PERFUSION PRO: A Bold Approach to EMR

  Editor’s Note: I guess the proof is in the pudding so to speak… when I found myself on a 3 hour pump run yesterday, instinctively looking for my clipboard.  I think that’s a common trait for perfusionists as we pump cases, we look for a clipboard not necessarily to enter data, but it keeps […]

A Locum’s ScrapBook: 2 Amigos & a Bag

Editor’s Note: To view the entire “Locum’s ScrapBook” series- click here My life is Family First and then Perfusion.  I switched from staff perfusionist to becoming a Locum’s traveler to make sure my kids and family would have a solid place to call home.  I travel because it puts me in charge of my life, it […]

Perfusion Policies 101: IABP

Editor’s Note: PERFUSION POLICIES 101 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 […]

A Locum’s ScrapBook: Sometimes… The Bear Gets YOU…

“The simple fact that a centrifugal hand-crank is in the room, does not at all satisfy the “yes” box in the checklist” Editor’s Note: Just when you get to the comfort zone of thinking “you are pretty good”? You find out you’re pretty NOT! But don’t get knocked down and NOT get back up.  Shit […]

Unexpected Air: An ECMO Discussion

Editor’s Note: I was on FB and was visiting the Malaysian Perfusion Page, monitoring a discussion regarding venous air entrainment in an ECMO circuit, and the efforts made to save the patient.  This a true emergency, and with a closed system, much more difficult to resolve. The discussion however is what captured my interest because […]

International CQI: Vaporizer Obstructing O2 Q

Editors Note: This is a new Section. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would like to share. Please email details if you feel that your story […]

Perfusion CQI: Failed Heat Seal on Recirc Line Connection

Click Image Above to Add a “Glitch” to the Perfusion Database … Editors Note: This is a new Section. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would […]

Failed Hemonconcentrator: International CQI

Click Image Above to Add a “Glitch” to the Perfusion Database … Editors Note: This is a new Section. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would […]

International CQI: USA: Total Oxygenator Failure

Operation: ACB x 3. Pt. Data 70 years old Gender: Male 71 inches 79 Kilograms 1.94 BSA Baseline Hematocrit- 44% Pertinant Hx: Unremarkable. No coagulopathic issues No other issues-  patient appeared to be  robust and healthy. Plan: ACB x 3:  Mild Hypothermia- 34 degrees C.. Prime Constituents: 300 ml  Normosol 5,000 units heparin 37.5 g […]

24 Hours of STS: Demographics and Efficiency

24 Hours of STS:  Perfusion Style Demographics and Efficiency When I’m not doing hearts- I end up thinking about them… Getting ready for the late summer harvest.  Well that sounds like something out of the Farmer’s Almanac- but in reality it represents reviewing 152 cardiac patient case files, abstracting the data, entering them into a monolithic […]

HAS THIS HAPPENED TO YOU ? H2O Outlet Deformity on Oxygenator:

Click on image to enlarge Have you seen this happen before?  This is my 3rd time.  Plz respond in the comments section below- or send an email privately to ecclog@gmail.com to share your experience and identify if this is indeed a common issue. Editors Note: We are developing a database of common or not-so-common problems […]

9 Ways Medical Devices Fail

Posted in Quality Assurance by Chris Newmarker on March 31, 2014  Editor’s Note: Medical device recalls appear to be growing at a slower pace than the device industry itself. But when they do happen, they can produce tragic, even deadly, results for patients.  MPMN asked members of the LinkedIn Medical Devices Group why device failures […]

PLANNING FOR EMERGENCIES – The Perfusion Crash Cart

The Team PLANNING FOR EMERGENCIES – The Perfusion Crash Cart This is a ‘perfusion crash cart’ designed by me for my perfusionist and made locally . It comprises a industrial grade steel alloy body with medium sized wheels which allow fast mobility and keeps all essential items at one place . It can be easily […]

An International Perfusion CQI Registry: American, Asian, European, ALL Countries are Invited.

