CABG 3B Flashcards
WHAT DOES HEPARIN WORK ON ? WHAT IS HALF LIFE? DOSE?
BINDS TO ANTITHROMBIN 3
HALF LIFE: 90 MIN IN NORMOTHERMIC PT LONGER IN HYPOTHERMIC PATIENTS.
300 -400UNITS /KG ……3-4MG/KG
THEN NOTIFIED PERFUSIONIST ONCE YOU GAVE IT.
WHAT DRUG NEEDS TO BE GIVEN PRIOR TO CANNULATION?
HEAPARIN. GIVE IN CENTRAL LINE WAIT 3-5 MIN TO DRAW ACT. ACT MUST BE 480 PRIOR TO INITIATION OF CPB.
WHAT BP IS REQUIRED FOR AORTIC CANNULATION?
LOWER THE BP TO SBP 90-100. USE VA OR SMALL NITRO BOLUSES. WANT FAST ON/OFF SO BP IS BACK UP FOR RETROGRADE LINE.
THIS ASSISTS WITH CANNULATION AND PROTECTS AGAINST AORTIC DISSECTION.
WHERE DO YOU WANT PRESSURE FOR RETROGRADE LINE INSERTION? WHAT ELSE SHOULD YOU BE DOING AT THIS TIME?
WANT BP UP B/C BP WILL DECREASE WHEN SURGEON MANUALLY MANIPULATES HEART. NOTIFY THEM IF/WHEN SPB DROPS TO 80.
YOU SHOULD ALSO BE HAND VENTILATING DURING PLACEMENT. WATCH FOR HYPOTENSION AND ARRYTHMIAS.
USE PRESSORS AND HAVE PERFUSION GIVE SOME FLUID. SURGEON WILL HAND YOU PRESSURE TUBING FROM CORONARY SINUS….HOOK IT INTO PA TRANSDUCER.
WHERE DOES VENOUS CANNULATION AND ANTEROGRADE LINE GO?
RIGHT ATRIUM
AORTIC ROOT
BEFORE YOU GO ON BYPASS WHAT DO YOU DO WITH SWANN?
DOCUMENT SWAN MARKS AND PULL BACK 5CM. THIS REDUCES RISK FOR RIGHT VENT PERF DURING HEART MANIPULATION.
WHAT DO YOU DO WHEN CPB IS INITIATED?
STOP VENT. BIPASS MODE ON MACHINE. INSPECTS FACE AND EYES FOR SIGNS OF INCORRECT AORTIC/VENOUS CANNULATION. FLIP THE PA STOPCOCK SO PERFUSION CAN READ RETROGRADE CARDIOPLEGIA WAVEFORM. TURN IV’S OFF, LEAVE INSULIN ON. CHECK BS Q30MIN ON BYPASS. CONSIDER REDOSING VEC AND VERSED.
IF YOUR CEREBRAL OXIMETRY READINGS ARE EXCESSIVELY LOW WHAT CAN PERFUSION DO ?
INCREASE FLOWS, CO2 RETENTION, TEMP, HCT.
WHAT DO YOU WANT U/O ON BYPASS?
1CC/KG/HR
WHEN DO YOU START REWARMING? AND WHAT SHOULD YOU BE DOING THEN?
WHEN 2/3 GRAFTS IN PLACE..USUALLY AFTER LIMA (THE LAST DISTAL). IF YOU NEED BLOOD ORDER IT NOW.
WHAT DO YOU NEED TO DO TO PREPARE FOR REMOVAL OF THE AORTIC CROSS CLAMP?
- GIVE 2GM MAG TO PREVENT VENT ARRYTHMIAS JUST PRIOR TO AORTIC CROSS CLAMP
- PUSH 100MG LIDOCAINE PRIOR TO CARDIOVERSION
- 1GM CALCIUM CHLORIDE PUSHED SLOWLY AFTER CROSS CLAMP REMOVED JUST PRIOR TO SEPARATION FROM CPB. THIS HELPS INCREASE MAP AND AUGEMENTS LEFT VENT FUNCITON, RV FUNCITON AND CI.
- RESTART GTTS ONCE CROSS CLAMP OFF.
AFTER HOW LONG ON CPB DO YOU SEE IMPAIRED MYOCARDIAL PERFORMANCE?
> 120 MIN
WHAT ARE THE USUAL PACEMAKER SETTINGS ?
ASYNCHRONOUS. DOO 90-100, 20MA, 150 MS. HIGHER RATE FOR PTS WITH REGURGITANT LESIONS.
WHY DO YOU NEED TO GIVE MILRINONE SLOWLY?
IT CAN CAUSE HYPOTENSION. LOADING DOSE 50 MCG/KG FOLLOWED BY INFUSION OF .5-.75 MCG/KG/MIN
HOW SHOULD YOU START VENT WHILE WEANING FROM BYPASS?
LOW TITAL VOLUMES TO AVOID STRETCHING THE LIMA AND IMPROVE SURGICAL VISABILITY. MAY WANT TO START WITH HAND VENTILATION. GO TO FULL TITAL VOLUME AND RATE BEFORE COMING OFF PUMP. CHECK END TITAL BEFORE COMING OFF PUMP.
