1 / 23

Perfusion for the Non-Perfusionist

Perfusion for the Non-Perfusionist. Basics for the Extracorporeal Circuit Basics for Managing CPB during operation. Objectives. Perfusionist responsibilities CPB Equipment Components & cannulation. Mayo Clinic Rochester. The Mayo Clinic Cardiac surgery facts of interest.

sela
Télécharger la présentation

Perfusion for the Non-Perfusionist

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Perfusion for the Non-Perfusionist Basics for the Extracorporeal Circuit Basics for Managing CPB during operation

  2. Objectives • Perfusionist responsibilities • CPB Equipment • Components & cannulation

  3. Mayo Clinic Rochester

  4. The Mayo ClinicCardiac surgery facts of interest • 2nd US News & World Report • 2,800+ annual cardiac surgeries • 10 surgeons, 16 anesthesiologists, 16 perfusionists, ATs, MTs, CRNAs and CSTs • 8-9 cardiac ORs, 8-16 procedures per day • Annually: 200 pediatric, 295 adult congenital, 50 VADs, 60 ECMOs,, and multiple DHCAs and re-operation procedures

  5. CPB / ECC Components

  6. TART oC TVEN oC O2 Content: PaO2 CO2 Content: PaCO2 pH, [HCO3-] SaO2 O2 Content: PvO2 CO2 Content: PvCO2 pH, [HCO3-] SvO2 Artificial Heart Artificial Lung +VO2 -VCO2 +/- Kcal/min The V-A ECLS Patient Interface -VO2 +VCO2 +/- Kcal/min TNP oC Patient Systemic Circulation Right Heart Left Heart +VO2 -VCO2 Patient Lungs

  7. CPB / ECC Components

  8. CPB / ECC Components • Artificial heart [blood propulsion devices] • Artificial lung [VCO2,VO2]; Internal HE, ALF • Artificial circulation [tubing, cannulae, connectors] • Accessories • Heat exchangers: kcal/min • Reservoirs: level detectors • Hemoconcentrator • Safety devices • Filters: Solution, blood, gas, particulate • In-line monitors [pressure, flow, temperature, BG, O2 Sat, %O2 gas] • One-way valves

  9. Circuit Design Issues: Cannulation

  10. Cannulation • The critical interface • Typically insert arterial first • double purse string • meticulous debubbling • Venous • single atrial • dual caval (for total CPBP) • Cardioplegia • Ventricular vent

  11. Dual Stage Single Cannulation • Most common approach • Single cannula • Traverses right atrium from right auricle • Basket in atrium • Tip in inferior cava

  12. Dual Caval Cannulation • Traditional approach • Individual cannulation of inferior and superior vena cava • Necessary for “total” bypass

  13. Partial vs. Total Bypass

  14. Ventricular Venting • Right superior pulmonary vein • Ventricular apex • Cardioplegia cannula • Pulmonary artery • Trans-septal

  15. Responsibilities: Perfusionist • Safe CPB • Avoid embolism • Myocardial and cerebral protection • Record keeping, communication • Flow, pressure (P), resistance • Velocity, shear, hemolysis • Acid-base status, pH, VCO2, [CO2], pCO2 • Oxygen transfer: VO2, [O2], pO2 • Heat transfer: kcal/min, temperature

  16. ICEBP

  17. Known Problems Associated with Cardiopulmonary Bypass Particulate or gaseous micro- or macro-embolization; Potential neurologic consequences Cannula misplacement; Excessive pressure drop or blood flow distribution patterns Biocompatibility issues; Cell destruction, hemolysis Oxygenator failure or wet-out; O2 and CO2 transfer limitations Inadequate heat transfer; Patient temperature after-drop in ICU

  18. “Orpheus” Cardiopulmonary BypassSimulation System

  19. “Orpheus” Cardiopulmonary Bypass Simulation System

  20. Summary • Basic components needed for safe CPB • Perfusionist’s role • Management of CPB is evidence-based and multi-disciplined • Patient management is guided by evidence- and consensus-based procedure guidelines

More Related