To Join the International Perfusion CQI Registry-  cick image above Editors Note: This is a new platform for Quality Improvement. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB.  We are inviting perfusionists, groups, and institutional participation to develop a universal platform for identifying areas of concern […]

Perfusion Glitches: Deprimed Cardioplegia Line

Click Image Above to Add a “Glitch” to the Perfusion Database … Editors Note: This is a new Section. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would […]

Cardiac Team Performance: Are You As Good As You Think You Are?

“I have taken a 14+ page form and reduced it to it’s 1 page bare essentials…” (Click Image to View STS Website) Editor’s Note: I had an interesting discussion with one of our cardiac anesthesiologists the other day. We were talking about our cardiac program’s outcomes, and the fact that I felt our program needed […]

AT3 Deficiency

Antithrombin III (AT III) is a plasma glycoprotein with a molecular weight of 58,000 daltons.  AT III deficiency may be noticed when the patient’s activated clotting time (ACT) does not respond to heparin administration as would be expected when given a standard dosage.  Also can be confirmed by a laboratory value of the patient’s AT […]

Cold Agglutinins

Literature: Click image to view source article Cold Agglutinins in Cardiac Surgery: Management of Myocardial Protection and Cardiopulmonary Bypass CAs are autoantibodies to RBC antigens [3], which can causesystemic thrombosis and hemolysis. The cause of these CAs maybe primary/idiopathic, or more commonly, secondary to an infectiveprocess (eg, mycoplasma, human immunodeficiency virus) or alymphoproliferative disorder [2]. […]

HELP ! Looking for Medos Oxygenators

Editor’s Note: I received an email today regarding the Medos pediatric oxygenator: “Frank, browsing for a supply of pediatric oxy’s and found your post on the Medos oxygenator system. I used this once eons ago in Italy- worked superbly. I want to try to get some for a big project. Any contacts out there?” Jeffrey […]

Protamine Reaction

“It binds to heparin to form a stable ion pair which does not have anticoagulant activity; on its own, protamine has a weak anticoagulant effect.”   Protamine sulfate is a drug that reverses the anticoagulant effects of heparin by binding to it. Protamine was originally isolated from the sperm of salmon and other species of […]

Malignant Hyperthermia

Editor’s Note: Just a brief primer on Malignant Hyperthermia, should the need ever arise to place a patient on CPB who has been diagnosed with this condition. It is an unusual co-morbidity and should be approached and treated with an abundance of clinical respect and caution.  Any insight or recommendations from readers would be greatly […]

Letter To ‘Surfers: Protocols & ECC Setups ?

Editor’s Note: I received an email today regarding ECC setups and institutional protocols.  If you have any suggestions or written protocols, perhaps you could share them with Ryan ? Hello Frank,  I sent a post to you back in June that you entitled, ‘Is Perfusion a Dead Language?’. I am happy to say that I […]

A Quick Guide to Changing Out the Terumo FX15 / 25 Oxygenator

Editor’s Note: I had an early Op-Cab and was looking at a primed circuit that I had set up the day before- for a case that was also an Op-Cab.  It was primed with Normal Saline, no meds, and would have been fine to use on our patient today. I decided to go ahead and […]

Sickle Cell Anemia & CPB

I.    DESCRIPTION: Sickle Cell hemoglobinopathy is a single gene recessive disorder that involves an abnormality of the hemoglobin (Hgb) molecule.  This disorder causes the red cell to sickle under certain circumstances.  A sickled cell cannot undergo normal respiratory functions and they interfere with normal blood circulation. Sickle cell disease is genetic and a patient may […]

Jehovah’s Witness & Open Heart Bypass

Jehova’s Winesses:  A Background Jehovah’s Witnesses believe that the Bible prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion.[1] Watch Tower Society publications teach that the Witnesses’ refusal of transfusions of whole blood or its four primary components—red cells, white cells, platelets and […]

Perfusion Techniques: Parallel Oxygenators

Perfusion Techniques: Parallel Oxygenators  _____Click image to enlarge Perfusionist:  Randy Ransom, CCP Equipment:  FX25 Terumo Oxygenators x 2 / Tubing and “Y” connectors Issues:  None Narrative:  Large Patient:  Preoperative adjustment: Bumped up the ECC capacity  to 2 oxygenators setup as a parallel circuit. Time & Place:   2013 About The Perfusionist:  CCP Click to Donate Click […]

A Letter to ‘Surfers : From Jordan: How Many Perfusionits are Required Per Case?

