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Perfusion Technology Flashcards

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1
Q

Involves the study of physiology, pathology, and the associated equipment used to support the function of heart’s and/or lungs during surgical procedures

It can be a cardiopulmonary bypass, heart surgery, or anything related to the heart

A

Perfusion Technology

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2
Q

True or False:
The term “perfusion” is derived from the Latin verb “perfuse” meaning “pour over or through.”

A

False (French verb)

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3
Q

Flow of blood outside the body
Ex: dialysis

A

Extracorporeal Circulation (ECC)

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4
Q

Any fluid flowing through a tissue or organ

A

Perfusate

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5
Q

Flow of blood during contraction of the heart

A

Systole

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6
Q

AKA Artificial Perfusion
A cardiopulmonary bypass

A

Medical Perfusion

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7
Q

A natural perfusion

A

Heart

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8
Q

A skilled, allied health professional, trained and educated specifically as a member of an open-heart, surgical team responsible for the selection, setup, and operation of a mechanical device commonly referred to as the heart-lung machine

Capable of combining sterile tubing and artificial organs to build an ECC to meet the needs of several physician specialists to treat patients with specific operable diseases.

A

Perfusionist

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9
Q

Needed to attach organ to sterile tubings

A

Cannula

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9
Q

Functions of the heart:
Contractions of the heart generate blood pressure, which is responsible for moving blood through the blood vessels

A

Generating blood pressure

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10
Q

Functions of the heart:
The heart separates the pulmonary and systemic circulations and ensures better oxygenation of the blood flowing to the tissues

A

Routing blood

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11
Q

Functions of the heart:
The valves of the heart ensure a one-way flow of blood through the heat and blood vessels

A

Ensuring one-way blood flow

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12
Q

Functions of the heart:
The rate and force of heart contractions change to meet the metabolic needs of the tissues, which vary depending on such conditions as rest, exercise, and changes in body position

A

Regulating blood supply

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13
Q

Used to support patients with severe heat and/or lung failure which is unresponsive to optimal conventional care.

The main objective is to provide systemic perfusion and gas exchange allowing the heart and/or lungs to rest and recover or to bridge a patient to a different modality of support or to transplantation.

A

Extracorporeal Membrane Oxygenation (ECMO)

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14
Q

ECMO used for LUNGS

A

Venovenous ECMO

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15
Q

ECMO used for heart-lungs

A

Venoarterial ECMO

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16
Q

A machine used to support the function of the heart and/or lungs during surgery when the heart of the patient is stopped

A

Cardiopulmonary Bypass (CPB)

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17
Q

NOTABLE SCIENTIST:
Development of a roller pump in the 1930’s led to the first successful extracorporeal assist in 1953

A

Dr. John Gibbon

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18
Q

NOTABLE SCIENTIST:
Revolutionized the artificial lung with the development of synthesis of silicone rubber.

A

Kammermeyer

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19
Q

NOTABLE SCIENTIST:
Developed an approach to continuously titrate coagulation with Heparin

A

Bartlett and Drinker

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20
Q

NOTABLE SCIENTIST:
Reported the first successful cardiac ECMO run of 36 hours in a 2-year-old infant with cardiac failure

A

Bartlett, Gazzaniga et al.

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21
Q

Solution that prevents hemolysis in cases of Hypothermic patients wherein there is an increase oxygen demand and blood is viscous

A

Priming Solution

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22
Q

Part of CPB circuit that filters bubbles, solutions and etc.

