test 1 part 2 Flashcards

Question 1

Q

Neonates and pediatric overview

Answer

A

 Many pediatric organ systems are immature / vulnerable
 Neonates have higher metabolic demands
 Neonates have IMMATURE MYOCARDIUM (matures 3-12 months)
 Neonates utilize GLUCOSE OXIDATION
 Immature myocardium prone to “stretch injury”
 Utilize alpha-stat and pH-stat blood gas management

Question 2

Q

adults overview

Answer

A

 Adult circuits tend to be “one size fits all”
 Many adult organ systems have acquired disease
 Some organ systems have failed
 Adults utilize FATTY ACID DEPENDENT energy source
 Not affected as much by prime volume dilution
 Mature clotting cascade and organ systems
 Utilize mostly alpha-stat and some pH-stat blood gas management

Question 3

Q

estimating blood volumes:
Weight (kg):
<10
11-20
21-30
31-40
>40

Answer

A

Blood volume (cc/kg)
< 10 = 85
11-20 = 80
21-30 = 75
31-40 = 70
> 40 = 65
- used for calculating post dilutional hematocrit

Question 4

Q

Circuits are commonly called:
3/16” x ¼”
¼” x ¼” 
¼” x 3/8” 
3/8” x 3/8”
3/8” x ½”

Answer

A

 3/16” x ¼” = Neonatal Pack
 ¼” x ¼” = Infant Pack
 ¼” x 3/8” = Pediatric/Small Adult Pack
 3/8” x 3/8” = Adult Pack
 3/8” x ½” = Large Adult Pack

Question 5

Q

Sequence to choosing an appropriate pediatric CPB circuit

Answer

A

Determine BSA (kg weight may suffice)
Determine maximum flow rate (KG weight based or BSA based)
Choose oxygenator
4.Choose appropriate pump boot
Determine arterial line size
Determine venous line size
 *Packs (1/8” x 3/16”, 3/16”x3/16”, 3/16”x¼”, ¼” x ¼”, ¼”x3/8”, 3/8”x3/8”, 3/8”x½”)
Pick arterial cannula
Pick venous cannula

Question 6

Q

Kg weight - based flows
Weight (kg)
0-3
3-10
10-15 
15-30
>30
>55

Answer

A

 0-3 = 200 cc/kg
 3-10 = 150 cc/kg
 10-15 = 125 cc/kg
 15-30 = 100 cc/kg
 >30 = 75 cc/kg
 >55 = 65 cc/kg

Question 7

Q

Terumo Baby RX05 (Max Flow and Prime volume)

Answer

A

Max Flow: 1.5 L/min (in red)

Prime volume: 43 cc (in red)

Question 8

Q

Terumo RX10

Answer

A

Max Flow: 4 L/min
Prime volume: 135 cc
-used for bigger kids

Question 9

Q

Terumo RX15

Answer

A

Max Flow: 5 L/min
Prime volume: 135 cc
-used for bigger kids

Question 10

Q

Sorin Kids D100

Answer

A

Max Flow: 0.7 L/min

Prime volume: 31 cc (in red)

Question 11

Q

Sorin Kids D101

Answer

A

Max Flow: 2.5 L/min

Prime volume: 87 cc

Question 12

Q

Stroke volume/ revolution for boot diameter:
3/16”
¼”
3/8”
½”

Answer

A

 3/16” = 7 cc
 ¼” = 13 cc
 3/8” = 27 cc
 ½” = 45 cc

Question 13

Q

do NOT exceed how many RPM’s for maximum tubing flows

Answer

A

100 RPM’s

Question 14

Q

Max tubing flows for:
3/16”
¼”
3/8”
½”

Answer

A

 3/16” 7 cc => (x 100 =700 cc)
 ¼” 13 cc => (x 100= 1300 cc)
 3/8” 27 cc => (x 100= 2700 cc)
 ½” 45 cc => (x 100= 4500 cc)

Question 15

Q

Reynolds number

Answer

A

Reynolds number = (velocity of fluid x density of fluid x diameter of pipe) / viscosity of fluid

Question 16

Q

Poisueille’s law

Answer

A

total volume that flows through a tube
Flow = (change in pressure x pi x radius^4) / (length of tube x viscosity of fluid x 8)
radius is the only thing that changes

Question 17

Q

how does turbulent flow effect the critical velocity

Answer

A

Turbulence decreases flow at any given perfusion pressure
turbulence increases the perfusion pressure required for a given flow
there is a “critical reynolds number” that when it is exceeded, there is a difference between turbulent flow and laminar flow

