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special diagnostic procedures > Perfusion (part 2) > Flashcards

Perfusion (part 2) Flashcards

1
Q

What are the two types of pump heads?

A

Roller and centrifugal pump

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2
Q

Which pump head is afterload independent?

A

Roller pump

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3
Q

Which pump head needs flowmeter?

A

Centrifugal pump

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4
Q

Which pump head has possibility of retrograde flow if pump stops?

A

Centrifugal pump

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5
Q

Which pump head is cheaper?

A

Roller pump

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6
Q

Which pump head is portable?

A

Centrifugal pump

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7
Q

Which pump head is short term use only?

A

Roller pump

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8
Q

Which pump head has circuit disruption from excessive line pressure?

A

Roller pump

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9
Q

Which pump head has greater risk of air embolism?

A

Roller pump

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10
Q

Which pump head has more priming volume?

A

Centrifugal pump

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11
Q

Which pump head is mostly used by CPB?

A

Roller pump

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12
Q

Why is the roller pump bulky?

A

Because it uses 2 rollers

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13
Q

Which pump head is more prone to heat generation?

A

roller pump

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14
Q

What is the purpose of the 2 rollers in pump head?

A

it rolls blood through tubing

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15
Q

The roller pump positively displace blood through _________________

A

peristaltic motion

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16
Q

TRUE OR FALSE:

Centrifugal pump is used because the roller pump can damage in blood components

A

TRUE

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17
Q

Roller pump produces ____________ while centrifugal pump produces _____________

A

flow, pressure

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18
Q

The centrifugal pump spins as a result of __________________

A

magnetic force

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19
Q

When the cone spins in centrifugal pump, it generates ____________

A

negative pressure = sucks blood creating vortex

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20
Q

What is the range of centrifugal force of centri pump?

A

2000-4000rpm

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21
Q

Which is more preferred pump head?

A

Centri pump

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22
Q

This pump head is reserved for more complex surgery of prolonged duration

A

Centri pump

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23
Q

Which pump head produces less hemolysis and platelet activation?

A

Centri pump

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24
Q

This component of the CPB acts as a CHAMBER FOR VENOUS BLOOD to drain into before it is pumped into the oxygenator and permits ready access for the addition of fluids and drugs

A

Reservoir

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25
Q

What are the other function of reservoir?

A

provides high efficiency filtration, defoaming, and responsible for removing foreign particles

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26
Q

To reduce the risk of perfusion accident, the reservoir needs _______________

A

to maintain a level of fluid

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27
Q

What are the two types of reservoir?

A

Hard shell and collapsible

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28
Q

Between the two types of reservoir, which is used for adult cardiac surgery?

A

Hard shell

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29
Q

This reservoir is comprised of polycarbonate housing, has polyester depth filter, and polyurethane defoamer

A

Hard shell

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30
Q

What is the function of oxygenator?

A

It provides an interface of high surface area between blood on one side and gas on the other

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31
Q

For the gas to travel across the interface, the oxygenator must be ____________

A

constructed with very thin material

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32
Q

What is the requirement for an oxygenator?

A

needs efficient oxygenation of desaturated hemoglobin and simultaneous removal of CO2

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33
Q

What is the most commonly used ooxygenator?

A

membrane oxygenator with microporous polypropylene hollow fiber structure

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34
Q

The internal diameter of membrane oxygenator is ________

A

100-200um

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35
Q

This is used to reduce the release of gaseous emboli due to alteration of temperature of saturated blood

A

Heat exchanger

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36
Q

The heat exchanger is placed _________________

A

proximal to oxygenator

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37
Q

This acts as the arterial capillary system of CPB machine

A

Oxygenator

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38
Q

What is the common constituent of all cardioplegia solutions?

A

High concentration of potassium

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39
Q

The common constituent of all cardioplegia solutions produces ____________________

A

diastolic cardiac arrest

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40
Q

This component of CPB is used to induce arrest of heart

A

Cardioplegia delivery system

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41
Q

This method is used to protect the heart or myocardial protection

A

Cardioplegia delivery system

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42
Q

The electromechanical arrest from the cardioplegia solution reduces ___________

A

oxygen consumption

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43
Q

The cardioplegia cannula is inserted _____________

A

proximally

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44
Q

This cannula is placed distal to plaque

A

aortic cannula

45
Q

What does the aortic root vent does?

