Bypass CLP competancy exam Flashcards Preview

Perfusion Program Fall 2014 > Bypass CLP competancy exam > Flashcards

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

Go ahead and test the line !

I GET UP AND INSPECT FOR AIR IN THE ARTERIAL CANNULA!!!