Topic 4 - Review of CPB Flashcards
Surgeon remove clamp in arterial cannula next you…?
Check for pulsations to make sure there is adequate line pressure and pulsations
Asked to do a test transfusion means you?
make sure that the cannula is in fact in the aorta and not in a false lumen
-if pressure risees greatly during the test transfusion (check cannula placement/position)
order of cannulations?
arterial cannulation
venous cannulation
retrograde cadioplegia cannula placed
Going on bypass first start …
- Arterial pump (give a little preload)
- Remove clamp from venous line (make sure level rises)
While you are turning up arterial pump head to get to full flow when starting bypass you do what?
- Open shunts
- Turn on gas flow
- start your timers “on bypass at..”
- get to full flow “at full flow”
- anesthesia stops ventilating
Getting ready for AoXC placement
turn down flow
make sure CPG line is filled/clear of bubbles
cool to desired systemic temperature
After the AoXC is on - what is given?
- Cardioplegia “Start cardioplegia”
- Watch delivery pressures (start slow)
this is the beginning of the ischemic time of the heart
MAP on bypass
80-85mmHg gives better neurological outcomes
SVO2 on bypass
> 70%
if it lowers oxygen consumption could be increasing which means maybe pt waking up - consult anesthesia
U.O. on bypass
should be between .5-1mls/kg/hr
Normothermia pressure range for proper organ function?
80-100mmHg
Decreased perfusion pressurse of 50-60mmHg cause
cerebral injury and kidney function reduced
Increased perfusion pressures of >100mmHg causes?
- increased intracranial pressures
- excessive blood return to heart
- fluid shifts create edema
- increased SVR may decrease tissue perfusion
Pediatric Flow rate
80 - 100mls/min/kg
2.4-2.8 L/min/m2
Neonate
120-150mls/min/kg
3.0-3.4 L/min/m2
Adult
60-70mls/min/kg
2.2-2.6 L/min/m2
Cross clamp drugs
lidocaine, mannitol and magnesium sulfate
Surgical correction complete and Surgeon intrusts flow down - what will happen next?
Surgeon will remove the AoXC
“Cross clamp is off” - what do you do, and than what is placed?
come back on flow gradually
- watch pressures
Temporary pacemaker is placed (usually)
Final checks - make sure K is acceptable
k of 5.0mEq/L is accepatable
K will drop about 1.0mEq/L in the immediate post CPB period
Surgeon says come for to 1/2 flow and stay there - what do you do?
- Clamp the venous line partially
- Fill patient
- Come down on flow slowly to desired filling pressure number
- Adjust clamp on venous lone accordingly
chasing the circuit
transfuse most of the pump blood in the reservoir. add crystalliod to the reservoir, which will keep the circuit primed while displacing all good pump blood back to patient
Once protamine is given and pt stable surgeon will…
decannulate
