4. Plegia and MUF- Exam 1 Flashcards
(78 cards)
1
Q
When choosing a cpg system- what 4 things do we look for in peds
A
Small prime
Good heat exchange
Air handling capabilities
**A versatile system
2
Q
What 5 things are included in a cpg circuit
A
Blood shunt Crystalloid component Blood component Heat exchanger/Bubble trap Air detector
3
Q
what component of the cpg is very important
A
priming dial
4
Q
why does the CSC-14 use a 4-way stop cock w/ purge line
A
use one as a recirc line and the second as a pressure pop off line and the third as a pressure monitor.
5
Q
Retrograde cpg (coronary sinus)- DLP cannula size for neonate
A
6 F
6
Q
Retrograde cpg (coronary sinus)- DLP cannula size for pediatrics
A
10 F
7
Q
Retrograde cpg (coronary sinus)- DLP cannula size for small adults
A
13F
8
Q
Retrograde cpg (coronary sinus)- DLP cannula size for adults
A
15F
9
Q
What cpg had the greates marketing ploy ever
A
sorin CSC 14
most people think the 14 represents only 14ml of prime but thats not the case
10
Q
hard tip coronary ostium cpg cannula sizes
A
10, 12, 14 F
11
Q
soft tip coronary ostium cpg cannula sizes
A
universal
12
Q
aortic root cpg cannula size for: 0-7 kg
A
18 guage
13
Q
aortic root cpg cannula size for: 7-20 kg
A
16 guage
14
Q
aortic root cpg cannula size for: 20-35 kg
A
14 guage
15
Q
aortic root cpg cannula size for: >35kg
A
12 guage
16
Q
LV vent cannula size and type for: <14 kg
A
DLP Malleable tip= surgeons request
DLP Curved LV Vent= 10F
17
Q
LV vent cannula size and type for: 14-30 kg
A
DLP Curved LV Vent= 13F
18
Q
LV vent cannula size and type for: 30-50 kg
A
DLP Adult LV Vent= 16F
19
Q
LV vent cannula size and type for: >50 kg
A
DLP Adult LV Vent= 20F
20
Q
antegrade delivery dose and target root pressure for peds
A
30 ml/kg
70 mmHg
*Make sure to look at pre-op pressures
21
Q
why is there no exact dose for peds
A
flow is variable depending on patient size- so the dose and time of dose is weight based
22
Q
where is retrograde delivered into
A
coronary sinus
23
Q
after retrograde is delivered into the coronary sinus- A
balloon is inflated or self inflated and provides what two
functions:
A
Prevents backflow
Holds cannula in place
24
Q
with retrograde cpg- flow is variable based on size. Flow should be titrated to maintain a coronary sinus
pressure of what?
A
30-40 mmHg
25
what coronary sinus pressure should not be exceeded in peds
40 mmHg
26
Are there other avenues CP might be
given in pediatrics?
(What other vessel – think congenital anomalies)
Arch- PDA
go off bypass
bump CPG up
screw it into the aortic or PDA cannula
27
with DHCA- you have to go off bypass before doing what
delivering cpg- remember to recirc
28
Myocardial-protection strategies are used to halt the ________ of the heart and to allow intracardiac procedures to be performed in a motionless, bloodless field
mechanical contractions
29
how much blood is in custodial cpg
none
30
The myocardial-protection strategy is designed to sufficiently ____________, so that myocardial function can resume at the end of the procedure with minimal dysfunction
reduce myocardial oxygen consumption
31
action potential phase 0=
Na+ influx (sodium arrest)
32
action potential phase 1=
Transient K+ efflux
33
action potential phase 2=
Ca++ efflux
34
action potential phase 3=
K+ efflux (potassium arrest
35
action potential phase 4=
Na/K ATPase
36
Blood cardioplegia solution is typically a mixture of what
4 parts of oxygenated blood and 1 part crystalloid solution
37
The addition of blood to the cardioplegic solution enhances what
oxygen delivery, especially at the microcirculation level.
38
8:1 has more or less blood
more
39
1:8 has more or less blood
less
40
% of blood based cpg
86%
41
% of crystalloid based cpg
14%
42
```
BLOOD-BASED CPG SOLUTION KIDLETS
Del Nido solution (1:4) __%
Customized solutions __%
St. Thomas, Plegisol, or Baxter __%
Microplegia __%
```
Del Nido solution (1:4) 38%
Customized solutions 32%
St. Thomas, Plegisol, or Baxter 11%
Microplegia 5%
43
CRYSTALLOID CPG KIDLETS
Custodiol __%
St. Thomas, Plegisol, or Baxter __%
customized solutions __%
Custodiol 7%
St. Thomas, Plegisol, or Baxter 5%
customized solutions 2%
44
Cold ( __%
| Antegrade administration __%
Cold ( 21%
| Antegrade administration 89%
45
____________ cardiopulmonary bypass is more common in neonates and infants
Moderate (28° to 31°C) hypothermic
46
Longer intervals between cardioplegia doses were associated with surgeons using _____ and _____.
