Cardiolegia

Question 1

S: “Leave some volume in please!”

Answer 1

Clamp 1/2 on venous line, then infuse volume at same RPMs. Call out every 100 mL of volume.
P: That’s 100, 200, 300 in.
P: CVP is X
P: How does the heart look?

Question 2

S: “ Are you ready for cross clamp?”

Answer 2

• Bypass is good
• Proper Solution high K+ (20 mEq/L)
• Proper Temperature (Cold)
• Primed to the field.

Question 3

S: “Pump Down”!

Answer 3

RPMs down till patients ABP = 30-40 mmHg.
- Hold & wait
S: “Clamp is on”
P: Turn RPMs back up to full flow

Question 4

S: Cardioplegia delivery prime

Answer 4

• Vent on at 500 (removes any air)
• Plegia on at 400 (primes plegia & recircs. trapped air)
• Vent is off (plegia is no vented out)

Question 5

S: Antegrade delivery

Answer 5

• High dose K+
• 4/1 delivery on roller pump
  P = 180 - 220 mmHg ALP
  Q = .200 - .300 L/min
• Vent Off

Question 6

S: Retrograde delivery

Answer 6

• High dose K+
• 4/1 delivery
• P = 30 -45 mmHg (pressure 2)
• Q = .250 - .400 L/min
• Vent On

Question 7

S: Ed’s Vein graft / hand held delivery

Answer 7

P = 150  mmHg
Q = 30 - 110 mL/Min

Question 8

S: Maintenance delivery

Answer 8

P = 30 - 45 mmHg (pressure 2)

- 8/1 delivery (300 mL)

Question 9

S: “What’s the flow down this vein?”

Answer 9

Flow is .030 mL/m @ 50 mmHg

Question 10

S: “How is your myocardial protection ?”

Answer 10

• Time (since last cardioplegia dose)
• Temp (obtained from probe on septum/ Cold)
• EKG = asystole
• PA / LVEDP
• Vent Flow = full heart = warm heart = Not Good

Question 11

S: Bruce’s Vein graft / hand held delivery

Answer 11

P = 200  mmHg
Q = 30 - 110 mL/Min

Question 12

“Hot Shot”

Case is coming to an end.

Answer 12

• Warm the patient to 38

- Warm CLP to 38