Topic 2 Flashcards
When does the myocardium matures?
3-12 months
Neonates utilize what type of oxidation?
glucose oxidation
Immature myocardium prone to “stretch injury”
Neonatal: age range
< 30 days
Pediatric:
up to 18 yo (< 18)
Adults have what type of energy source that peds dont?
fatty acid dependent energy source
Adult characteristics different from peds?
Adult circuits tend to be “one size fits all”
Many adult organ systems have acquired disease
Some organ systems have failed
Adults have 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
Weight < 10kg
what is Blood Volume (cc/kg)?
< 10kg
85 cc/kg
WT 11-20 kg
what is Blood Volume (cc/kg)?
80 cc/kg
WT 21-30 kg
what is Blood Volume (cc/kg)?
75 cc/kg
WT 31-40 kg
what is Blood Volume (cc/kg)?
70 cc/kg
WT > 40 kg
what is Blood Volume (cc/kg)?
65 cc/kg
Neonatal Pack sizes?
3/16” x ¼”
Infant Pack sizes?
¼” x ¼”
Pediatric Pack sizes?
¼” x 3/8”
Small Adult Pack sizes?
3/8” x 3/8”
Adult Pack sizes?
3/8” x ½”
Steps in choosing Pediatric Circuit ? (9)
- Determine BSA (kg weight may suffice)
- Determine maximum flow rate (KG weight based or BSA based)
- Choose appropriate pump boot
- Pick arterial cannula
- Determine arterial line size
- Pick venous cannula
- Determine venous line size *Packs (1/8” x 3/16”, 3/16”x3/16”, 3/16”x ¼”, ¼” x ¼”, ¼”x3/8”, 3/8”x3/8”, 3/8”x½”)
- Choose oxygenator
- Choose arterial filter
Wt (kg): 0-3 kg
Flow (cc/kg/min) ?
200 cc/kg
kg weight x cc/kg/min flow = maximum flow
Wt (kg): 3-10 kg
Flow (cc/kg/min) ?
150 cc/kg
kg weight x cc/kg/min flow = maximum flow
Wt (kg): 10-15 kg
Flow (cc/kg/min) ?
125 cc/kg
kg weight x cc/kg/min flow = maximum flow
Wt (kg): 15-30 kg
Flow (cc/kg/min) ?
100 cc/kg
kg weight x cc/kg/min flow = maximum flow
Wt (kg): >30 kg
Flow (cc/kg/min) ?
75 cc/kg
kg weight x cc/kg/min flow = maximum flow
Wt (kg): >55 kg
Flow (cc/kg/min) ?
65 cc/kg
kg weight x cc/kg/min flow = maximum flow
Boot Diameter 3/16
Stroke Volume/Revolution (cc)?
MAX VENOUS CALCULATED BFR (mLmin)?
7cc
1100 mL/min
Boot Diameter 1/4”
Stroke Volume/Revolution (cc)?
MAX VENOUS CALCULATED BFR (mLmin)?
13cc
2000 mL/min
Boot Diameter 3/8”
Stroke Volume/Revolution (cc)?
MAX VENOUS CALCULATED BFR (mLmin)?
27cc
6500 mL/min
Boot Diameter 1/2”
Stroke Volume/Revolution (cc)?
45cc
Reynolds Number
Density Velocity Diameter of pipe/Viscosity of fluid
Poiseuille’s law can be used to calculate volume flow rate only in the case of laminar flow
Flow =
ΔP x πr4 / L x V x 8
Arterial Cannulae selection Aim? Pressure drop?
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
Venous Cannulae selection Aim? Pressure drop?
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)
Since all venous return essentially goes to the RA: Approximately 100% can be drained by what kind of cannulae?
a single venous cannula
Terumo Baby RX05 max flow and prime volume?
1.5 L/m
43 cc
Sorin Kids D100 oxygenator max flow and prime volume?
0.7 L/m
31 cc
Terumo RX10 oxygenator max flow and prime volume?
4.0 L/m
135 cc
Terumo RX15 oxygenator max flow and prime volume?
5.0 L/m
135
Capiox Infant ALF - flow range?
<2500 ml/min
Intersect Pediatric ALF - flow range?
> 2500 to < 3000 ml/min
Gish ALF - flow range?
> 3000 ml/min
Pall Leuco-Guard 3 ALF for Transplant Cases flow range?
<3000 ml/min
Pall Leuco-Guard 6 Criteria for Transplant Cases flow range?