A

It separate pump that delivers cardioplegia antigrade to aortic root or retrograde to venous

46
Q

What is the ratio of cardioplegia of oxygenated blood to crystalloid?

A

1:1 or 8:1

47
Q

What is the most common cardioplegia?

A

Potassium

48
Q

What are the other constituents of cardioplegia solution?

A

Bicarbonate, mannitol, magnesium, calcium, adenosine, procane, glucose, glutanone

49
Q

What is the primary purpose of cardioplegia?

A

produce rapid diastolic cardiac arrest

50
Q

This part of CPB contains semipermeable membranes that permit passage of water and electrolytes out of blood

A

Hemofilters

51
Q

What are the other terms used for hemofilters?

A

ultrafilters or hemoconcentrators

52
Q

What is the purpose of hemofilters?

A

it provides driving force of blood to device (allow blood to filter before returning blood to px)

53
Q

What is the volume per min fluid removal?

A

30-50mL/min

54
Q

What is the size of molecules na pwede maremove ng hemofilter?

A

up to 20,000 Daltons

55
Q

When is the hemofilter utilized?

A

during and after CPB

56
Q

Hemofiltration is mainly used ____________________

A

to manage hyperkalemia or acidosis

57
Q

This device provides real time blood gas, acid-base, Hgb Hct, electrolyte analysis. It utilizes optical fluorescence and reflectance

A

Terumo CVI 500

58
Q

This device is the real time saturation and hemog monitoring system. Non-invasive simultaneous arterial saturation monitors.

A

Spectrum Medical

59
Q

The monitoring device is placed in circuit for blood gas analysis using ____________

A

electrochemical electrodes and cuvettes

60
Q

The monitoring device is placed in external tubing for blood gas analysis using ____________

A

Light absorbance or reflectance

61
Q

What does the primary perfusionist does in pre-bypass checklist?

A

check mismong nakalagay sa checklist

62
Q

What does the secondary perfusionist does in pre-bypass checklist?

A

goes through list and check if nacheck lahat

63
Q

This is where the minimum requirements for cardiopulmonary bypass procedures is stated

A

pre-bypass checklist

64
Q

What should be checked prior to CPB?

A

review patient for allergies, significant comorbidities or conditions like diabetes, anemia, thrombocytopenia, hyperkalemia

blood availability in dk

note height and weight for heparin dosage (300mg/kg) and select appropriate size of venous and arterial cannula for flow rate

65
Q

What should be the activated clotting time?

A

more than 400secs

66
Q

To reduce the risk of perfusion accident, ____________________

A

dapat di mawawalan ng laman ang reservoir

67
Q

This is the deairing of CPB circuit consisting of a mixture of crystalloids and colloids

A

Priming solutions

68
Q

Priming causes _______________________

A

hemodilutions which improves flows during hypothermia

69
Q

What are the commonly used additives?

A

Heparin, bicarbonate, mannitol, calcium, and steroids

70
Q

What is the measurement of prime to ensure adequate anticoagulation?

A

1000-2500 U/L

71
Q

How many heparin is added to prime?

A

3-4units/mL

72
Q

What is the target Hct in bypass?

A

21-24% (adults) and 28-30% (children)

73
Q

How to assess target Hct?

A

Compute for TCV (Total circulating volume)

74
Q

How to compute for TCV?

A

Px’s blood volume + priming volume

75
Q

How to compute for target Hct?

A

Px’s blood volume + Hct/TCV

76
Q

How to compute for the blood required on prime?

A

(Target Hct x TCV) - Px’s Hct x PBV ) / Hct of donor

77
Q

What is the cardiac index for a 70kg adult w/ normal metabolism at 37 deg C?

A

2.2-2.4L/m2/min

78
Q

How much prime of bicarbonate is used as buffer when unbalanced priming solutions are used?

