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Flashcards in topic 2 Deck (110):
1

Neonatal:

less than 30 days

2

pediatrics

up to 18 yrs

3

Neonates have immature

myocardium

4

Neonates utilize _______ for energy

glucose

5

Immature myocardium prone to

stretch injury

6

Adult circuits tend to be

one size fits all”

7

blood volume for < 10 (kg)

85 cc/kg

8

blood volume for 11-20 kg

80 cc/kg

9

blood volume for 21-30 kg

75 cc/kg

10

blood volume for 31-40 kg

70 cc/kg

11

blood volume for >40 kg

65 cc/kg

12

A 1100 gram child has how much BV

93.5 mL

13

Adult circuit characteristics

3/8” arterial line 3/8”, 1⁄2” venous line Large oxygenators Larger priming volume

14

pediatric circuit cicuits

1/8”, 3/16”, 1⁄4”, 3/8” arterial line 3/16" 1⁄4”, 3/8”, 1⁄2” venous line Small/Med/Large Oxygenators Smaller Priming Volumes

15

Neonatal Pack

3/16” x 1⁄4”

16

infant pack

1⁄4” x 1⁄4”

17

pediatric pack

1⁄4” x 3/8”

18

small adult pack

3/8” x 3/8”

19

adult pack

3/8” x 1⁄2”

20

sequence to determine appropriate pediatric circuit

It is Imperative to ascertain kg weight prior to choosing  1. Determine BSA (kg weight may suffice)  2. Determine maximum flow rate (KG weight based or BSA based)  3.Choose appropriate pump boot  4. Pick arterial cannula  5. Determine arterial line size  6. Pick venous cannula  7. Determine venous line size

*Packs (1/8” x 3/16”, 3/16”x3/16”, 3/16”x1⁄4”, 1⁄4” x 1⁄4”, 1⁄4”x3/8”, 3/8”x3/8”, 3/8”x1⁄2”)
 8. Choose oxygenator  9. Choose arterial filter

21

CPB normothermic flows for 0-3 kg

200 cc/kg

22

CPB normothermic flows for 3-10 kg

150 cc/kg

23

CPB normothermic flows for 10-15 kg

125 cc/kg 1

24

CPB normothermic flows for 15-30 kg

100 cc/kg

25

CPB normothermic flows for >30kg

75cc/kg

26

CPB normothermic flows for >55kg

65cc/kg

27

kg weight x cc/kg/min flow =

max flow 5.3 kg x 150 cc/kg/min = 795 cc/min or 0.795 L/min

28

Normothermic CPB flows :  1. BSA:

1.8 l/m/m2 up to 2.4 l/m/m2  2.4 l/m/m2 X 2.00 m2 BSA = 4.8 L/m

29

Normothermic CPB flows .KG:

50-75 cc/kg/min  75 cc/kg/min x 70 kg = 5.25 L/m

30

SV FOR Rollerpump Callibration Chart: Boot Diameter 3/16

7 CC x 100 rpm =700 ml/monn

31

SV FORRollerpump Callibration Chart: Boot Diameter 1/4

13 CC x 100 rpm = 1300 ml/min

32

SV FOR Rollerpump Callibration Chart: Boot Diameter 3/8

27 CC x 100 rpm = 2700 ml/min

33

SV FOR Rollerpump Callibration Chart: Boot Diameter 1/2

45 CC x 100 rpm =4500 ml/min

34

Do NOT exceed ______ RPM for max tubing flow

100

35

reynolds # equals

(velocity of fluid)(density)(diameter)/viscosity

36

Poiseuille's law

Flow = (ΔP x πr4)/( Lx V x 8)

37

pediatric arterial cannula selection aim:

Aim: utilize the smallest cannula w/ the highest flow rate
 Do NOT exceed pressure drop > 100 mmHg
 Critical velocity is reached when laminar flow becomes turbulent (Reynolds #)
 Higher pressures = higher sheer stress = hemolysis = bad

