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CVPR 371 Techniques II > Safety & Techniques part I > Flashcards

Safety & Techniques part I Flashcards

1
Q

Name 2 CPB related problems ?

A
  • Prevention

- Treatment

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2
Q

What type of protein is Protamine ?

A

Polycationic

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3
Q

What type of molecule is Heparin ?

A

Polyanionic

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4
Q

What is a major protamine reaction ?

3 Risk Factors ?

A
  • Catastrophic pulmonary vasoconstriction.
  • Vasectomized males
  • Hx of PPHN
  • Seafood allergies
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5
Q

What would be the Classification of the following Protamine Reaction:

Hypotension from rapid administration.

A

Type I

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6
Q

What would be the Classification of the following Protamine Reaction:

Anaphylactic reaction

A

Type II a

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7
Q

What would be the Classification of the following Protamine Reaction:

Immediate Anaphylactic reaction

A

Type II b

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8
Q

What would be the Classification of the following Protamine Reaction:

Delayed Anaphylactic reaction

A

Type II c

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9
Q

What would be the Classification of the following Protamine Reaction:

Catastrophic vasoconstriction

A

Type III

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10
Q

Preventions/ preparations for Protamine Reaction.

A
  • Slow Injection
  • Give peripherially
  • Careful history
  • LV fx
  • Vasectomized pts.
  • Redo’s
  • Fish allergies
  • Keep circuit intact
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11
Q

Treatment / Response to a Protamine Reaction.

A
  • Administer Fluids
  • Administer O2, Steroids, Epi
  • Positive Pressure Ventilation
  • Alpha vasopressor
  • Dopamine
  • If unresponsive:
  • Give Heparin
  • Reinstituted CPB
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12
Q

Prevention / Preparation for an AIR EMBOLISM

A
  • Careful priming
  • Flush CO2
  • Level sensor
  • Bubble sensor
  • Arterial filter
  • Pre-CPB checklist
  • Verify before infusion
  • Limit traffic
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13
Q

Treatment / response

for an AIR EMBOLISM

A
  • Automatic pump shut down, if possible
  • Protocol for massive air embolism during CPB
  • Retrograde cerebral perfusion
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14
Q

Prevention / Preparation for Oxygenator Failure

A
  • Preform Drills
  • Diagnosis algorithm
  • Check all gas connections
  • To oxygenator
  • vaporizer
  • Correct source
  • Kink free
  • Size oxygenator to patient
  • Check oxygenator for leaks
  • Pre-CPB
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15
Q

Treatment / response

for an Oxygenator Failure.

A
  • Assuming all optimizing steps have failed:
  • Communicate
  • Consider cooling
  • Change-out membrane
  • Pre-primed if poss.
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16
Q

Prevention / Preparation for Electrical Failure

A
  • Be familiar w/institution
  • Inspect cords and plugs pre-CPB
  • Check flashlight
  • Hand cranks accessible
17
Q

Treatment / response

for Electrical Failure

A
  • Clamp venous line to avoid exsaungination
  • If necessary, illuminate reservoir
  • Shut off pump, hand crank to previous level and resistance
  • Have assistant hand crank vent, sucker, CP as needed
18
Q

Prevention / Preparation for Hypoperfusion

A
  • Assess volume status; add as needed to maintain flow
  • Scan venous line for air
  • Set occlusion before every case
  • Centrifugal pump users; scan flows frequently
  • Monitor venous saturations
  • Watch line pressure to insure proper cannulation
  • Does calculated flow rate make sense?
19
Q

Treatment / response

for Hypoperfusion

A
  • Increase flow, add fluids
  • Walk air lock out and increase flow
  • Modify cannulation
20
Q

Prevention / Preparation for Drug Errors

A
  • Label/date/conc/initial all syringes
  • Have back-up verify drug
  • Document all drugs and dosages administered
  • Communicate w/surgeon and anesthesia regarding use of non-protocol drugs
21
Q

Treatment / response

for Drug Errors

A

Consult anesthesia and/or surgeon

22
Q

Prevention / Preparation for Clots in circuit

A
  • Add heparin to prime
  • Monitor ACT’s closely
  • Keep [hep] .300u/kg
  • Use hep bonded components
  • Shut off pump suction before/early in protamine admin.
  • Careful history for coaguable states
23
Q

Treatment / response

for Clots in circuit

A
  • Add heparin
  • Communicate w/surgeon
    Discontinue CPB ASAP
  • Monitor circuit pressures
  • Monitor oxygenator function
  • Change out circuit
24
Q

Prevention / Preparation for Line Separation

A 
- Check all circuit connectors
tie band
- Monitor line pressure closely
servoregulate
- Visually check arterial line
Safety drills
25
Q

Treatment / response

for Line Separation

A
  • Stop pump clamp AV lines
  • Make necessary connections, fill lines w/fluid
  • Aspirate air from arterial line and resume CPB
26
Q

Prevention / Preparation for Transfusion Error

A
  • Document pt’s ID # and blood type on pump record prior to bypass
  • 2 person check on blood products
  • Final check before adding to circuit
27
Q

Treatment / response

for Transfusion Error

A
  • Stop transfusion immediately
  • Notify appropriate personnel
  • Recheck all labels
  • Obtain urine specimen
28
Q

Prevention / Preparation of Gross Circuit Contamination

A
  • Use sterile technique when cutting into circuit
  • Do not allow wet set-up to sit extended periods of time
  • Limit traffic around pump
  • Do not remove lines from field until chest is closed
  • Verify package intergrity before opening
29
Q

Treatment / response

for Gross Circuit Contamination

A
  • Antibiotics

- cultures

CVPR 371 Techniques II (6 decks)

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