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Perfusion Technology. Perfusion Circuits, Pumps, and Oxygenators (oh my) Questions and Answers 100% Solved
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Perfusion Technology. Perfusion Circuits, Pumps, and Oxygenators (oh my)
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Perfusion Technology. PerfusionCircuits, Pumps, and Oxygenators (oh
my)
While a patient is on total bypass, his blood flow is entirely provided by the heart lung
machine.
On partial bypass, the patient partially provides their own cardiac output that is
supplemented by the heart lung machine. - answer What is the fundamental difference
between partial and total bypass?
During the beginning of surgery (when a patient is first placed on bypass) and during
the end of surgery (when a patient is weaned off of bypass). - answer When might a
patient be placed on partial bypass?
1. Caval tapes are placed on the venae cavae (essentially a suture surrounding the
cannulae in the venae cavae to ensure complete venous return to the heart lung
machine).
2. If the heart is fibrillating (i.e. cardiac muscle fibers are contracting individually), no
blood flow is occurring.
3. The aorta is cross-clamped (X-clamp) to prevent coronary venous return. -
answerHow is a patient placed on total bypass?
See image. (Image does not contain cardiotomy reservoir, cell saver, arterial filter or
purge line from arterial filter.) - answerDraw an ideal perfusion circuit.
Simplicity - the less complicated a circuit is the easier it is to control.
Safety device implementation.
Surgeon requirements - personal to the surgeon but important for surgical effectiveness.
Patient requirements - size, other requirements.
Pump console requirements.
Component requirements.
Adherence to a routine - important to maintain a consistent workflow and ensure
consistent outcomes. - answerThough each heart-lung machine will be designed
differently, what are some design considerations the perfusionist should know to
encourage safe perfusion practice?
Adults (>50kg)
Pediatric (30-50kg)
Infant (4-30kg)
, Neonate (<4kg) - answerHow are different sizes of perfusion circuit selected for a
patient based on their size?
An external heater/cooler water source provides temperature controls without exposure
to the blood. - answerHow does the heat exchanger control the temperature of blood
pumped through it?
Oxygenated blood is pumped from the oxygenator through a separate cardioplegia
pump, where this blood is combined with cardioplegia solution before being delivered
through a cardioplegia heat exchanger/bubble track to the coronary arteries by
administering cardioplegia below the X clamp. - answerHow is blood cardioplegia
administered to the patient?
Design considerations include:
- Transparency of tubing
- Resilience (ability to reexpand following tubing compression)
- Flexibility
- Kink resistance
- Hardness (ability to resist collapse, tested by durometer)
- Toughness (resists cracking and rupture)
- Low spallation rate
- Non-wettable inner surface, smooth
- Toleration for heat sterilization and compatibility - answerHow are custom tubing packs
designed for purposes of CPB?
Polyvinyl chloride (PVC), silicone, and latex. PVC is the most common because it is
clear, flexible, tough, difficult to collapse, and has low spallation rate. - answerWhat are
three common tubing types used in CPB, and which is the most common? Why?
Heparin or an alternative?
Biopassive?
Longevity? (ionic vs. covalent bonding)
Expensiveness?
Which components can be coated? - answerWhat are some considerations for tubing
surface modifications?
Reduced air-blood interface.
Increased safety--the collapsible bag will close and prevent the pumping of massive air.
- answerWhat are the advantages of a closed venous reservoir (bag reservoir)?
Limited reservoir volume.
Requires separate cardiotomy reservoir.
Unable to use vacuum assist.
Difficult to determine the volume inside the reservoir.
No electronic level alarms.
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