38

pediatric venous cannula selection aim:

 Aim: drain the patient with the smallest cannulas
 Be aware if the cannulation is bicaval or single atrial cannula
 Pressure drop is in the -30 to -40 range (pressure-flow curve)
 Vacuum Assist Venous Drainage (VAVD) may help but at a cost (micro-emboli may be associated with VAVD)

39

tubing pack selection for single atrial cannula neonatal

3/16,1/4 <800ml/min

40

tubing pack selection for single atrial cannula infant

1/4,1/4 800-1278 ml/min

41

tubing pack selection for single atrial cannula peds

1/4,3/8 1278-2898 ml/min

42

tubing pack selection for single atrial cannula small adult

3/8,3/8 2898-3500 ml/min

43

tubing pack selection for single atrial cannula adult

3/8,1/2 >3500 ml/min

44

tubing pack selection for bicaval atrial cannula neonatal

3/16,1/4 < 800 ml/min.

45

tubing pack selection for bi caval atrial cannula infant

1/4,1/4 800-1566 ml/min

46

tubing pack selection for bi caval atrial cannula peds

1/4,3/8 1566-3000 ml/min

47

tubing pack selection for bi caval atrial cannula small adult

3/8,3/8 3000-3500 ml/min

48

tubing pack selection for bi caval atrial cannula adult

3/8,1/2 > 3500 ml/min

49

PED ALFs

Terumo AFX02 Medtronic affinity Integral oxygenator filtration

50

the new integral filter oxgenators _______is currently
changing the landscape

(FX 05)

51

Pediatric CannulaSelection: Arterial PROCESS

 Determinemaxflow:  Cannulation may be aortic / femoral / neck  Pressure drop should not exceed 100 mmHg  Anticipate larger flow needs when warming  Anticipateviscositychanges

52

Pediatric CannulaSelection: venous PROCESS

 Determine max flow  Cannulation utilizes Bicaval or Single Atrial  Pressure drop -30 to -40 mmHg  ( MEASURE IT - its gravity! )  Anticipate larger flow needs when warming  Anticipate viscosity changes

53

bicaval cannulation max flow 12/12

846

54

bicaval cannulation max flow 12/14

1120

55

bicaval cannulation max flow 12/16

1197

56

bicaval cannulation max flow 14/14

1287

57

bicaval cannulation max flow 14/16

1332

58

bicaval cannulation max flow 16/16

1377

59

bicaval cannulation max flow 16/18

1512

60

bicaval cannulation max flow 18/18

1566

61

venous 3/16" MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

1100,7

62

venous 1/4" MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

2000,9.65

63

venous 3/8" MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

6500,21.7

64

venous 1/2" MAXIMUM VENOUS CALCULATED BFR (mLmin) and PRIME VOLUME (mL/ft)

-----,38.6

65

capiox infant ALF flow range

< 2500 ml/min

66

intersect pediatric ALF flow range

2500-3000 ml/min

67

GISH ALF flow range >3000 ml/min

>3000 ml/min

68

pall leuco guard 3 max flow

3000 ml/min

69

pall leuco guard 6 flow range

3000-6000 ml/min

70

basic prime constituents adults

 Normosol Hetastarch/Albumin  Antibiotic  NaHCO3  Mannitol Heparin 10 K units

71

basic prime constituents peds

 Normosol25% Albumin  Antibiotic  Solumedrol  NaHCO3 Heparin 100 units  Mannitol  CaCl  PRBC’s

72

25% albumin purpose

 Largemolecule  Aids passification of tubing  Elevates C.O.P. and serum osmolarity  Good osmotic “pull” from tissues (1.3:1)  Be careful in recommendations  (i.e X-coating calls for wetting with crystalloid 1st)

73

Cefazolin(Kefzol,Ancef) dosage

25 mg/kg (max dose = 1 g)

74

Ampicillin dosage

 50 mg/kg (max dose = 1 g)

75

gentamicin dosage

2 mg/kg (max dose = 80 mg)

76

nafcilliin dosage

25 mg/kg (max dose = 1 g)

77

vancomycin dosage

0 -15 mg/kg (max dose = 1 g)
 Vancomycin is titrated during CPB. All other of the antibiotics listed can be safely administered to the extra-corporeal circuit prior to the intiation of CPB.