> 3000 to <6000 ml/min
flow range for single atrial cannulae?
flow range for bicaval cannulation?
3/8” x 3/8”
Single: > 2898 to < 3500 ml/min
Bicaval: >3000 to < 3500 ml /min
flow range for single atrial cannulae?
flow range for bicaval cannulation?
¼” x 3/8”
single atrial > 1278 to 2898
Bicaval. 1566 to <3000 ml/ min
flow range for single atrial cannulae?
flow range for bicaval cannulation?
¼” x ¼”
single atrial: > 800 to 1278
Bicaval : 800 to <1566 ml/min
flow range for single atrial cannulae?
flow range for bicaval cannulation?
3/16” x ¼”
single and bicavL <800 ml/min
flow range for single atrial cannulae?
flow range for bicaval cannulation?
3/8” x ½”
single atrial > 3500 ml/min
bicaval > 3500 ml/min
Adults Basic Prime Constitutes (6)
Normosol Hetastarch/Albumin Antibiotic NaHCO3 Mannitol Heparin 10 K units
Pediatric Basic Prime Constitutes (9)
Normosol 25% Albumin Antibiotic Solumedrol NaHCO3 Heparin 100 units Mannitol CaCl PRBC’s
25% Albumin
Large molecule 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)
Cefazolin (Kefzol, Ancef) Dose?
Antibiotic
25 mg/kg (max dose = 1 g)
Ampicillin Dose?
Antibiotic
50 mg/kg (max dose = 1 g)
Gentamicin Dose?
Antibiotic
2 mg/kg (max dose = 80 mg)
Nafcillin Dose?
Antibiotic
25 mg/kg (max dose = 1 g)
Vancomycin Dose?
Antibiotic
10-15 mg/kg (max dose = 1 g)
Solumedrol (methyprednisolone) pump prime may contain what amount – for peds and adults?
The pump prime may contain 30 mg/kg methylprednisolone (up to 500 mg) on all to patients undergoing procedures requiring CPB.
Pediatric transplant patients receive 30 mg/kg methylprednisolone when the aortic crossclamp is released.
NaHCO3 pump prime should contain what amount?
The prime should have a bicarbonate concentration of approximately 24 mEq/L
The amount of NaHCO3 necessary for a given amount of asanguineous volume – how do you calculate?
where x = mEq NaHCO3 and V =mL asanguineous volume:
x = 0.025V
If PRBC’s are added to the prime, then a sample should be taken, and NaHCO3 administered according to the following formula:
?mEq NaHCO3 = 0.3(kg wt)(BE)
Mannitol what does it do?
Osmotic dieuretic
Elevates Osmolarity rapidly
Given over a range of medical disciplines
Oxygen radical scavenger
0.25 g/kg in the prime
An additional 0.25 g/kg is administered on the release of the aortic cross-clamp
Mannitol Dose, in prime and additional doses
.25 g/kg in the prime
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
CaCl2 - normal values?
Not routinely added to the prime. However, an ionized Ca++ level of the perfusate should be measured shortly after the initiation of CPB and corrected upward to 0.7-0.8 mM/L, if necessary.
This is imperative because a level of 0.7 to 0.8
mM/l would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution
<10 kg intravascular bld vol index?
85mL/kg
> 10 kg to <20 kg - intravascular bld vol index?
80 mL/kg
> 20 kg to <30 kg - intravascular bld vol index?
75mL/kg
> 30 kg to <40 kg - intravascular bld vol index?
70mL/kg
> 40 kg - intravascular bld vol index?
65 mL/kg
For neonates/infants < 5kg, what is given to avoid a prolonged period a asanguineous perfusion.
100 ml PRBC’s are added to the prime
TEG
Sporatic use in Or/Perfusion labs
Takes a long time to finalize (takes patience)
Looks at the larger spectrum
Viscoelastic test on whole blood –rotates specimen in cuvette every ten seconds
Platelet Works
Assesses platelet function and compares functional and
non-functional platelets by percentage (%)
More useful due to looks at function, not number
CDI in-line analyzer
Standard of care
Important in pediatrics
pH stat or Alpha stat use
(NIRS) Near-infrared spectroscopy
NIRS technology, such as that used in pulse oximetry, has been used and trusted in the world of medicine for decades
Is a spectroscopic method that uses the near-infrared region of the electromagnetic spectrum (from about 800 nm to 2500 nm)
