2. Circuits- Exam 1 Flashcards
1
Q
define neonatal and pediatric in regards to age
A
Neonatal: < 30 days
Pediatric: up to 18 yo (< 18)
2
Q
Pediatric patients are ___ small adults
A
NOT
3
Q
Neonates have higher or lower metabolic demands
A
higher
4
Q
Neonates have immature myocardium. When does it mature and what is the immature myocardium prone to?
A
matures 3-12 months
Immature myocardium prone to “stretch injury”
5
Q
Neonates utilize what for of energy consumption
A
glucose oxidation
6
Q
What form of blood gas management do neonates utilize?
A
Utilize alpha-stat and pH-stat blood gas management
7
Q
Adults utilize what for energy consumption?
A
fatty acid dependent
8
Q
What form of blood gas management do adults utilize
A
Utilize mostly alpha-stat and some pH-stat blood gas management
9
Q
<10 kg= _____ cc/kg blood volume
A
85 cc/kg
10
Q
11-20 kg= _____ cc/kg blood volume
A
80 cc/kg
11
Q
21-30 kg= _____ cc/kg blood volume
A
75 cc/kg
12
Q
31-40 kg= _____ cc/kg blood volume
A
70 cc/kg
13
Q
> 40 kg= _____ cc/kg blood volume
A
65 cc/kg
14
Q
Circuits fitting for Neonatal Pack
A
3/16” x ¼”
15
Q
Circuits fitting for Infant Pack
A
¼” x ¼”
16
Q
Circuits fitting for Pediatric Pack
A
¼” x 3/8”
17
Q
Circuits fitting for Small Adult Pack
A
3/8” x 3/8”
18
Q
Circuits fitting for Adult Pack
A
3/8” x ½”
19
Q
What are the 9 steps to building a Peds circuit
A
It is Imperative to ascertain kg weight prior to choosing
- Determine BSA (kg weight may suffice)
- Determine max flow rate (KG weight or BSA based)
- Choose appropriate pump boot
- Pick arterial cannula
- Determine arterial line size
- Pick venous cannula
- Determine venous line size
- Choose oxygenator
- Choose arterial filter
20
Q
0-3 kg= ______ Flow (cc/kg/min)
A
200 cc/kg/min
21
Q
3-10 kg= ______ Flow (cc/kg/min)
A
150 cc/kg/min
22
Q
10-15 kg= ______ Flow (cc/kg/min)
A
125 cc/kg/min
23
Q
15-30 kg= ______ Flow (cc/kg/min)
A
100 cc/kg/min
24
Q
> 30 kg= ______ Flow (cc/kg/min)
A
75 cc/kg/min
25
>55 kg= ______ Flow (cc/kg/min)
65 cc/kg/min
26
Formula to determine max flow
Weight * flow for that group
| EX: (5.3kg*150cc/kg/min= 795 cc/min or 0.795 L/min)
27
Boot diameter of 3/16"= ______ stroke vol/revolution and ______ max RPM's
7 cc
| 700 rpm
28
Boot diameter of ¼”"= ______ stroke vol/revolution and ______ max RPM's
13 cc
| 1300 rpm
29
Boot diameter of 3/8"= ______ stroke vol/revolution and ______ max RPM's
27 cc
| 2700 rpm
30
Boot diameter of ½”"= ______ stroke vol/revolution and ______ max RPM's
45 cc
| 4500 rpm
31
Ohms law and its hydraulic analogy?
VIR
| PQR
32
Reynolds Number= [formula]
(Velocity*Density*Diameter) / Viscosity
33
Poiseuilles Law= [formula]
Flow = (ΔP x πr4) / (Length x Viscosity x 8)
34
Reynolds number for blood flow is
2000
35
When selecting a cannula, what do you look for?
Look for high flow – low pressure drops
36
What type of cannula give us good flow with a lower pressure drop?
Thin walled reinforced and thin wall metal cannula
37
It’s all about the __(for us) and the __ (for surgeons)
It’s all about the ID (for us) and the OD (for surgeons)
38
When selecting an arterial cannula, what is the goal
utilize the smallest cannula w/ the highest flow rate
39
When selecting an venous cannula, what is the goal
drain the patient with the smallest cannulas
40
Do not exceed a pressure drop of ____ for arterial cannulas
> 100 mmHg
41
Do not exceed a pressure drop of ____ for venous cannulas
-30 to -40 range
42
For arterial cannula's, when is critical velocity reached?
- when laminar flow becomes turbulent (Reynolds #)
| - Higher pressures = higher sheer stress = hemolysis = bad
43
Vacuum Assist Venous Drainage (VAVD) may help but at what cost
micro-emboli
44
When selecting the arterial cannula, what should you anticipate?