A

Arterial line filter

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23
Q

Most common pump in CPB

A

Roller pump

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24
Additional components of CPB: To remove blood from surgical fields
Suckers
25
Additional components of CPB: To decompress the heart
Vents
26
Additional components of CPB: For ultrafiltration
Haemofilters
27
Additional components of CPB: Includes diastolic heart arrest Has concentrated potassium Stops the heart
Cardioplegia system
28
When is CPB done
Coronary artery bypass Heart transplantation Heart septal defect repairs
29
Interconnects all of the main components of the circuit and must be biocompatible (does not cause hemolysis)
Tubing
30
Tubing size: Cardioplegia section of the blood Cardioplegia delivery system
3/16’ (4.5mm)
31
Tubing size: Suction tubing, blood section of the blood cardioplegia delivery system
1/4’ (6.0mm)
32
Tubing size: Arterial pump line for the flow rates <6.71/minutes, majority of the arterial tubing in the extracorporeal circuit
3/8’ (9.0mm)
33
Tubing size: Venous line larger tubing is required to gravity drain blood from the patient
1/2’ (12.0mm)
34
Connect the patient to the circuit and hence to the CPB machine.
Cannulae
35
Types of Cannulae: Used to connect the “arterial limb” of the CPB circuit to the patient and so deliver oxygenated blood from the heart-lung machine directly into the patient’s arterial system
Arterial Cannulae
36
Most common site of arterial cannulation for routine cardiovascular surgery
Ascending aorta
37
Types of Cannulae: Allows deoxygenated blood to be drained from the patient into the extracorporeal circuit of venous (Remove the oxygenated blood from the patient to machine)
Venous Cannulae
38
Common site for venous cannulation
Right atrium
39
Types of Cannulae: Delivers cardioplegic solution to stop the heart temporarily for surgery
Cardioplegia cannulae
40
Types of Cannulae: Removes excess blood from the heart chambers
Venting cannulae
41
Used for most closed-heart procedures, where a single cannula is inserted into the right atrium.
Dual stage cannulae
42
Used during most open-hearted surgeries, where two cannulae are inserted into the superior and inferior vena cava and joined by a Y-piece.
Single-stage cannulae
43
An alternative method for venous cannulation for CPB Used for procedures that require cardiac chambers to be open
Bicaval Cannulation
44
Responsible for creating the necessary pressure to circulate oxygenated blood from the CPB machine to the patient’s body and then return deoxygenated blood back to the machine.
Pumps/ Pump Heads
45
Includes two rollers positioned on a rotating arm, which compress a length of tubing to produce forward flow. They tend to resemble or mimic the pattern of blood flow generated by the heart cycle or cardiac cycle. Most commonly used because of its price and reusability
Roller Pump
46
Consists of impellers/stacked cones within housing.
Centrifugal Pump (Kinetic Pump)
47
They collect the blood drained from the heart May be hard shell or collapsible
Reservoirs
48
More commonly used Allow passive removal of entrained venous air along with the option of applying vacuum to assist drainage Process suctioned blood
Open Reservoirs
49
Have limited volume capacity, but offer a smaller area of blood contact with artificial surfaces Require a separate circuit for processing suctioned blood.
Closed Reservoirs
50
Provides an interface of high surface area between blood on one side and gas on the other
Oxygenator
51
Types of oxygenator: Largely of historical interest in the era of membrane oxygenators.
Bubble oxygenators
52
Types of oxygenator: Consist of hollow microporous polypropylene fibres
Membrane oxygenator
53
Also known as ultra filters or hemoconcentrators
Hemofilters
54
A method of myocardial protection where the heart is perfused with a solution to cause electromechanical arrest which reduces myocardial oxygen consumption
Cardioplegia
55
Blood cardioplegia is a combination of oxygenated blood and crystalloid in a ratio ranging from
1:1 to 8:1
56
The process in conducting of cardiopulmonary bypass where in calculations are performed to determine necessary blood flow and if blood or other products are needed. Drugs doses: Heparin, and Cardiopleagia
Pre-Bypass
57
A solution consisting of a mixture of crystalloids and colloids that causes hemodilution which improves flows during hypothermia.
Priming solutions
58
Priming solutions: 1000-2500 U/L of prime to ensure adequate anticoagulation
Heparin
59
Priming solutions: 25 mmol/L of prime as buffer when unbalanced priming solutions are used
Bicarbonate
60
Priming solutions: Osmotic diuretic and free radical scavenger
Mannitol
61
Priming solutions: Needed if citrated blood is added to the prime to prevent chelation of calcium
Calcium
62
Priming solutions: To attenuate systemic inflammatory response to CPB (evidence weak)
Steroids
63
The process in conducting of cardiopulmonary bypass wherein during arterial cannulation, systolic pressure should be 90-100 mmHg to reduce the risk of aortic dissection, and with which provides volume resuscitation in cases of hypotension associated with venous cannulation
Initiation
64
Frequently used during CPB for its presumed organ protective effects, increases blood viscosity which allows maintenance of a higher perfusion pressure despite hemodilution but reversibly inhibits the clotting factors and platelets.
Hypothermia.
65
Bypass that has less platelet dysfunction and higher blood flow which increases trauma
Normothermic bypass
66
It was first described by Naik et al. in 1991 wherein it is the process done during and after CPB which removes inflammatory mediators and excess fluid thereby producing hemoconcentration
Ultrafiltration
67
Ultrafiltration that is used after completion of the surgical repair before protamine administration, with blood removed from the arterial line and returned to the venous line after passing through the hemofilter.
Modified Ultrafiltration
68
The process in conducting a cardiopulmonary bypass where extracorporeal support is gradually withdrawn as the heart takes over the circulation. The process of transition from CPB to normal, physiological circulation, requires excellent communication and teamwork between perfusionist, surgeon and anesthetist.
Weaning
69
Remains the standard anticoagulant for CBP for several reasons. It is relatively safe, easy to use, has a fast onset of action and is measurable, titratable and reversible. It is also cost-effective.
Unfractionated Heparin (UFH)
70
Mechanical Complications: can be associated with bleeding, cannula malposition causing selective cerebral perfusion, plaque dislodgement and dissection
Arterial Complications
71
Mechanical Complications: can be associated with bleeding, cannula malposition/air locking causing an inadequate return, leading to cerebral and splanchnic congestion. Massive air embolism is due to pumping from an empty reservoir.
Venous Complications

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