78

solumedrol dosage pump prime

The pump prime may contain 30mg/kg. methylprednisolone (up to 500 mg) on all to patients undergoing procedures requiring CPB.

79

Pediatric transplant patients receive ______methylprednisolone when the aortic crossclamp is released.

30 mg/kg

80

The prime should have a bicarbonate concentration of approximately

24 mEq/L.

81

formula for he amount of NaHCO3 necessary for a given amount of asanguineous volume

x = 0.025V

82

f PRBC’s are added to the prime, then a sample should be taken, and NaHCO3 administered according to the following formula:

? mEq NaHCO3 = 0.3(kg wt)(BE)

83

mannitol purpose

 Osmoticdieuretic
 ElevatesOsmolarityrapidly
 Given over a range of medical disciplines
 Oxygen radical scavenger

84

mannitol dosage

0.25g/kgintheprime
 An additional 0.25 g/kg is administered on the release of the aortic cross-clamp.
 Since mannitol is 25% solution (5.3 kg x .25 = 1.325 g) And that is 5.3 cc

85

CaCl2 is not

routinely added to the prime.

86

perfusate level of CaCL2 should be_______ because_______

0.7 - 0.8 mM/L, if necessary. would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution

87

PRBCS patient kg weight range intravascular BV index <10KG


85 mL/kg

88

PRBCS patient kg weight range intravascular BV index 10-20 KG

80 mL/kg

89

PRBCS patient kg weight range intravascular BV index 20-30KG

75 mL/kg

90

PRBCS patient kg weight range intravascular BV index 30-40 KG

70 mL/kg

91

PRBCS patient kg weight range intravascular BV index >40KG

65 mL/kg

92

PRBCS patient kg weight range intravascular BV index For neonates/infants < 5kg

100 ml PRBC’s are added to the prime
to avoid a prolonged period of asanguineous perfusion.

93

CPB Hct =

(((IVBV x kg x (patient Hct / 100)) / ((IVBV x kg) + mL prime))) x 100

94

TEG use in PEDS

 Sporatic use in Or/Perfusion labs  Takes a long time to finalize (takes patience)  Looks at the larger spectrum

95

TEG Viscoelastic test on whole blood – rotates specimen in cuvette

10 seconds

96

platelet works

 Assesses plateletn function and compares functional and non-functional platelets by percentage (%)
 More useful due to looks at function, not number

97

nirs


Near-infrared spectroscopy (NIRS) technology, such as that used in pulse oximetry, has been used and trusted in the world of medicine for decades.
Near-infrared spectroscopy (NIRS) is a spectroscopic method that uses the near-infrared region of the electromagnetic spectrum (from about 800 nm to 2500 nm)

98

CDI in line analyzer


Standard of care Important in pediatrics pH stat or Alpha stat use

99

Capiox Rx05 flow range

< 1500 ml. Min

100

Capiox sx10 flow range

1500-4000 ml./min.

101

Capiox sx18 flow range

4000-6000 ml./min

102

Dlp wire reinforced a ending aortic cannula sizes

8 10 12 16 fr

103

Biomedicus femoral arterial cannula sizes

8 10 12 14 fr

104

Max flow dlp 8 fr

750

105

Max flow dlp 10 fr

1300

106

Max flow dlp 12 fr

2200

107

Max flow dlp 14 fr

2900

108

Max flow dlp 16 fr

4000

109

Pediatric muf / 4:1cardioplegia

<30 kg

110

Adult 4:1 cardioplegia

>30 kg