Terms of the Trade …

YOUR CHUGGING:  Really ? ? ?

That was what I heard…  the Surgeon saying;  “you’re chugging”…

It made me think of all the terms we use during a pump run, and what they must sound like to people unfamiliar with the common colloquialisms used during open-heart surgery.

So I thought I would run a few of them down with a brief explanation here and there- of what the phrases really mean.

CHUGGING

(Click on Image to Enlarge View of Turbulent Q )

No it’s NOT a drinking contest.

This is a situation where turbulent venous return, causes a stop-and-go motion to the blood flow, causing the venous line to jerk a bit- or “chug”.  Usually alleviated by partially clamping your venous line.

WATCH YOUR LEVEL

This has nothing to do with carpentry,

and everything to do with making sure you have adequate venous reserve in your reservoir, to not accidentally drain it and deprime your circuit.

The surgeon usually mentions this if he is obstructing the venous return to your reservoir, in order to let the heart expand and get an accurate saphenous vein graft measurement.

More often than not- it is said as an afterthought, and you will already be aware of it.  If your cool like Nadia (below) is.

Nadia- Watching her level, being ever vigilant, and NOT taking pictures…  LOL

REDUCE YOUR CHATTER

No…  The surgeon isn’t telling you to shut up.

If he wanted you to do that- he would just say it.

Chatter is a term synonymous with “chugging” and refers to “Line Chatter” or- line movement.  See above (Chugging) for causes and Rx.

LET’S GET A QUICK ARREST …

Ok.  You’re NOT in the LAPD and your aren’t chasing the bad guys…

If a surgeon tells you this, he wants you to administer cardioplegia as efficiently as possible, to put the heart into cardiac arrest as quickly as possible.  This is usually what we all want to do anyway- but it tends to emphasize that this particular heart is more at risk for myocardial ischemia

PINCHING …

Nobody’s getting pinched today- by anybody 🙂

When you hear this from a surgeon, it means he is literally “pinching” down on the venous line to occlude it and allow the heart to fill up- in order to size his venous grafts.

The typical response from a perfusionist is…

“WATCHING… ”

By saying this- you let the surgeon know- that you are watching your reservoir levels. 

This is more of a term used in the upper Midwest- than other places in the country where I have pumped cases.

I’M DROWNING HERE …

Obviously the surgeon isn’t drowning,

but he IS letting you know that he can’t see where to sew to- because there is too much blood in the field obscuring his vision.

Typical remedies are , increasing your vent suction, increasing your line suction, reducing your flow briefly, or readjusting the venous cannula to improve drainage from the heart.

“THE HEART’S BLOWING UP LIKE AN ‘EFFING’ TOAD!”

You REALLY never want to hear this from the surgeon.  It’s always bad, and he’s usually pissed.

He is letting you know that the heart isn’t draining well-

Quite the opposite-

It is totally filling up- making it impossible for him to work, as well as potentially harming the heart muscle by stretching it beyond it’s normal limit. (See Frank-Starling Law)

The immediate remedy is to quickly drop flow and find out if there is a venous line occlusion issue, or malposition of something.

Untoward or hard retraction can also be a contributing factor, or the venous cannula may have slipped and become partially occluded.

If you have any favorite or unique expressions- leave them in the comments section- and I will include them in Part 2:

More Terms to Come …

0 thoughts on “Terms of the Trade …

  1. Years a ago I worked with a truly grand fellow: Dr. Horace Robert Trumbull, known to all as Rob Trumbull. He had been everywhere and told wonderful stories about bizarre events. He developed visual problems at a relatively young age. The upshot of the surgery was a loss of depth of field. Not only could he not do tiny anastomosis, but he had to stop flying, too. With a wife and three ex-es he first invested in an auto parts venture, then moved on to become a Vice President of a major medical manufacturer. He died suddenly and oh too soon a decade or so ago.
    He comes to mind when discussing operating room expressions because he told us now and then, when circumstances warranted, that one place he worked had a rule: If when on bypass someone said “Ut-oh”, that person bought lunch for the team. “Oh shit!” meant buying drinks after work.

  2. Ha ha ha! Sounds like my kind of guy. Those are two good rules. Some other words I’ve comes across:

    Retard = hold volume in the heart (venous line)
    Magic “on”-“off” = cardioplegia
    Let the big wheels turn = go on bypass
    Let the salmon swim = give protamine

    Just a few that come to mind. Others I’ve encountered may be a bit rated R 🙂

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