Perfusion Policies 101: Anticoagulation Reversal

Renee Toth, BS, CCP   Editor’s Note: Renee is a colleague I work with quite often.  She is an amazing perfusionist as well as administrator, mom, and just a decent all around human being. She has a pretty scathing wit- so beware.  She offered to share a policy she has worked on for a quite […]

A Locum’s ScrapBook: Modifying the ECC for Antegrade Cerebral Protection

Editor’s Note: To view the entire “Locum’s ScrapBook” series- click here My life is Family First and then Perfusion.  I take BOTH very seriously. 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 […]

Heater/Cooler Survey Results are In!

  Editor’s Note: Well… I started this survey back in the Fall of last year. (Click image above to view or take the survey) Since then I have been at 4 other institutions and have had the opportunity to observe how my colleagues addressed this issue.  No footprint changes regarding the relative position of the […]

Perfusion Policies 101: Oxygenator Changeout

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 […]

Perfusion Policies 101: Nitric Oxide

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 […]

Perfusion Policies 101: I-STAT

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: A Cool ECC Modification

“These shunts were put in place to allow for passive recirculation of the Qust MPS Microplegia system, so that an unexpected negative pressure will NOT deprime the MPS system.” 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 […]

The Physics of Negative Pressure

Editor’s Note: We all deal with the concepts of positive and negatives pressures, and certainly pay attention to those values during the course of a bypass run, or ECMO, or a myriad of other perfusion modalities. This is a rather insightful and esoteric view of the basic perfusion principle that we both respect and fear- […]

Why is my Patient Bleeding? A Snapshot of Hemostasis, Part II

Click on image to view source article Editor’s Note: We have all revisted this pathway intensively throughout our careers, and of course, we have all been clinically challenged by open-heart cases that test our fundamental understanding of coagulation theory in real time, at a level that certainly reflects a fairly deep dive into esoteric hematology. So i am keeping it simple, and found […]

LPM: A Student’s Perspective- ECMO

“I realized that I learned what a vast difference it is to move from doing a case in the OR, to following up on a patient on a daily basis and monitoring their care.” Editor’s Note: This is a continuation of a series with our newest associate editor, Shayla Johnson, who is currently enrolled in a […]

Welcome to HIPEC!

2 Cone Heads 🙂 Editor’s Note: I had an opportunity to assist and learn how to do a HIPEC procedure.  This was an extraordinary experience, and this perfusion group in Iowa should definitely be recognized for the advanced perfusion techniques they do routinely, that many of us have never had the opportunity to be a part […]

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 […]

A Locums ScrapBook: A Day in the Life…

“I joked with the crew, and said, we are in the land of the Paramedics, cuz that’s pretty much all you could see.” Editor’s Note: To view the entire “Locum’s ScrapBook” series- click here I’m doing some perfusion traveling as I am taking my show on the road.  As such, every once in awhile I […]

Some Thoughts about Pump Configuration and Design: Collin Green

“Admittedly there are machines today where the arterial pump can be re-positioned closer to the table and sometimes higher but to the best of my knowledge sucker and cardioplegia pumps tend to stay on the machine base.“ Editor’s Note: I would like to introduce you to a perfusionist that contacted me recently and is the […]

Perfusion Life: Why We Do This

Editor’s Note: I do a lot of “why we do this” posts, not because it is rhetorical or thought provoking, but because we as a profession are pioneers as well.  In the past 40 years, the technological achievements in cardiac medicine defy belief at times, in that we have come so far- so very quickly. […]

On Being a Perfusionist: The Perfect Recovery from an Adverse Situation

ON BEING A PERFUSIONIST I think we are reminded of our human fallibility (the potential to err is in all of us) every day we pump a case. With so many steps and moving parts in the equation, the goal is to choreograph out a perfect “10” every single time. Of course that doesn’t always […]

From Belgium: What is a Perfusionist?

Editor’s Note: Below you will see a very inspiring video detailing the scope of practice of a perfusionist, and describing the vast array of talents as well as the personal fortitude that is required to seriously engage the profession. I want to thank Dr. Verhofste for forwarding me this video, and allowing me to share […]

The ‘Third Space’–Fact or Fiction?

