Topic 4 Flashcards
Pre-Bypass includes (6)
- Review the patient chart.
- Calculate/ determine the necessary blood flow
- Determine proper cannulas required for procedure
- Calculate drug doses
- Calculate predicted hematocrit
- Discuss with surgeon (predicted hct and plan for blood product usage)
Pre-Bypass Checklist=
Checklist that is completed prior to handing up the lines (most of it)
-Usually has a component to complete once lines are up at the field just prior to initiation of bypass
Pre-Bypass Checklist section-
Patient
Chart reviewed
Procedure verified
Pre-Bypass Checklist section-
Sterility
Checked for package integrity/ expiration date Heat exchanger(s) leak tested
Pre-Bypass Checklist section-
Pump
Speed controls operational
Roller heads smooth and quiet
Occlusions set
Flow meter in correct direction/ calibrated
Flow rate indicator correct for patient and tubing size
Holders secure
Pre-Bypass Checklist section-
Electrical
Power cords securely connected
Pre-Bypass Checklist section-
Gas Supply
Gas line securely connected
Blender functional
Hoses leak-free
Gas exhaust is unobstructed
Pre-Bypass Checklist section-
Lines/Pump Tubing
Connections secure Tubing direction traced and correct No kinks noted One way valve(s) in correct direction Debubbled/leak-free Patency of arterial line/ cannula verified
Pre-Bypass Checklist section-
Cardioplegia
Solution(s) checked
System debubbled/ leak-free
Pre-Bypass Checklist section-
Safety Mechanisms
Alarms operational and engaged
Arterial filter/ bubble trap debubbled
Cardiotomy reservoir vented
Pre-Bypass Checklist section-
Monitoring
Temperature probes in place and calibrated
Pump pressure monitors calibrated
In-line and/or online sensors calibrated
Oxygen analyzer calibrated
Pre-Bypass Checklist section-
Temperature control
Water source connected and functional
Pre-Bypass Checklist section-
Supplies
Tubing clamps available Drugs available and properly labeled Solutions available Blood available Sampling syringes/laboratory tubes available
Pre-Bypass Checklist section-
Anticoagulation
Heparin time and dose verified
Anticoagulation tested and reported
Pre-Bypass Checklist section-
Backup
Hand cranks available
Emergency lighting available
Duplicate circuit components available
Preparing to Initiate – Handing up lines=
- Prime was recirculating warm.
- Arterial AND Venous Lines clamped
- Lines handed up
- Someone will ask to divide the lines.
- They will remove the pre-bypass filter
Preparing to Initiate - Heparin=
Heparin is given
- Loading dose usually 300units/kg given via central line
- 3-5 minutes later draw an ACT
- Goal of 480 seconds for initiation of bypass
- Suckers may be turned on once ACT reaches 2x baseline
Once heparin is in, surgeon will put in
purse string sutures
Arterial Cannulation=
- De-air arterial cannula and clamp the cannula
- Bring up arterial line to the cannula
- Will ask to “come forward”/ “roll up”/ “trickle flow”…
- Turn on arterial pump SLOWLY!!
- Will make a wet-wet connection to the arterial cannula
- Check for air/bubbles
After arterial cannula is placed=
- Surgeon will remove clamp on arterial cannula
- Check for pulsations
- Make sure there is adequate line pressure, and adequate pulsations
- May be asked to do a test transfusion
- Make sure the cannula is in fact in the aorta and not in a false lumen/ misplaced.
After arterial cannula placement is secure=
- Venous cannula will be placed
- Retrograde cardioplegia cannula placed
- Now all lines should be placed, we should be ready to go on bypass.
- ACT should be complete by this time
Immediately pre-bypass=
- Double check you’re ready!!
- Everything’s clamped that should be clamped.
- Last chance to change anything and to check/tighten any and all connections
- FiO2 is preset
- CDI is ready to be turned on
- Timers are ready to be turned on
- Heater-cooler is set appropriately
Initiation of Bypass=
- Surgeon will instruct to “go on bypass”/ “let’s go on”
- Repeat command – LOUD!!! “Going on bypass”
- Then go on
- Start arterial pump first slowly
- Give a little preload
- Remove clamp from the venous line-Watch your level
Initiation of bypass once clamp is removed from venous line=
- Keep turning up arterial pump until you reach full flow
- Open shunts
- Turn on gas flow
- Start your timers
- Announce “On bypass at _______”
- Get to full flow
- Most places announce when full flow is obtained (“At full flow!”)
- Anesthesia stops ventilating