Ch. 13 Isolated Limb Perfusion

Question 1

Rule of Nines

Answer 1

arm= 9% SA, CO
leg= 18% SA, CO

Question 2

Limb HCT

Answer 2

> 15%

Question 3

ISP prime

Answer 3

LR, bicarb, heparin 5,000

Question 4

ILP heparin

Answer 4

-full heparin (incase leak across tourniquet

Question 5

name of tourniquet

Answer 5

Esmarch Tourniquet with Steinman pin

-over femur or humerus

Question 6

ISP pump flow rate formula

Answer 6

CO x limb%

Question 7

ISP pump resistance formula

Answer 7

(limb perfusion pressure x 80)/ pump flow rate

Question 8

ISP FiO2 and temp

Answer 8

FiO2 >80% (PO2 > 400 mmHg is harmful to cancer***)

temp 38-40 C

Question 9

Leak Detection

Answer 9

• change in volume (can go both ways)
• **keep perfusion pressure lower than patients diastolic so leak goes inward
• can test with dye

Question 10

ILP Drugs- 2 Types

Answer 10

1) Alkylating Agents
- Mustargen .5 mg/kg
- Melphalan (L-Pam) 1 mg/kg
- DTIC-DOME 1000
2) Natural Agents
- Cosmegen (Actinomycin D) .01 mg/kg
- bolus over 1 min every 15 minutes for 1.5 hours

Question 11

Removing Drug

Answer 11

• remove before releasing tourniquet
• remove into waste bag with y off venous
• replace volume with crystalloid (1500-3000 to wash out chemo)
• HCT will drop 9% or 18%