Click Image above to go directly to Mr. Ali’s FB page 🙂 Editor’s Note: Most places I have worked, it was with one perfusionist per case- unless the degree of difficulty implied the need for more assistance.  At one point in my career we did have a perfusion assistant on each case.  At another point, […]

STS & Perfusion

STS Updates for Perfusionists & Data Managers A series of STS Updates and Insights: (Click Image to View STS Website) The Society for Thoracic Surgery (STS) national cardiac database is the all-consummate monster of consolidated data requirements that most cardiac programs subscribe to. To be left off of the report card, is to be isolated […]

VAD / ECMO Policy: Generic & Universal

Editor’s Note: This is a disclaimer: As with all material presented on this site,  please use your own judgement as to what you feel is clinically safe, vetted, and makes sense to you.  This blog is NOT peer reviewed or sanctioned by any perfusion associated review board or academic body. That is not to say […]

Long-Term Outcomes Favor Heart Surgery Over Stents and Angioplasty

Long-Term Outcomes Favor Heart Surgery Over Stents and Angioplasty Released: 1/23/2013 8:00 AM EST Embargo expired: 1/29/2013 3:05 AM EST Source Newsroom: Society of Thoracic Surgeons (more news from this source) Press conference: Tuesday, January 29, 2013 at 11:00 a.m. PT Room 512, LA Convention Center Newswise — Los Angeles—Patients who undergo coronary artery bypass […]

Perfusion Glitches: Loss of Vacuum VAVD : Request for Your Opinions

Click Image Above to Add a “Glitch” to the Perfusion Database … Editors Note:  This is a new Section.  We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would […]

Deep Hypothermia: Antegrade & Retrograde Cerebral Perfusion

Editor’s Note: Deep Hypothermic Circulatory Arrest (DHCA), is a concept discussed here in this forum, as well as a significant perfusion event when it comes to the horizon. Obviously an issue for aortic dissections, transections, or congenital malformations that require a surgical approach and repair that can only be accomplished by intermittent or momentary cessation […]

Deep Hypothermia: Rapid Cooling & Nitroglycerine

Editor’s Note: Deep Hypothermic Circulatory Arrest (DHCA), is a concept discussed here in this forum, as well as a significant perfusion event when it comes to the horizon. Obviously an issue for aortic dissections, transections, or congenital malformations that require a surgical approach and repair that can only be accomplished by intermittent or momentary cessation […]

Current Survey Results: Perfusion Events or Unique Issues

Click Image Above to Add a “Episode” to the Perfusion Event Database … Editors Note: This is a new Section.  We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. This is not an “Incident Report” section.  So Anyway, although the responses are not great in number- they […]

Post A Perfusion Event or Unique Issue…

Click Image Above to Add a “Episode” to the Perfusion Event Database … Editors Note: This is a new Section.  We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. This is not an “Incident Report” section.  It’s really more of a registry of the odd things that […]

Pregnancy & CPB

“Bicaval venous cannulation with right atrial opening to scavenge the cardioplegia solution may be necessary to protect the fetal heart from depression by the high potassium solution.”   Perfusion of the Pregnant Patient To provide cardiopulmonary bypass to patients which suffer clinical cardiac disease during their pregnancy.  When this cardiac disease has become exacerbated and […]

Refining Extracorporeal Support Strategy: Oxygen Pressure Field Theory IX

OPFT Part IX:   Using OPFT to Refine Extracorporeal Support Strategy. The anion gap is the difference in the measured cations and the measured anions in serum, plasma, or urine. The magnitude of this difference (i.e. “gap”) in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis. If the […]

