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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

A Global Foum ? Yeah ! We Can Do It !

A Picture of the Sun… I would like a Global Forum. It is necessary and far past due. My hope is that eventually, this blog will be considered a resource for all of us. I need help. I need writers and opinions from all over the globe. So please tell your friends if they are […]

Survey Results: ECC Setups [RePrint)

Pre-Assembled ECC’s and the Rationale Behind Them… Authored by:  Jeff Campbell, MPS, CCP,CCT; Frank Aprile, BBA, LP, CCP; – Survey Design:  Frank Aprile, BBA, LP, CCP; Jeff Campbell, MPS, CCP, CCT; Discussion: The reasons perfusionists have increasingly adopted the practice of a having pre-assembled dry or wet ECC over the past decade may be multi-factorial.  […]

Sickle Cell Anemia v1

SICKLE CELL ANEMIA 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 […]

AngioVac

Looking for Written protocols Anybody have any Experience with this Technology? (Click Image to View Website) I got a Facebook Question today… “Do you know of any written protocols for the Angiovac? I have emailed the company and asked for an inservice and protocols and have not heard back from them. Thanks, Michelle” The Company […]

Survey Results: ECC Setups

Pre-Assembled ECC’s and the Rationale Behind Them… Authored by:  Jeff Campbell, MPS, CCP,CCT; Frank Aprile, BBA, LP, CCP;  – Survey Design:  Frank Aprile, BBA, LP, CCP; Jeff Campbell, MPS, CCP, CCT; Discussion: The reasons perfusionists have increasingly adopted the practice of a having pre-assembled dry or wet ECC over the past decade may be multi-factorial.  […]

Rx for Hemolytic Reaction

Rx  FOR HEMOLYTIC REACTION As a result of gross exposure to a hypotonic environment. Hemolysis of blood samples. Red blood cells without (left and middle) and with (right) hemolysis. If as little as 0.5% of the red blood cells are hemolyzed, the released hemoglobin will cause the serum or plasma to appear pale red or […]

CEREBRAL PERFUSION

Retrograde Cerebral Perfusion PURPOSE: To provide an alternative method of cerebral protection during procedures which require the cessation of cardiopulmonary bypass.  To provide an alternative method of cerebral protection during procedures where no other means of aortic perfusion, and thus cerebral perfusion, can or will be performed.  To provide an adjunctive therapy for the management […]

CPS Support

CPS Support (Written with assistance from Thomas Doyle, MS, CCP) CPS used by EMS … Click to read article… An interesting paper on using expanding percutaneous cannulas with CPS. Click to read article… Procedure for CPS A.    Disposable Equipment: 1.  CPS Pack 2.  Percutaneous cannulae (arterial/venous) 3.  Membrane oxygenator with integral heat exchanger and holder. […]

VAD / ECMO Policy v. 1.0

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 […]

MicroCircuits & Rapping

MicroCircuits & Rapping (Click Here if you want to skip to a list of posts) In the last 5 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 […]

AT3 Deficiency v.1

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 v.1

I.    BACKGROUND: Hypothermic cardiopulmonary bypass with the use of cold blood cardioplegia carries with it the risk of red cell agglutination caused by unsuspected cold agglutinin disease.  Patients with this condition possess serum antibodies which become reactive at temperatures usually less than 30°C and are directed against an antigen of the human erythrocyte causing agglutination […]

HIT

Heparin Induced Thrombocytopenia I.    DESCRIPTION: Heparin induced thrombocytopenia (HIT) and heparin induced thrombocytopenia thrombosis syndrome (HITTS) are immune mediated complications of heparin therapy.  An antibody, produced by the body upon initial exposure to     heparin, reacts with an antigen upon re-exposure or continuous exposure to heparin. HIT is characterized by a dramatic decrease in platelet […]

Protamine Reaction v1

I.    DESCRIPTION: Following cardiopulmonary bypass with heparin anticoagulation, protamine sulfate is used to neutralize the effects of heparin and reverse anticoagulation.  Currently protamine is the only drug available in the United States that can be used for this purpose. Hexadimethrine bromide (Polybrene) and toluidine blue are for laboratory use only. II.    ADMINISTRATION: The method of […]

Malignant Hyperthermia v 1

I.    PATHOPHYSIOLOGY: Malignant hyperthermia (MH) is a pharmacogenetic disorder characterized by a fulminant hypermetabolic reaction of skeletal muscle induced by volatile inhalational anesthetics, succinylcholine, and possibly stress and exercise.  Until the advent of dantrolene, the mortality rate was 65% but since the introduction of dantrolene in 1979, it has decreased to between 1 and 10%. […]

Jehovah’s Witness v.1

JEHOVAH’S WITNESSES Jehovah’s Witness patients are at increased risk for morbidity and mortality associated with blood loss due to their refusal, on religious grounds, of both homologous blood transfusion and autologous blood that has been removed from  continuity with the body.  They believe that it is wrong to accept or receive any type of blood […]