“While I was familiar with the concept of “third spacing”, I needed to clarify the implied “first”, and “second” spaces.” Editor’s Note: Back quite a while ago, I was really into publications, and the academic side of cardiac perfusion and education.  Part of what we do involves some major fluid shifts within the patient as […]

How to Calculate EBL with Cell Savers

“It was simple- but in theory is consistent with other ways I have used to extrapolate that mysterious number we always come up with- that is sometime just barely a step away from ‘home cooking’.”   Editor’s Note: Well, I was @ a new venue, doing a locum’s gig- and ran into an interesting formula/calculation […]

Modified Ultrafiltration During Cardiopulmonary Bypass

“MUF following separation from extracorporeal circulation (ECC) provides well known advantages in children with improvements in the hemodynamic, pulmonary, coagulation and other organs functions.” Editor’s Note: Please consider the fact that I am NOT a pediatric perfusionist, so this article may be too rudimentary for you Peds guys out there 🙂 Nevertheless- this post began […]

Perfusion Innovation! Kudos to Quick Thinking

The arrows point to key components that helped make this all work… Editor’s Note: The above picture was posted on the “Surfers FB page, with some caption’s (see below) describing briefly, an event (ruptured RA) post CPB while closing.  I was impressed with the simplicity of the setup and it’s obvious effectiveness. The quest remains- where […]

LPM: A Student’s Perspective- Dialysis

“Once the basic pump set-up is learned, there are so many other additional instruments and methods that also need to be understood.” Editor’s Note: This is a continuation of a new series with a guest blogger who is currently enrolled in a perfusion program.  I am impressed that as a perfusion student she has the initiative […]

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 […]

Perfusion Life: The InElegant Hack

Editor’s Note: Here is a guest post presented in it’s raw and natural form, written by Michael Colligan, RN, MS, CCP. Thank you Michael, for contributing 🙂 -Frank PERFUSION LIFE HACK What is a life hack? The term life hack started out as “hack”, having evolved from the original definition to the current meaning of an […]

Why We Do This: LVAD_one 2009 Days +

“So yes, we engage hope and strive to do our best, but our vision for this patient’s future is sometimes less than vibrant- for the reasons stated above.  Many of us have become LVAD pessimists.” 2009 days x 24 hours x 60 minutes = 2,892,960 minutes of life support… Editor’s Note: I think there is a tendency […]

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 […]

Synchronized vs. Unsynchronized Cardioversion

Courtesy of ACLS-Algotithms.com  (Click image to view site) Editor’s Note: It’s funny how you can go an entire career doing something (CPB) and hear the same thing every day, but actually not evaluate what it means.  Yes, I have taken ACLS and studied the electrophysiology of the heart. So anyway, we have just taken off the […]

An ECMO in OMAN: FB Discussion

Editor’s Note: I saw this discussion on the Perfusion.com Group FB page, and thought it merited a post here on ‘Surfes– to demonstrate how effective new media communication can be in real time. Please feel free to add to the discussion 🙂 Frank = Saleh Al Harthy Yesterday at 9:36am · Al Amarat, Oman – […]

Cairo, Egypt: Case Study: AVR with Antiphospholipid Syndrome

Editor’s Note: I saw this post of Ramy’s FB page (or maybe one of the perfusion groups on FB) and reached out to Ramy to submit this as a case study.  He has graciously forwarded the case study and I thank you Ramy. Feel free to leave comments in the comments section- Happy Saturday 🙂 […]

Heart-To-Heart: International Perfusion Missions

Editor’s Note: Other world perfusion is something I think I missed out on.  Can’t call it 3rd world- because it is after all OUR world. There is something exotically exciting about becoming involved in a mission- in a new and different country- and making such a huge difference to people you would otherwise never have met […]

MN or ND: Potential Student Seeking Job Shadow Opportunity

Potential Student Seeking Job Shadow Opportunity Editor’s Note: Hello to Minnesota and MN CCP’s 🙂 This young man is looking for a job shadow opportunity somewhere (he lives in ND and hails from MN).  I know some great people in Duluth- and of course Rochester (Mayo) is a tremendous opportunity. Can you give him a […]

Perfusion Iraq: Night Lights

Editor’s Note: Found this enlightening (no pun) innovation on the perfusion.com FB page. Submitted by:  Ahmed G. Sarfan Local machine light When we loss the support, we should go on.. Local HLM light designed by local Nasiriyah Heart Center team. Very nice 🙂

Pressors; Q; or Volume?

