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
