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Perf Tech III (Exam 2) > Topic 7: Embolic events > Flashcards

Topic 7: Embolic events Flashcards

1
Q

Incidence of clinically obvious strokes post CPB is what %?

• % MRI suggests could be new cerebral infarcts in those same patients?

A

~1-5%

~30%

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2
Q

% of CABG patients experienced cerebral infarct prior to surgery

A

~50%

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3
Q

Types of emboli (4)

A
  • Biologic (bloodborne)
  • Foreign material (Circuit, Manufacturing)
  • Gaseous
  • Micro vessels main target -3 to 500m in diameter
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4
Q

greatest period of risk of emboli during CPB

A
  • Insertion arterial cannula
  • Initiation of bypass
    * Hypotension
    * Most circuit “junk”
  • Cross-clamp application / removal
    * Manipulation of aorta
    * Trauma to aorta can contribute to brain infarctions for up to 1 month
  • Use of centrifugal pump
    * Any time you have to decrease BF
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5
Q

Biological Emboli

A
  • Fibrin / fibrinogen microthrombi
  • Fat or lipids
  • Protein
  • Cold-reacting antibodies
  • Calcium fragments
  • Bone fragments
  • Muscle fragments
  • Platelet aggregates
  • Neutrophil aggregates
  • RBC aggregates
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6
Q

Homologous transfused blood emboli chance increases with what?

A

Increase with the storage time

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7
Q

Areas at Risk of Inadequate anticoagulation (5)

A
  • Minimal flow
  • Stagnant areas
  • Turbulence
  • Cavitation
  • Rough Surfaces
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8
Q

Areas of the Circuit where inadequate anticoagulation is a problem (5)

A
  • Connectors
  • Bubble Oxygenators
  • Arterial line filters
  • Cardiotomy (venous) reservoir
  • Intraluminal projections
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9
Q

Do you need bypass to produce fat emboli?

A

Do not need bypass to produce fat emboli
Median sternotomy
Thoracotomy

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10
Q

2/3 fat/lipid emboli within a circuit come from

A

cardiotomy suction

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11
Q

Large particles are what size range?

A

4-200 microns

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12
Q

Formation of Biologic Emboli how?

A

•Trauma to fat cells of epicardium and trauma to tissue of the surgical wound

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13
Q

Platelet count drops what % with initiation of bypass?

A

30-50%

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14
Q

Drop in Platelets causes what?

A

Post op bleeding, neurologic dysfunction, release of histamine (membrane permeability), release of serotonin/thromboxane (vasoconstriction)

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15
Q

Increased Neutrophils does what?

A

aggregation, interaction with endothelial cells, change permeability

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16
Q

Foreign Particulate Emboli examples

A
  • Cotton fibers
  • Plastic particles
  • Filter material
  • Tubing fragments (spallation)
  • Metal
  • Talc
  • Thread
  • Bone wax
  • Microfibrillar collagen
  • Silicone antifoam
17
Q

Bubble oxygenator

•bubbles of what size are associated with CPB mortality and morbidity?

A

in 35 to 40m
•Mainly oxygen
•Transitioned to membrane oxygenators

18
Q

Air emboli formed what ways?

A

Bubble oxygenator
Temperature gradients
Surgical air
Pump / Circuit problems

19
Q

Surgical Air caused by what?

A

Heart contracts before chambers completely de-aired
•Surgeon cuts into chamber of beating heart
•Placement of arterial, venous or LV vent
cannulae
•Air present in heart 30 to 40 minutes post bypass
•Flush with CO2–86% bubbles gone within 1 minute

20
Q

2 Biggest causes of air contamination?

gray round graph

A

Inattention to reservoir level -37%

Aortic Root Air during CPG delivery - 29%

21
Q

Blood blubble interactions - adsorption of what?

A

Adsorption / denaturation plasma proteins
Adsorption phospholipids
Adsorption fibrinogen
Endothelial wall damage

22
Q

Blood blubble interactions - activation and production of what?

A
  • Complement activation
  • Clumping red blood cells
  • Leukocyte activation / adherence
  • Lipid peroxidation
  • Microthrombi production
  • Platelet activation / adherence
  • Thrombin activation
  • Phospholipase activation
23
Q

Safety devices?

A
  • Low level alarm
  • Air bubble detector
  • Arterial line filter
  • cardiotomy filter
  • One-way purge line from arterial line filter to cardiotomy reservoir
  • One-way valve in vent line
  • One-way valve in arterial line
  • Clear lines of communication
  • Use of protocols, policies and procedures
  • Use of prebypass checklist
24
Q

How Do You Minimize Biologic Emboli
Formation?
use what? 2
minimize what? 4

A
  • Use of transfusion filters
  • Use membrane oxygenator
  • Adequate anticoagulation
  • Design of circuit components
  • Minimize surface area of circuit
  • Minimize complement / immune activation
  • Minimize platelet activation
  • Minimize neutrophil activation
25
Q

How Do You Minimize Introduction of Foreign

Particle Emboli? (4)

A

•Component design and manufacturing
•Circulate crystalloid solution through entire circuit
•Flush circuit with crystalloid solution in
conjunction with a pre-bypass filter in AV loop
•Don’t use silicone tubing in arterial pump head
•Use medical grade tubing

26
Q

How Do You Minimize Formation of Gaseous

Microemboli ?

A
  • Check all equipment for proper operation
  • Ensure all tubing / component connections are secure
  • Flush circuit with CO2 prior to priming
  • Careful priming of arterial filter
  • Check circuit for proper alignment of tubing and components
  • Check proper placement of tubing in roller pump raceway
  • Proper use of all safety devices
  • Open one-way purge line from arterial filter to cardiotomy reservoir
  • Use of pressure relief valve on venous reservoir when using VAVD
  • Test vent line prior to attachment to vent catheter
  • Continual circuit scan while on bypass
  • Continual monitoring of centrifugal pump flow and RPM–ensure forward flow at all times
  • Avoid air in venous line
27
Q

How Do You Minimize Formation of Gaseous

Microemboli temps?

A

•Warm prime–then let it cool

Perf Tech III (Exam 2) (6 decks)

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