Interpretation of the Anion Gap: Oxygen Pressure Field Theory VIII

OPFT Part VIII:  Interpreting the Anion Gap The anion gap is the difference in the measured cations and the measured anions in serum, plasma, or urine. The magnitude of this difference (i.e. “gap”) in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis. If the gap is greater […]

The Anion Gap: Oxygen Pressure Field Theory VII

OPFT Part VII:  The Anion Gap The anion gap is the difference in the measured cations and the measured anions in serum, plasma, or urine. The magnitude of this difference (i.e. “gap”) in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis. If the gap is greater than […]

Microvascular Redistribution: Oxygen Pressure Field Theory VI

Part VI:  Microvascular  Redistribution (Click Image to View Online Power Point Presentation) Authored by:  Gary Grist,  BS, RN, CCP, LCP    To View all of Gary Grist”s Posts Regarding OPFT-  click here Mr Gary Grist delivered a seminar on this topic at The Missouri Perfusion Society 16th Annual Meeting titled “Beyond The Fick Equation”  on June […]

The Role of Carbon Dioxide: Oxygen Pressure Field Theory V

Part V:  The Role of Carbon Dioxide Which of these unlikely bypass candidates- ” Ain’t Gonna Make It? “ Authored by:  Gary Grist,  BS,  CCP, LCP    To View all of Gary Grist”s Posts Regarding OPFT-  click here Carbon Dioxide Pressure Field Theory The term Oxygen Pressure Field Theory is a misnomer if the perfusionist is […]

Axial Gradients: Oxygen Pressure Field Theory IV

Part IV:  Axial Gradients Authored by:  Gary Grist,  BS, RN, CCP, LCP    To View all of Gary Grist”s Posts Regarding OPFT-  click here Axial Gradients To review, Oxygen Pressure Field theory states that there is an oxygen pressure field established in the tissues around each capillary where oxygen is present in varying concentrations from as […]

Offering: Perfusion Group- QA / P&P Development…

Do You Need A Vibrant- Interactive- Internet Presence ? A Corporate Website A Searchable Online Policy & Procedure Database An On-Line QA / Demographic database A Staff Credentialing Database A Face Book Presence A Twitter Presence Do YOU NEED an Interactive On-Line QA / Policy & Procedure Site ? If you are interested in developing […]

We Build OUR Castles …

Perfusion Nesting… I think so … Perfusion nesting. It is a science in-and-of-itself, and most of us do it. The Circuit has to be a certain way- One line over another- The exact number of pump clamps Hand towels a certain way Cardioplegia line wrapped and placed perfectly The mannifold food chain (my neo’s always […]

Perfusion Group- Website Development…

If you are interested in developing a corporate web presence for your perfusion group, or wish to develop an online QA program please contact: email:  Lazarus Technologies, LLC When is a Policy or Procedure Recommendation Welcomed the Most? When you need it immediately Which implies an emergency or unexpected clinical event Which further suggests that […]

Oxygenator Changeout

PROCEDURE FOR IMPLEMENTATION: A.        Equipment Needed: 1.         One (1) new oxygenator 2.         Four (4 – 6) tubing clamps 3.         Sterile heavy scissors or knife blade 4.         Alcohol swabs B.         Procedure for Changing Membrane Oxygenators: 1.         If warm, cool the patient if time permits. 2.         Close the arterial line filter bleed line, turn off the […]

Perfusion Glitches: Waking Patient

Click Image Above to Add a “Glitch” to the Perfusion Database … Editors Note:  This is a new Section.  We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would […]

MicroCircuits & Rapping : [Reprint]

MicroCircuits & Rapping (Click Here if you want to skip to a list of posts) In the last 15 months, our institution decided to get aggressive about reducing our transfusion rate, and the numbers of patients that had postoperative bleeding issues. Originally our aim was to reduce the circuit size and use the integrated microcircuits […]