Topic 2

Question 1

When does the myocardium matures?

Answer 1

3-12 months

Question 2

Neonates utilize what type of oxidation?

Answer 2

glucose oxidation

Immature myocardium prone to “stretch injury”

Question 3

Neonatal: age range

Answer 3

< 30 days

Question 4

Pediatric:

Answer 4

up to 18 yo (< 18)

Question 5

Adults have what type of energy source that peds dont?

Answer 5

fatty acid dependent energy source

Question 6

Adult characteristics different from peds?

Answer 6

Adult circuits tend to be “one size fits all”
Many adult organ systems have acquired disease
Some organ systems have failed
Adults have fatty acid dependent energy source
Not affected as much by prime volume dilution
Mature clotting cascade and organ systems
Utilize mostly alpha-stat and some pH-stat blood gas management

Question 7

Weight < 10kg

what is Blood Volume (cc/kg)?

Answer 7

< 10kg

85 cc/kg

Question 8

WT 11-20 kg

what is Blood Volume (cc/kg)?

Answer 8

80 cc/kg

Question 9

WT 21-30 kg

what is Blood Volume (cc/kg)?

Answer 9

75 cc/kg

Question 10

WT 31-40 kg

what is Blood Volume (cc/kg)?

Answer 10

70 cc/kg

Question 11

WT > 40 kg

what is Blood Volume (cc/kg)?

Answer 11

65 cc/kg

Question 12

Neonatal Pack sizes?

Answer 12

3/16” x ¼”

Question 13

Infant Pack sizes?

Answer 13

¼” x ¼”

Question 14

Pediatric Pack sizes?

Answer 14

¼” x 3/8”

Question 15

Small Adult Pack sizes?

Answer 15

3/8” x 3/8”

Question 16

Adult Pack sizes?

Answer 16

3/8” x ½”

Question 17

Steps in choosing Pediatric Circuit ? (9)

Answer 17

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”x ¼”, ¼” x ¼”, ¼”x3/8”, 3/8”x3/8”, 3/8”x½”)
8. Choose oxygenator
9. Choose arterial filter

Question 18

Wt (kg): 0-3 kg

Flow (cc/kg/min) ?

Answer 18

200 cc/kg

kg weight x cc/kg/min flow = maximum flow

Question 19

Wt (kg): 3-10 kg

Flow (cc/kg/min) ?

Answer 19

150 cc/kg

kg weight x cc/kg/min flow = maximum flow

Question 20

Wt (kg): 10-15 kg

Flow (cc/kg/min) ?

Answer 20

125 cc/kg

kg weight x cc/kg/min flow = maximum flow

Question 21

Wt (kg): 15-30 kg

Flow (cc/kg/min) ?

Answer 21

100 cc/kg

kg weight x cc/kg/min flow = maximum flow

Question 22

Wt (kg): >30 kg

Flow (cc/kg/min) ?

Answer 22

75 cc/kg

kg weight x cc/kg/min flow = maximum flow

Question 23

Wt (kg): >55 kg

Flow (cc/kg/min) ?

Answer 23

65 cc/kg

kg weight x cc/kg/min flow = maximum flow

Question 24

Boot Diameter 3/16
Stroke Volume/Revolution (cc)?
MAX VENOUS CALCULATED BFR (mLmin)?

Answer 24

7cc

1100 mL/min

Question 25

Boot Diameter 1/4" Stroke Volume/Revolution (cc)? MAX VENOUS CALCULATED BFR (mLmin)?

Answer 25

13cc 2000 mL/min

Question 26

Boot Diameter 3/8" Stroke Volume/Revolution (cc)? MAX VENOUS CALCULATED BFR (mLmin)?

Answer 26

27cc 6500 mL/min

Question 27

Boot Diameter 1/2" | Stroke Volume/Revolution (cc)?

Answer 27

45cc

Question 28

Reynolds Number

Answer 28

Density Velocity Diameter of pipe/Viscosity of fluid

Question 29

Poiseuille's law can be used to calculate volume flow rate only in the case of laminar flow Flow =

Answer 29

ΔP x πr4 / L x V x 8

Question 30

Arterial Cannulae selection Aim? Pressure drop?

Answer 30

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

Question 31

Venous Cannulae selection Aim? Pressure drop?

Answer 31

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)

Question 32

Since all venous return essentially goes to the RA: Approximately 100% can be drained by what kind of cannulae?

Answer 32

a single venous cannula

Question 33

Terumo Baby RX05 max flow and prime volume?

Answer 33

1.5 L/m | 43 cc

Question 34

Sorin Kids D100 oxygenator max flow and prime volume?

Answer 34

0.7 L/m | 31 cc

Question 35

Terumo RX10 oxygenator max flow and prime volume?

Answer 35

4.0 L/m | 135 cc

Question 36

Terumo RX15 oxygenator max flow and prime volume?

Answer 36

5.0 L/m | 135

Question 37

Capiox Infant ALF - flow range?

