How old is considered "Neonatal"?
How old is considered "Pediatric"?
Up to 18 yo (<18)
What is the primary energy source for peds?
What is the primary energy source for adults?
When do neonates myocardium mature?
What is immature myocardium prone to?
Weight: <10 kg Volume: ?
Weight: 11-20 kg Volume: ?
Weight: 21-30 kg Volume: ?
Weight: 31-40 kg Volume: ?
Weight: > 40 kg Volume?
What weight is considered an adult?
What size are Neonatal Packs?
3/16'' x 1/4''
What size are infant packs?
1/4'' x 1/4''
What size are pediatric packs?
1/4'' x 3/8''
What size are small adult packs?
3/8'' x 3/8''
What size are adult packs?
3/8'' x 1/2''
Normothermic Flow Weight 0-3 kg
Normothermic Flow Weight 3-10
Normothermic Flow Weight 10-15 kg
Normothermic Flow WEight 15-30 kg
Normothermic Flow Weight >30 kg
Normothermic Flow Weight >55 kg
Some hospitals will index peds flows @ ____m^2 up to ______ m^2
2.4 m2 up to 3.2m2
What is the SV/rev in a 3/16'' boot diameter?
Do not exceed ______ rpms for max tubing flows?
Look for _____ flow- ______ pressure drops.
What is the max flow and the prime volume of the Terumo Baby RX05
1.5 L/min 43 ccs
Basic Prime Constituents: Adults
Mannitol NaHCO3 Albumin/Hetastarch Normosol Antibiotic Heparin 10 K units
Basic Prime Constituents: Pediatrics
Mannitol 25% Albumin CaCl2 Solumedrol Packed RBCs NaHCO3 Normosol Antibiotic Heparin 100 units
Large molecule Aids passification of tubing Elevates COP and serum osmolarity Good osmotic "pull" from tissues (1.3:1) Be careful in recommendations
What does X-coating call for?
Wetting with crystalloid first
What antibiotic is titrated during CPB?
Name the common antibiotics used on bypass.
Cefazolin (Kefzol, Ancef) Ampicillin Gentamicin Nafcillin Vancomycin
Cefazolin (Kefzol, Ancef) Dose
25 mg/kg (max dose = 1 g)
50 mg/kg (max dose = 1g)
2 mg/kg (max dose= 80 mg)
25 mg/kg (max dose= 1g)
10-15 mg/kg (max dose = 1g)
Solumedrol (Methylprednisolone) Dose; What two times is it given?
30 mg/kg (up to 500mg) in prime and in peds when aoritc xc is released
NaHCO3 Prime Concentration
How to calculate amt of NaHCO3 necessary for a given amount of asanguinous volume?
mEq NaHCO3 = 0.025 (ml asanguinous vol) x = 0.025 V
If PRBCs are added to the prime, NaHCO3 dose should be calculated using what formula?
mEq NaHCO3 = 0.3 (kg wt) (BE)
Osmotic Diuretic Elevates Osmolarity rapidly Given over a range of medical disciplines Oxygen radical scavenger
Mannitol Dose in the prime; when is it given?
0.25 g/ kg in the prime; an additional 0.25 g/kg is administered upon release of the XC
Mannitol is what percent solution?
What should be measured shortly after the initiation of CPB?
Ionized Ca++ level of the perfusate
What should ionized Ca++ level of the perfusate be corrected up to? Why?
0.7- 0.8 mM/L; this would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution
For neonates/infants, how much PRBCs should be added to the prime? Why?
Neonates/infants <5kg, 100 ml PRBCs are added to the prime to avoid a prolonged period of asanguinous perfusion
Pediatric Monitoring Devices: Common equipment in the pediatric OR
ACT TEG Hepcon HMS Platelet Works NIRS CDI Blood gas analyzer
What has higher ACT readings: Hemochron or the Hepcon
Hemochron has higher ACT readings; hepcon has lower readings
Sporatic use in OR/Perfusion Labs Takes a long time to finalize looks at the larger spectrum
TEG uses a __________ test on whole blood.
Measures both elastic and viscous behavior
How often does TEG rotate the specimen in the cuvette?
Every 10 seconds
Asseses Platelet function and compares functional and non-functional platelets by percentage (%) More useful due to looks at function ,not number
Near-infrared spectroscopy (NIRS), such as that used in pulse oximetry has been used and trusted in the world of medicine for decades Spectroscopic method uses near-infrared region of the electromagnetic spectrum
What spectrum does NIRS use?
800 nm to 2500 nm
CDI In-line Analyzer
Standard of care Important in pediatrics pH State or Alpha stat use
Anticoagulants/ Hemophilia TEG
Platelet Blockers (TEG)
DIC: Stage 1 (TEG)
DIC: Stage 2 (TEG)