Question 18

Q

Choosing arterial tubing size base on max blood flow and how much prime it contains
1/8 
3/16”
¼”
3/8”

Answer

A

1/8 => 700 mls/min => 3 mls/ft
3/16 => 1100 mls/min => 7 mls/ft
1/4 => 2000 mls/min => 10 mls/ft
3/8 => 6500 mls/min => 20 mls/ft

Question 19

Q

why is venous line normally larger

Answer

A

need a bigger line to drain more

Question 20

Q

Choosing arterial tubing size base on max blood flow and how much prime it contains
3/16”
¼”
3/8”
½”

Answer

A

3/16 => 1100 mls/min => 7 mls/ft
1/4 => 2000 mls/min => 10 mls/ft
3/8 => 6500 mls/min => 20 mls/ft
½ = > ———- => 40 mls/ft

Question 21

Q

Resistance in the venous reservoir

Answer

A

We will not be dealing with a wide open venous line
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
◦ This is called “holdup volume”
◦ As your viscosity goes up - so may your holdup volume

Question 22

Q

Pediatric Cannula Selection

Answer

A

Cannulation can be achieved in various vessels depending on the anomaly
Look for high flow – low pressure drops
Thin walled reinforced and thin wall metal cannula give good flow with lower pressure drops
It’s all about the ID (inner diameter) (for us) and the OD (outer diameter) (for surgeons)

Question 23

Q

Pediatric Cannula Selection: arterial

Answer

A

 Aim: utilize the smallest cannula w/ the highest flow rate
 Do NOT exceed pressure drop > 100 mmHg
 Critical velocity is reached when laminar flow becomes turbulent (Reynolds #)
 Higher pressures = higher sheer stress = hemolysis = bad

Question 24

Q

Pediatric Cannula Selection: venous

Answer

A

 Aim: drain the patient with the smallest cannulas
 Be aware if the cannulation is bicaval or single atrial cannula
 Pressure drop is in the -30 to -40 range (pressure-flow curve)
 Vacuum Assist Venous Drainage (VAVD) may help but at a cost (micro-emboli may be associated with VAVD)

Question 25

Q

Determining arterial cannula

Answer

A

 Determine max flow:
 Cannulation may be aortic / femoral / neck
 Pressure drop should not exceed 100 mmHg
 Anticipate larger flow needs when warming
 Anticipate viscosity changes

Question 26

Q

Main ascending aortic cannulae

Answer

A

DLP wire reinforced

Question 27

Q

main femoral arterial cannulae

Answer

A

Biomedicus arterial cannulae

Question 28

Q

Determining venous cannula

Answer

A

 Determine max flow
 Cannulation utilizes Bicaval or Single Atrial
 Pressure drop -30 to -40 mmHg
 ( MEASURE IT - its gravity!)
 Anticipate larger flow needs when warming
 Anticipate viscosity changes

Question 29

Q

when choosing a cannula, it’s all about what

Answer

A

resitance

Question 30

Q

priming with 25% albumin

Answer

A

Start with prime then take out the filter and put in your albumin. displace all of the prime and all that is left in there is pretty much albumin
 Aids passification of tubing
 Elevates C.O.P. and serum osmolarity
 Good osmotic “pull” from tissues
make sure tubing isn’t coated with X-coating which calls for priming with crystalloid first

Question 31

Q

Cefazolin (Kefzol, Ancef) dose

Answer

A

 25 mg/kg (max dose = 1 g)

Question 32

Q

Pump prime may contain how much solumedrol (methylprednixolone)

Answer

A

30 mg/kg up to 500mg

Question 33

Q

bicarbonate equation

Answer

A

0.3(kg wt)(BE) = NaHCO3 mEq

Question 34

Q

Mannitol calculation

Answer

A

0.25 g/kg in prime

Question 35

Q

CaCl

Answer

A

 If priming with blood, a good rule of thumb is to use 1 mg CaCl per 1 mL of blood product

Question 36

Q

for neonates/infants < 5kg

Answer

A

100 ml PRBC’s are added to the prime to avoid a prolonged period a asanguineous perfusion.

Question 37

Q

calculate the PDHCT

Question 38

Q

hemochron vs hepcon (ACT)

Answer

A

hemochron gives you abnormally high values compared to the hepcon
could result in having clotting problems in the circuit

Question 39

Q

Platelet works

Answer

A

 Assesses platelet function and compares functional and nonfunctional platelets by percentage (%)
- does not tell you a platelet count

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test 1 part 2 Flashcards

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