Welcome to PERFUSION POLICIES 101. This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause…
The intention here is to disseminate some basic recipes that have probably been implemented at countless institutions, for God knows how long. The usual disclaimers obviously apply:
Due Diligence is the Responsibility of the Reader!
Use the information as you feel fit, recognizing that this is information gleaned from multiple sources, it is recruited from the public domain of the internet, with no implied assurance of accuracy- but is cogent, and based on logical and reasonable clinical rationale.
Frank Aprile 🙂
Is your oxygenator failing? Mechanical considerations need to be evaluated before oxygenator changeout.
- Is oxygen being delivered to the oxygenator?
- Is the gas path obstructed?
- Is the gas connected to the correct ort?
- Are FiO2 and gas flow appropriate?
Patient considerations need to be evaluated
- Is the hematocrit adequate?
- What is the temperature?
- Is blood flow adequate?
- Are anesthesia and relaxant levels adequate?
Calculate O2 transfer of your oxygenator.
(arterial O2 content – venous O2 content) x (10) x (flow in LPM)
Art. Content= [9ven. Sat.%) x (1.34ml O2)x(Hgb gm %)]+[(PaO2)(.003)]
Ven. Content=[(ven.sat.%)(1.34ml O2)(Hgb gm %)]+[(PvO2)(.003)]
Maximum Value = 360ml/min @ blood flow 6L/min
Gas flow 15L/min
Blood temp 37*C
- tubing clamps – 4
- 400 ml of prime solution
- sterile scissors
Prepare to change out the oxygenator by getting any necessary extras into the room, including additional perfusionists, oxygenators, clamps, sterile scissors, etc. Notify the surgical team of your intentions and discuss your plans. If possible, terminate cardiopulmonary bypass (CPB) and remind anesthesia to ventilate. If changeout during bypass is unavoidable, then the following protocol should be observed. Turn off water lines and disconnect from oxygenator. Prep lines for sterile severance (alcohol). Remove new oxygenator from package. Come off bypass and clamp the arterial and venous lines to the patient and open the AV bridge. Clamp out the arterial filter and/or open the filter bypass. Double clamp all inlets and outlets of the oxygenator where you have previously prepped. Using sterile scissors, cut inlet and outlet tubings and remove the failed oxygenator. Insert new oxygenator into circuit and deair through the bridge. Replace oxygen delivery line to air/O2 inlet on new oxygenator. Open the arterial filter and clamp/close the arterial filter bypass while recirculating. Deair filter. Come off recirculation and clamp the AV bridge. Reinitiate CPB as soon as possible. Reconnect water lines and open valves. Reuse checklist to confirm adequate reinitiation of CPB.