Flashcards in Embolic Events- Exam 2 Deck (46)
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31
Flush with Co2, what percent of bubbles are gone within 1 minute?
86%
32
Why do you co2 flush?
Helps with air solubility, some of that CO2 transfers to the blood and PaCo2 will increase, increases vasodilation. Any type of embolism makes it easier to go to the brain
33
What, involving the venous reservoir, can lead to pumping air?
Inattention to level in venous reservoir
Vortexing of blood in venous reservoir at low volume levels
Pressurized cardiotomy reservoir
34
What involving the pump can lead to pumping air?
Reversed roller pump
retrograde flow through centrifugal pump
runaway pump
mechanical jarring of circuit components
over occluded arterial pump head
35
What involving the tubing can lead to pumping air?
Tubing reversed in roller head
cavitation
leak/kink in tubing on negative side of the roller pump
disconnection/breakage, detachment of tubing
36
What involving the oxygenator can lead to pumping air?
disconnection/breakage detachment of oxygenator
pulsatile flow through microporous membrane oxygenator
37
What involving the arterial filter can lead to pumping air?
Inadequate debubbling, especially the arterial filter
38
What involving drugs can lead to air?
Drug injections into circuit and perfusion interventions
39
What involving volume can lead to air?
Inattention while transfusing volume to patient post bypass
40
What was the highest incidence of CPB emergency? Second highest?
Inattention to reservoir level (37%)
Aortic root air during CPS aminitration (29%)
41
What has the highest proportion of total emboli?
Drug
then blood samples
42
Blood-Bubble Interactions
Adsorption/denaturation plasma proteins
Adsoprtion phospholipids
Adsorption fibrinogen
Complement activation
Clumping red blood cells
Leukocyte activation/adherence
Lipid peroxidation
Microthrombi production
Platelet activation/adherence
Thrombin activation
Phospholipase activation
Endothelial wall damage
43
Safety Devices
Low level alarm
Air bubble detector
Arterial line filter (cardiotomy filter)
one-way purge line form arterial line filter to cardiotomy reservoir
one-way valve in vent line
one-way valve in arterial line
clear lines of ocmmunication
use of protocols, policies and procedures
Use of prebypass checklist
44
How do you minimize biologic emboli formation?
use of transfusion filters
adequate anticoagulation
design of circuit components
minimize surface area of circuit
use of membrane oxygenator
minimize complement/ immune activation
minimize platelet activation
minimize neutrophil activation
45
How do you minimize introduction of foreign particle emboli?
Componnet design and manufacturing
circulate crystalloid solution through entire circuit
flush circuit with cystalloid solution in conjuction with a pre-bypass filter in AV loops
don't use silicone tubing in arterial pump head
use medical grade tubing
46