Answer 37

<2500 ml/min

Question 38

Intersect Pediatric ALF - flow range?

Answer 38

> 2500 to < 3000 ml/min

Question 39

Gish ALF - flow range?

Answer 39

> 3000 ml/min

Question 40

Pall Leuco-Guard 3 ALF for Transplant Cases flow range?

Answer 40

<3000 ml/min

Question 41

Pall Leuco-Guard 6 Criteria for Transplant Cases flow range?

Answer 41

> 3000 to <6000 ml/min

Question 42

flow range for single atrial cannulae? flow range for bicaval cannulation? 3/8” x 3/8”

Answer 42

Single: > 2898 to < 3500 ml/min Bicaval: >3000 to < 3500 ml /min

Question 43

flow range for single atrial cannulae? flow range for bicaval cannulation? ¼” x 3/8”

Answer 43

single atrial > 1278 to 2898 | Bicaval. 1566 to <3000 ml/ min

Question 44

flow range for single atrial cannulae? flow range for bicaval cannulation? ¼” x ¼”

Answer 44

single atrial: > 800 to 1278 | Bicaval : 800 to <1566 ml/min

Question 45

flow range for single atrial cannulae? flow range for bicaval cannulation? 3/16” x ¼”

Answer 45

single and bicavL <800 ml/min

Question 46

flow range for single atrial cannulae? flow range for bicaval cannulation? 3/8” x ½”

Answer 46

single atrial > 3500 ml/min bicaval > 3500 ml/min

Question 47

Adults Basic Prime Constitutes (6)

Answer 47

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

Question 48

Pediatric Basic Prime Constitutes (9)

Answer 48

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

Question 49

25% Albumin

Answer 49

``` Large molecule 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) ```

Question 50

Cefazolin (Kefzol, Ancef) Dose?

Answer 50

Antibiotic | 25 mg/kg (max dose = 1 g)

Question 51

Ampicillin Dose?

Answer 51

Antibiotic | 50 mg/kg (max dose = 1 g)

Question 52

Gentamicin Dose?

Answer 52

Antibiotic | 2 mg/kg (max dose = 80 mg)

Question 53

Nafcillin Dose?

Answer 53

Antibiotic | 25 mg/kg (max dose = 1 g)

Question 54

Vancomycin Dose?

Answer 54

Antibiotic | 10-15 mg/kg (max dose = 1 g)

Question 55

Solumedrol (methyprednisolone) pump prime may contain what amount -- for peds and adults?

Answer 55

The pump prime may contain 30 mg/kg methylprednisolone (up to 500 mg) on all to patients undergoing procedures requiring CPB. Pediatric transplant patients receive 30 mg/kg methylprednisolone when the aortic crossclamp is released.

Question 56

NaHCO3 pump prime should contain what amount?

Answer 56

The prime should have a bicarbonate concentration of approximately 24 mEq/L

Question 57

The amount of NaHCO3 necessary for a given amount of asanguineous volume -- how do you calculate?

Answer 57

where x = mEq NaHCO3 and V =mL asanguineous volume: | x = 0.025V

Question 58

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

Answer 58

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

Question 59

Mannitol what does it do?

Answer 59

Osmotic dieuretic Elevates Osmolarity rapidly Given over a range of medical disciplines Oxygen radical scavenger 0.25 g/kg in the prime An additional 0.25 g/kg is administered on the release of the aortic cross-clamp

Question 60

Mannitol Dose, in prime and additional doses

Answer 60

.25 g/kg in the prime 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

Question 61

CaCl2 - normal values?

Answer 61

Not routinely added to the prime. However, an ionized Ca++ level of the perfusate should be measured shortly after the initiation of CPB and corrected upward to 0.7-0.8 mM/L, if necessary. This is imperative because a level of 0.7 to 0.8 mM/l would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution

Question 62

<10 kg intravascular bld vol index?

Answer 62

85mL/kg

Question 63

> 10 kg to <20 kg - intravascular bld vol index?

Answer 63

80 mL/kg

Question 64

> 20 kg to <30 kg - intravascular bld vol index?

Answer 64

75mL/kg

Question 65

> 30 kg to <40 kg - intravascular bld vol index?

Answer 65

70mL/kg

Question 66

> 40 kg - intravascular bld vol index?

Answer 66

65 mL/kg

Question 67

For neonates/infants < 5kg, what is given to avoid a prolonged period a asanguineous perfusion.

Answer 67

100 ml PRBC’s are added to the prime

Question 68

TEG

Answer 68

Sporatic use in Or/Perfusion labs Takes a long time to finalize (takes patience) Looks at the larger spectrum Viscoelastic test on whole blood –rotates specimen in cuvette every ten seconds

Question 69

Platelet Works

Answer 69

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

Question 70

CDI in-line analyzer

Answer 70

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

Question 71

(NIRS) Near-infrared spectroscopy

Answer 71

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