Editor’s Note: Well I was surfing the perfusio.com FB perfusion group, when I came across a continuing dialogue on when and why to adjust pressure using flow, vasopressors, or volume… So it seemed to be a pretty advanced thread- and I thought I would share it to see if anyone else wanted to join in? Pressors; […]

HEROS! A Job Shadowing Experience

“I now understand even more why someone would want to go in this line of work; these men and women in the OR make a difference, together they do something incredible, literally life altering, they are nothing short of modern day hero’s.” Editor’s Note: This is a narrative from a future perfusion student who job-shadowed […]

Plz Donate: Intervention Doesn’t Stop AFTER the Operation…

“This would make the realistic GoFundMe goal approximately $10,800- a sum that represents less than the purchase price of a used car…” Click Image Above to Donate 🙂 Editor’s Note: I was checking FB the other day, and spotted a compelling story on the page of a long distance friend (as well as colleague on this […]

PICU Nursing: Honing Your ECMO Skills

Editor’s Note: So I was @ Women’s & Children’s Hospital – here in West Texas, doing some platelet gel cases, when I decided to drop by the PICU to visit friends I hadn’t seen in awhile. The PICU staff was pretty thin- so I asked where everybody was- and found out they were conducting an ECMO wet […]

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 […]

Using Occlusive Foley Catheters to Control Excessive Tumor-Related Bleeding

Dr.Harinder Singh Bedi = = The lowly Foley to the rescue – It was the 4th case . A meticulous  total arterial off pump bypass and and two hectic mitral and tricuspid valve repairs – the 2nd had required some extra  time as it was a young lad and I wanted to avoid a valve […]

From Italy [ 7 ] Reshaping the Heart

Editor’s Note: Once again, just checking early morning news and chatter on Facebook, and another interesting link rears it’s head.   I found this article on an Italian perfusion FB page by CardioPeople- an Italian resource- very well organized, and very professional. Link:  https://www.facebook.com/universita.campobasso They provided an English version of the above cited topic- so […]

From Italy [ 6 ] Mitral Prosthesis, Implantation on the Beating Heart

Editor’s Note: Once again, just checking early morning news and chatter on Facebook, and another interesting link rears it’s head.   I found this article on an Italian perfusion FB page by CardioPeople- an Italian resource- very well organized, and very professional.  http://www.cardiopeople-network.com/social/index.php?do=%2Fpages%2F10%2F They provided an English version of the above cited topic- so I […]

Letters from a Perfusionist in Germany: Coming to America…

Editor’s Note: Hi Guys, I got this letter from a perfusionist in Germany. I don’t know if the ABCP recognizes Perfusion Certification from Europe.  I guess the question is- can he sit for the ABCP boards? Hi Frank, hope u can help.. i want to immigrate to the states after i finish my Master degree […]

My Perfusion Job Shadowing Experience: Day 1

Click HERE to view entire series 🙂 Editor’s Note: This is part 1 of what is going to be a 3-part series- the first two posts presented by a young, soon-to-be medical professional who job shadowed for two days with me.  The last will be a re-post of something I had written- that reflects the […]

My Perfusion Job Shadowing Experience: Day 3

Click HERE to view entire series 🙂 Editor’s Note: This is part 3 of what is a 3-part series- two posts are presented by a young, soon-to-be medical professional who job shadowed for two days with me.  This last post will be a re-post of something I had written- that was about this particular case- that reflects […]

Writers & Bloggers Wanted :

Hi- Wanted to see if there are any perfusionists out there that like to write- or want to write about their perfusion experiences? Perfusionists from all corners of the World are invited to participate … Writing / blogging is basically taking taking your point of view on aspects of perfusion and sharing it with others […]

