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topic 2 Flashcards

(110 cards)

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1
Q

Neonatal:

A

less than 30 days

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2
Q

pediatrics

A

up to 18 yrs

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3
Q

Neonates have immature

A

myocardium

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4
Q

Neonates utilize _______ for energy

A

glucose

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5
Q

Immature myocardium prone to

A

stretch injury

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6
Q

Adult circuits tend to be

A

one size fits all”

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7
Q

blood volume for < 10 (kg)

A

85 cc/kg

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8
Q

blood volume for 11-20 kg

A

80 cc/kg

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9
Q

blood volume for 21-30 kg

A

75 cc/kg

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10
Q

blood volume for 31-40 kg

A

70 cc/kg

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11
Q

blood volume for >40 kg

A

65 cc/kg

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12
Q

A 1100 gram child has how much BV

A

93.5 mL

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13
Q

Adult circuit characteristics

A

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

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14
Q

pediatric circuit cicuits

A

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

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15
Q

Neonatal Pack

A

3/16” x 1⁄4”

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16
Q

infant pack

A

1⁄4” x 1⁄4”

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17
Q

pediatric pack

A

1⁄4” x 3/8”

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18
Q

small adult pack

A

3/8” x 3/8”

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19
Q

adult pack

A

3/8” x 1⁄2”

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20
Q

sequence to determine appropriate pediatric circuit

A

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

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21
Q

CPB normothermic flows for 0-3 kg

A

200 cc/kg

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22
Q

CPB normothermic flows for 3-10 kg

A

150 cc/kg

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23
Q

CPB normothermic flows for 10-15 kg

A

125 cc/kg 1

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24
Q

CPB normothermic flows for 15-30 kg

A

100 cc/kg

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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

Pediatrics (14 decks)

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