A

25mmol/L

79
Q

The mannitol additive is a __________________

A

osmotic diuretic and free radical scavenger

80
Q

Calcium as additive is ____________________

A

needed if citrated blood is added to the prime to prevent chelation of calcium

81
Q

Steroids is used as additive to ____________________

A

attenuate systemic inflammatory response to CPB (evidence weak)

82
Q

TRUE OR FALSE:

Clotting in CPB may cause death

A

TRUE

Need to always check for ACT every 30-40mins during bypass

83
Q

What is a normal ACT?

A

80-120 secs

84
Q

What does ACT assess?

A

the adequacy of heparinization, affected by hemodilution and hypothermia

85
Q

This is the standard anticoagulant for CPB

A

Unfractionated heparin (UFH)

86
Q

What are the characteristics of UFH?

A 
Relatively safe
easy to use
fast onset of action
measurable, titratable
reversible
cost-effective
87
Q

Aside from UFH, the other anticoagulant used are: ________________________________

A

Low molecular weight heparin (Danaparoid)
FIbrinolytics (Ancrod = viprinex)
DTI (direct thrombin inhibitors = lepirudin, argatroban, bivalirudin)

88
Q

How would you say that a patient has heparin resistance?

A

Failure to achieve target ACT even with high dose of heparin (80-1000U/kg)

89
Q

Heparin resistance can be observed among ______________________

A 
geriatric
recent heparin exposure
nitroglycerin infusion
thrombocytosis
antithrombin III deficiency
90
Q

How to treat heparin resistance?

A

administer antithrombin III (1000 units) or FFP (2-4units)

91
Q

This is the main method of cerebral protection

A

Hypothermia

92
Q

TRUE OR FALSE:

Hypothermia has presumed organ protective effects

A

TRUE

93
Q

In perfusion, maintenance of higher perfusion pressure despite hemodilution, as blood viscosity increases ________________

A

theres hypothermia

94
Q

What are the 4 types of hypothermia?

A

Tepid
Mild
Moderate
Deep

95
Q

What is the use and temperature of Tepid hypothermia?

A

33-35deg C

good for short operations, healthy Px w/ high HCT

96
Q

What is the use and temperature of Mild hypothermia?

A

31-32 deg C

Protection of beating heart and neurological systems

97
Q

What is the use and temperature of moderate hypothermia?

A

25-30 deg C

Protection of non-beating heart and neurological systems

98
Q

What is the use and temperature of deep hypothermia?

A

15-20 deg C

DHCA (deep hypothermic circulatory arrest) for typically 40-50 minutes

99
Q

To prevent cerebral injury, it is important to observe the ____________

A

rate of rewarming and cerebral hyperthermia

100
Q

What are the core monitoring sites of tempearture?

A

rectum
urinary bladder
esophagus
pulmonary artery

101
Q

This gives an estimate of cerebral temperature

A

Nasopharyngeal temperature

102
Q

In acid base management of perfusion, with cooling, CO2 becomes __________

A

more soluble = DEC partial pressure causing alkalosis

103
Q

This is used in CPB to ensure small enough para makapasok sa semipermeable fiber of hemofilters

A

exogenous sodium bicarbonate (NaHCO3)

104
Q

Weaning is ____________________

A

process of transition from CPB to normal, physiological circulation

105
Q

Weaning requires ______________

A

excellent communication and teamwork between perfusionist, surgeon, and anesthetist

106
Q

What is the first step of weaning?

A

re-warming of core temperature above 36 deg C

107
Q

Hgb concentration should be ______________ prior to termination of CPB

A

> 7.5g/dL

108
Q

Prior to weaning, you must _____________

A

assess cardiac function (rate, rhythm, contractility)

109
Q

What are the complications in perfusion?

A 
selective cerebral perfusion
plaque dislodgement and dissection
massive air embolism
qualitative and quantitative platelet dysfunction
inflammatory response
hypotension
acute kidney injury (AKI) 
acute respiratory distress syndrome
anesthesia-induced atelectasis

special diagnostic procedures (10 decks)

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