CPB Techniques for ESRD/Hemodyalisis on Pt Awaiting Renal TX

Dr.Harinder Singh Bedi = = I have a 56 year old patient in ESRD on hemodialysis with a left radial AV fistula . He was being planned for renal transplant and was discovered to have critical and diffuse CAD- so being taken up for CABG . Plan so far : 1. avoid LIMA because of […]

Perfusion Evolution C/O Minnesota Perfusion

“Sure we get exhausted and frustrated at times like any human would in situations where rest and refreshment aren’t available to us as we wish it but WOW it’s awesome to be a perfusionist today.” Editor’s Note: I received the following letter and articles from David Hodnnick, CCP a prominent perfusionist in our profession. There […]

The First Ever Artificial Heart Transplantation in Azerbaijan

Editor’s Note: A FB friend and colleague of mine, Cuneyt Imamoglu, from Baku, Azerbaijan, shared the story below of the ground breaking procedure performed for the first time in Azerbaijan. Cuneyt is very active on-line promoting perfusion dialogue and education. Thank you for sharing this Cuneyt 🙂 Frank   The first ever artificial heart transplantation […]

Myocardial Ischemia: The Best Timing for Engaging CPB for Revascularization

Editors Note: Having been in the field for awhile, and being an STS data coordinator, the timing of surgery for patients suffering from an acute evolving myocardial infarction (AEMI) has always intrigued me. The STS data form is very specific in tracking these intervals, and I am naturally curious as to what the impact on […]

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 […]

Femoral Cannulation for CPB: Tips and Discussion…

Editors Note: I got this email today: “Respected Sir / Mam, This is Shahriar from Bangladesh. I am interested to know about femoral bypass technique.  Awaiting for your kind suggestion. Regards, Towfiq Shahriar Islam Khan, Perfusionist IBN SINA Hospital (Cardiac Centre) Bangladesh” Hence, the following article. Please feel free to add suggestions or advise as […]

A Unique Case Review:

Authored by Steve Sutton, LP, CCP Editor’s Note: Steve Sutton is well known and highly regarded into today’s Perfusion community.  He is a strong proponent for advancing Perfusion education and in pursuing that goal,  he has given numerous presentations at some of the most  premier Perfusion meetings held each year. Along with his dedication to […]

Diary of a Perfusion Slave: The Internship

Giorgiarobertandrea Isidoro COMING SOON Editors Note: Giorgiarobertandrea Isidoro is a student I met on FB a couple of years ago.  She has completed her perfusion training in Italy, and is going to do a perfusion internship in Rome.  She will pe submitting a picture diary of her life as a Roman perfusion intern, and all […]

Adequacy of Perfusion:

Adequacy of Perfusion:  By Steve Sutton, LP, CCP Editor’s Note: Steve Sutton is well known and highly regarded into today’s Perfusion community.  He is a strong proponent for advancing Perfusion education and in pursuing that goal,  he has given numerous presentations at some of the most  premier Perfusion meetings held each year. Along with his […]

And Then Comes Sunday …

24 Hours… of ECMO New Beginnings   (To view the entire “Day In The Life” series Click Here) Jesse Shipman struggles to do a stretch during a therapy session with occupational therapist Megan Taylor at TrustPoint Hospital in Lubbock, Texas Tuesday, June 12, 2011. (Miranda Grubbs/ Lubbock Avalanche-Journal) To view the entire “Day In The […]

H1N1- ARDS- & ECMO (Current Literature)

Editors Note: A big thank you to Marianne Veir Pilger, CCP, and her colleague John @ Meriter Hospital in Madison, Wisconsin for helping out so quickly and hooking us up with the below listed articles on ECMO management for ARDS and H1N1. This is something we are all facing- so I hope it helps. Again- […]

CNS & CPB

CNS & CPB The major postoperative neurological complication associated with open-heart surgery and cardiopulmonary bypass is stroke, which is defined as a sudden onset of a focal deficit of the central nervous system lasting longer than 24 hours.  While this clinical finding occurs in approximately 1-5% of cardiac surgery patients, 70% of cerebrovascular sequelae occur […]

Letters From the Philippines: Improving O2 Transfer?