(these solutions were commonly administered with a single dose _______ of aortic cross-clamp time)
del Nido and Custodiol solutions
| regardless
47
Myocardial protection techniques still remained highly _____ among congenital heart surgeons
variable
48
This survey demonstrates that there is a _______ that del Nido and Custodiol solutions can offer appropriate myocardial protection for longer intervals with decreased repeat dosing.
perception
49
4: 1 ((blood:crystalloid) is ____
1: 4 (blood:crystalloid) is ____
normal
| Del Nido
50
what form of cpg is a “pinkish solution”
del nido
51
Lies between depolarizing and hyperpolarizing solutions. It has a Osmolarity of ___ mOsm/L
340 mOsm/L
52
Del Nido dosing
20 mL/kg arrest
| 10 mL/kg maintenance
53
what rate (ml/min) do you deliver del nido at
90-180 mL min
54
describe custodial solution
Intracellular solution
Low Na arrest
Single administration: up to 2 hours
55
what is in a custodial solution
Histidine
Tryptophan
Ketoglutarate
56
Histidine=
buffer- against acidosis during XC
57
Tryptophan=
stabilizes cell membrane
58
Ketoglutarate=
improves ATP production during reperfusion
59
The addition of magnesium may provide a protective effect on the _________________
hypoxic-ischemic immature heart
60
hypoxic-ischemic immature heart. This effect probably due to what 3 things
the antiarrhythmic effect of magnesium
inhibited entry of calcium into the myocytes
decreased uptake of sodium by myocytes during ischemia
61
Magnesium is exchanged for ____ during reperfusion
calcium
62
what is the purpose of MUF
To allow recovery of the pump blood for the patient, while allowing the patient to be in a hemodynamic state to accept the volume is the a significant advance for pediatric perfusionists
63
who was MUF developed by and in what year
Developed Mr. Martin Elliott (Great Ormand Street/Hospital for Sick Children London UK) in 1985
64
name the 7 effects of MUF
A. Raising Hct
B. Extravascular fluid crosses (increase in COP & OSMO)
C. Removes inflammatory mediators
D. C-Reactive Proteins cross
E. Protein reactive cytokines cross
F. Complement activation factors cross (C3a, sC56-9, C3 bound)
G. Pulmonary effects > Systemic effects with IL-6, IL-8, and TNF
65
MUF after CPB in infants did result in ________ in both static and dynamic pulmonary compliance, but the effect was not sustained after __________ after the operation
immediate improvements
| admission to the PICU or 24 hours
66
Name 3 reasons why MUF IMPROVEMENTS are NOT SUSTAINED
1. pulmonary compliance is affected both by excess fluid from the hemodilutional effect of bypass (As well as by the systemic inflammatory response)
2. Ultrafiltration after CPB decreases total body water and removes inflammatory cytokines. However, the initiation of the systemic inflammatory response most likely occurs during rewarming. (MUF starts after the inflammatory cascade has been activated)
3. the effects of hemoconcentration and removal of water after CPB by MUF are unable to overcome the ongoing effects of capillary leak possibly caused by an activated ongoing inflammatory response
67
The technique of MUF is performed after CPB is complete and allows filtration of both the ...
patient and remaining contents of the CPB circuit, including the venous reservoir
68
Using the MUF technique, an ultrafilter is interposed in the CPB circuit between the ____ and ____. After weaning from CPB, the blood is removed from the patient via the _____ and fed through the ultrafilter. The outlet of the ultrafilter is fed to the _____ of the patient
aortic arterial line and the venous
aortic canula
right atrium
69
Blood flow through the ultrafilter approximates
20mL/kg/min max
70
Suction is applied to the filter port of the ultrafilter, resulting in an ultrafiltration rate of ____ mL per minute. A constant left atrial or right atrial pressure is maintained, achieving continued _________ in the patient
100 to 150 ml/min
| hemodynamic stability
71
Ultrafiltration is carried out with the end point being either time (_____ minutes) or the achievement of a hematocrit value of approximately ______
10–20
| 40-50%
72
name 5 benifits of MUF
1. total body water is reduced as a direct result of removing the ultrafiltrate.
2. Reduced edema
3. Reduced hospital stay
4. Reduced ventilation times
5. Reduced incidence of pleural and pericardial effusions.
73
name 5 arguments against MUF
1. Possible air embolism
2. Remember that air would be entering venous side
3. Circuit complexity and cost
4. Prolonged exposure to foreign surface
5. “Patient can be concentrated before coming of CPB”
74
Endpoints of hemofiltration vary among institutions and can be defined by (3)
time, volume, or hematocrit
75
In the postoperative period, patients receiving MUF have smaller increases in _____
total-body weight
76
In addition to decreasing edema, hemofiltration increases the hematocrit, which translates into _____
increased oxygen-carrying capacity
77
Removed fluids also contain _____ and _____
inflammatory mediators and vasoactive substances
78
CLINICAL STUDIES HAVE DEMONSTRATED THAT MUF IS ASSOCIATED WITH what 4 things
1. Increased ventricular systolic function;
2. Improved cerebral blood flow (CBF), cerebral metabolic activity, cerebral oxygen delivery
3. Pulmonary function: decreased postoperative ventilation
4. Decreased postoperative bleeding, chest-tube drainage, pleural effusions
