At some point in time, we have all had (or will have) the opportunity to customize our pump packs (ECC) in order to make them more efficient, adjust or integrate to new techniques, reduce cost, adjust to new clinical expectations from the surgeon, or minimize priming volume.
So today, that was exactly what was on the plate for my colleague and chief perfusionist Renee, who invited me to assist and perhaps throw in some ideas or observations.
A shout out to Mr. Chris S. from Terumo, who was the rep sent in to help effect this process, and he certainly proved his mettle in terms of putting our ideas down onto hardcore specs and blueprints.
Overall I had a lot of fun, we exchanged many different viewpoints, Renee was ultimately the final say in the matter, but it reinforced how important it is to engage this process with multiple perspectives and paradigms.
Below is a small glimpse into some of the changes considered, and the rationale behind them
It always begins at the door- Chris brings us some disposables as a framework with which to work from.
We use our backup pump- and bring it into our main heart room, next to a pump fully assembled with the current version of our ECC so that we can compare differences as well as look at changes in tubing lengths as well as hardware (holders) placement.
We are switching from the Capiox RX series to the Capiox Fx integrated hardshell oxygenator that eliminates our need for an external ALF. The first question is posed as to whether we go with the pre-attached (oxy + reservoir) system, or implement the stand alone reservoir with a separate holder for either using the Fx15 or the Fx25. This basically means that when we start a case- we select the oxygenator we want based on the size of the patient, and hook it up to the system. The other option would have required two separate pump setups- one for the Fx25 and one for the Fx15, and moving the pumps in and out of the OR based on te patients requirements. Pretty inefficient and for us- not feasible.
The disposables that Chris brought in…
Perfusion SWAG bag (mine) with the tool of choice for the day- a tape measure!
Terumo’s first change was to change the shape of the venous inlet to the reservoir- making the blood pathway smoother (thus less sheer force and less turbulence). Nice
Our old circuit: Red arrows point to the major areas of change- the Oxygenator, and eliminating the arterial line filter.
Major design changes are on the outlet arterial “tree”.
With this configuration we have a RAP line coming off the recirc line- that also allows us to shunt volume to our Rapid prime bags.
The arterial “tree”
Renee- getting things into perspective…
A lot of options available from the primary arterial “tree”. Recirc, RAP, Hemoconcentrator, pressure line, The cardioplegia comes off of a separate port from the oxygenator.
Chris has the schematics on his tablet- but you have to be working at NASA to figure it out.
All kidding aside-having the diagram in front of us- assures accuracy and eliminates confusion etc…
What I see- when I look at the diagram LOL
Chris- “The Architect”
Signed, sealed, and delivered. Nice job, and a good time
We should have a non-sterile sample in about two weeks- to setup, tweak, and test drive.