Editor’s Note: Hi Guys, I got this letter from a Filipino  perfusionist via FaceBook.  If any of you have any engineering insights into the mechanics of increasing Oxygenator surface area for improving O2/CO2 exchange , can you send replies to Kevin Tabamo’s FB page? Thanks ! = = 🙂 Frank Click image to respond directly […]

Diversity- Thy Name is ‘Surfers …

Close to 3 Years ago…  We looked a bit like this… = Now, We are starting to look a little more like this. Editor’s Note: I was thinking today about international perfusion awareness and how new media (blogs, Facebook, Twitter, YouTube, LinkedIn, StumbleUpon) has played a role in terms of the entire global perfusion community […]

Letters From Saudi Arabia: Plz Recommend a Perfusion Program

Editor’s Note: Hi Guys, I got this letter from a graduating nursing student from Saudi Arabia. If you have any suggestions for a great perfusion school you would like to recommend- please respond here in the comments section, or directly to Mr. Wafe at his listed email address. I need your help from Saudi Arabia […]

Letters From Pakistan: Questions on the CardioHelp System

Click image to view manufacturer’s information on this product- Editor’s Note: Hi Guys, I got this letter from a Pakistani perfusionist via LinkedIn.  If any of you have any Experience using the CardioHelp System, can you send replies here to ‘Surfers? I have no experience with the device, so it would be inappropriate for me […]

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 […]

Intracardiac Shunts

Principles of Intracardiac Shunts Significant hypoxemia can result from right-to-left intracardiac shunting through a patent foramen ovale, an atrial septal defect or a ventricular septal defect. Pulmonary embolus, congenital heart disease and pericardial tamponade are well-recognized causes of right-to-left shunting. With the continued presence of a congenital defect of the cardiac septum or great vessels […]

ECMO Research Study : This is a PAID Survey…

Editor’s Note: I spoke with this gentleman on the phone for a bit.  He was a well spoken and forthright individual.  This survey is important for our profession in terms of evaluating new ECMO principals and applications. Please respond to his email or phone number if you are interested in participating in the survey/study 🙂 […]

From Saigon to Facebook: An Interview With a Veteran Perfusionist & a Veteran of Foreign Wars

“Be willing to work many hours, often times in a very stressful situation where the human life; both adult and infant are at stake.“ Click images to enlarge … Editors Note: There is a guy I work with down here in West Texas, who helps us out with ABG’s, art lines, monitoring, Swanns, IABP’s, and […]

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]. […]

A Blast from the Past ! Perfusion 1995

Editor’s Note: In 1995: There was no ECECT meeting yet European Certificate in Cardiovascular Perfusion was a year away Standards of Practice in Clinical Perfusion in Australasia were two years away Perflist was just beginning under Sue Boetcher’s pioneering mantle- Perfusion dot com was becoming a reality (Bryan Lich was about to profoundly change perfusion […]

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 […]

Around the (Distant) Pump Room by Martin Gill, CCP.

An AMAZING Perfusion Publication ! (Contact Martin on how to Subscribe) Media Journalism by… Martin Gill: Perfusionist Editor (former), ANCZP Gazette email for subscription: martin.gill@health.nsw.gov.au (Children’s Hospital at Westmead, Sydney Australia) Editor’s Note: Martin Gill is a gifted writer and supporter of perfusion international relations and improving perfusion practice- wherever it may be. He has […]

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 […]

Hybrid OR [3] Day 1 Debut

In Technicolor or Black & White ? Editor’s Note: Over the past year or so, a Hybrid room as been under construction, here in West Texas.  Being very close to one of the cardiac operating rooms- during this process, the sounds of drilling and hammering mix in with Pink Floyd, Annie Lennox, some “ya-done-me-wrong” Texas […]

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 […]

Ventricular Hypertrophy & Perfusion

LVH :  Photo by:  Srinivas Rao @ Gruppo dei Perfusionisti!!! Ventricular Hypertrophy & Perfusion Subendocardial Q Determinants While subendocardial and sub-epicardial layers have the same determinants for blood flow, subendocardial layers are at greater risk from ischemia and infarction.  The deeper subendocardium is subjected to greater wall tension which then expresses as a metabolic requirement […]