Flashcards in Bypass CLP competancy exam Deck (20)
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1
S: How’s your Bypass ?
• Non-pulsatile ABP
• CVP = 0
• ALP is within range = (150 – 250)
• We’ve met our top flow / CI: 2.4
• PaO2 / FiO2 relationship looks great
• SVO2 > 70
• Cerebral sats look great
1. Anesthesia, you can stop ventilating the patient!
2. Can I cool the patient? Drift down to 34
2
S: Are you ready to cross clamp?
• Bypass is good.
• Proper Solution
• Proper Temperature
• Primed to the field
P: Yes, we’re ready to cross clamp.
3
S: Put some volume in the Heart!
• Clamp the Venous line until ABP is pulsatile.
ANOUNCE!
• ABP = Pulsatile
• Systolic = X
• CVP = X
4
S: Applying the cross clamp!
(7)
• Pump is down!
• Cross clamp is on!
• Pump back up!
• X Clamp Timer is On
• Vent ON
• Plegia ON!
• Vent OFF
• Start Counting Plegia. Were now delivering Antegrade
5
Induction Antegrade delivery!
(5)
• Cold 500 until fibrillation)
• Pressure = 180 – 220 mmHg ALP
• Flow = 200 – 300
• Vent OFF
• Report Changes in EKG and Volume Delivered
6
Induction Retrograde Delivery!
(5)
• Cold 500 until Asystole)
• Pressure = 35 – 45 mmHg (P4)
• Flow = 250 – 400
• Vent ON
• Report Changes in EKG and Volume Delivered
7
S: Turn Cardioplegia OFF, let me know in 2 minutes.
(5)
• Switch from Induction bag to Maintenance bag.
• Obtain ABG’s
• Obtain VBG’s
• Keep up with ACT
• Keep up with ABP
8
Maintenance Dose:
(2)
- Predominantly Retrograde
- Deliver every 5 min
9
Vein Graft Delivery !
(2)
• Pressure = 150 Ed ALP
Pressure = 200 Bruce ALP
• Flow = 30 – 110
10
Hand Held Delivery!
(2)
• Pressure = 150 Ed ALP
Pressure = 200 Bruce ALP
• Flow = 100 – 200
11
Hot Shot Delivery preparation !
(3)
• Switch to reperfusate bag
• Rewarm the patient to 38 degrees
• Rewarm the cardioplegia to 38 degrees
12
Hot Shot re-perfusate Antegrade Delivery ?
(5)
• Delivery 100 in
• Pressure = 180 – 220 mmHg ALP
• Flow = 200 – 300
• Vent OFF
• Report Changes in EKG and Heart Temperature
13
Hot Shot Re-perfusate Retrograde Delivery ?
(5)
• 100 in
• Pressure = 35 – 45 mmHg (P4)
• Flow = 250 – 400
• Vent ON
• Report Changes in EKG and Heart Temperature
14
At 3 min Switch to whole blood !
Hot Shot Whole Blood Preparation ?
(2)
• Unclamp bridge
• Clamp Reperfusate Bag
15
Whole Blood Retrograde Delivery ?
(5)
• 100 in
• Pressure = 35 – 45 mmHg (P4)
• Flow = 250 – 400
• Vent ON
• Report Changes in EKG and Heart Temperature
16
Cardioplegia administration is over and were back to Normal Sinus Rhythm !
(5)
• Pump down!
• Cross Clamp is Off! X-Clamp Timer Off
• Pump Back Up!!
• Administer 100 mL Lidocane & 2g Mg+ Sulfate
• Cardioplegia pump OFF!
17
S: Are you ready to come off Bypass?
• EKG = NSR
• Electrolytes = Good / Ca2+: K:
• Ventilator = ON
• Vents = Out/OFF
• Temp = 35 – 37
• Hct = >24
• Volume = Enough to wean from bypass
• Give Calcium
18
Are you ready to go on bypass?
Bypass check list was completed
Arterial cannula is patent / No air in it
Venous cannula is connected and unclamped
We are ready for bypass!
Turn ON Forane (0.8 - 1.0%)
Turn ON FiO2 (60-80%)
Turn ON timer
Go on bypass!
19
How does your pressure look ?
-we have a pulsatile pressure
-resembles our patients ABP
20
