

97
Q

nirs

A


Near-infrared spectroscopy (NIRS) technology, such as that used in pulse oximetry, has been used and trusted in the world of medicine for decades.
Near-infrared spectroscopy (NIRS) is a spectroscopic method that uses the near-infrared region of the electromagnetic spectrum (from about 800 nm to 2500 nm)

98
Q

CDI in line analyzer

A

Standard of care Important in pediatrics pH stat or Alpha stat use

99
Q

Capiox Rx05 flow range

A

< 1500 ml. Min

100
Q

Capiox sx10 flow range

A

1500-4000 ml./min.

101
Q

Capiox sx18 flow range

A

4000-6000 ml./min

102
Q

Dlp wire reinforced a ending aortic cannula sizes

A

8 10 12 16 fr

103
Q

Biomedicus femoral arterial cannula sizes

A

8 10 12 14 fr

104
Q

Max flow dlp 8 fr

105
Q

Max flow dlp 10 fr

106
Q

Max flow dlp 12 fr

107
Q

Max flow dlp 14 fr

108
Q

Max flow dlp 16 fr

109
Q

Pediatric muf / 4:1cardioplegia

110
Q

Adult 4:1 cardioplegia

Pediatrics (14 decks)

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