Anticipate larger flow needs when warming
| Anticipate viscosity changes
45
If given a french size, how do you convert to ml
divide by 3
46
What is the #1 type of arterial peds cannula
DLP wire reinforced
47
DLP wire reinforced cannula:
| 8F= _____ max flow at 100mmHg press gradient
750 ml/min
48
DLP wire reinforced cannula:
| 10F= _____ max flow at 100mmHg press gradient
1300 ml/min
49
DLP wire reinforced cannula:
| 12F= _____ max flow at 100mmHg press gradient
2200 ml/min
50
DLP wire reinforced cannula:
| 14F= _____ max flow at 100mmHg press gradient
2900 ml/min
51
DLP wire reinforced cannula:
| 16F= _____ max flow at 100mmHg press gradient
4000 ml/min
52
A tubing diameter of 1/8= ____ max flow with a prime volume of ___
Max arterial flow= 700 ml/min
| Prime volume= 2.5 ml/ft
53
A tubing diameter of 3/16= ____ max flow with a prime volume of ___
Max arterial flow= 1100 ml/min
| Prime volume= 7 ml/ft
54
A tubing diameter of 1/4= ____ max flow with a prime volume of ___
Max arterial flow= 2000 ml/min
| Prime volume= 9.65 ml/ft
55
A tubing diameter of 3/8= ____ max flow with a prime volume of ___
Max arterial flow= 6500 ml/min
| Prime volume= 21.7 ml/ft
56
A tubing diameter of 1/2= ____ max flow with a prime volume of ___
Max arterial flow= -------
| Prime volume= 38.6 ml/ft
57
When determining venous cannulas, what 2 do we utilize?
Bicaval or Single Atrial
58
When determining venous cannulas, what should we anticipate?
Anticipate larger flow needs when warming
| Anticipate viscosity changes
59
If you double the length of the cannula, what happens
blood flow is cut in ½
60
If you double the viscosity within the cannula, what happens?
blood flow is cut in ½
61
Whats the big difference between Bicaval or Single Atrial venous cannulas
Bicaval= you get 66% return from the IVC ans 33% SVC
| Single Atrial= you get 100% from the RA
62
What is hold-up volume
Resistance in your reservoir can be a factor in venous return. Since your venous line goes into the sock, a certain amount of volume is “delayed” there. As your viscosity goes up - so may your holdup volume
63
Terumo Capiox Baby RX05: Max flow____ Prime Vol ____
Max Flow= 1.5 L/m
| Prime Vol= 43 cc
64
Medos Hilite 1000: Max flow____ Prime Vol ____
Max Flow= 1.0 L/m
| Prime Vol= 57 cc
65
Sorin Kids D100: Max flow____ Prime Vol ____
Max Flow= 0.7 L/m
| Prime Vol= 31 cc
66
What are your choices for ped ALF?
Terumo AFX02
Medtronic affinity
Integral oxygenator filtration
67
What are the 9 basic prime constituents for peds?
```
Normosol
Solumedrol (methylprednisolone)
Antibiotic
25% Albumin
Mannitol
CaCl
NaHCO3
PRBC’s
Heparin 100 units
```
68
describe 25% Albumin (5 things)
- Large molecule
- Aids passification of tubing
- Elevates C.O.P. and serum osmolarity
- Good osmotic “pull” from tissues (1.3:1)
- Be careful in recommendations (i.e X-coating calls for wetting with crystalloid 1st)
69
Antibiotic dosage: Cefazolin (Kefzol, Ancef)
25 mg/kg (max dose = 1 g)
70
Antibiotic dosage: Ampicillin
50 mg/kg (max dose = 1 g)
71
Antibiotic dosage: Gentamicin
2 mg/kg (max dose = 80 mg)
72
Antibiotic dosage: Nafcillin
25 mg/kg (max dose = 1 g)
73
Antibiotic dosage: Vancomycin
10 -15 mg/kg (max dose = 1 g)
74
What is special about vancomycin?
Vancomycin is titrated during CPB. All other of the antibiotics listed can be safely administered to the extra-corporeal circuit prior to the intiation of CPB.
75
The pump prime may contain ___ mg/kg methylprednisolone (up to ___ mg) on ALL patients undergoing procedures requiring CPB.
30 mg/kg
| 500 mg
76
Pediatric transplant patients receive ___ mg/kg methylprednisolone when the aortic crossclamp is released
30 mg/kg
77
The prime should have a bicarbonate concentration of approximately __ mEq/L
24 mEq/L
78
The amount of NaHCO3 necessary for a given amount of asanguineous volume may be calculated using what formula?
? mEq NaHCO3 = 0.025 * mL asanguineous volume
79
If PRBC’s are added to the prime, then a sample should be taken, and NaHCO3 administered according to the following formula
? mEq NaHCO3 = 0.3(kg wt)(BE)
80
describe mannitol (4 things)
Osmotic dieuretic
Elevates Osmolarity rapidly
Given over a range of medical disciplines
Oxygen radical scavenger
81
How much mannitol os given in the prime? How much is given during AoXc removal?
0.25 g/kg in the prime
| An additional 0.25 g/kg is given during AoXc removal
82
Since mannitol is 25% solution, how do you determine the dose?
The amount of kg of the pt is the amount of ml's of mannitol (EX 5.3 kg= 5.3 ml of mannitol)
83
CaCl2 is not routinely added to the prime. However, an ionized Ca++ level of the perfusate should be measured shortly after the initiation of CPB and corrected upward to ____ mM/L, if necessary
0. 7 - 0.8 mM/L
- -This is imperative because a level of 0.7 to 0.8 mM/l would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution
84
For neonates/infants < 5kg, ___ ml PRBC’s are added to the prime to avoid what?
100 ml
| to avoid a prolonged period a asanguineous perfusion
85
Always keep an idea of where your hematocrit will be:
| CPB Hct = [formula]
(((IVBV x kg x (patient Hct / 100)) / ((IVBV x kg) + mL prime))) x 100
