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 on the far left)

The water lines- Soooo important

A break away circuit

CDI and Pressure monitors- lined up perfectly

Always an extra 10 cc syringe READY for meds

And it goes on –

and on –

and on …

It’s a Choreography of EVENTs Behind the Pump-


It looks effortless because of the above repetition.

It NEEDS to be effortless when things get dicey, and fortune leaves us briefly for the moment.

It is all about reflexive memory- you are reaching in the right direction the second the impulse to do it gets you there. You don’t make your hand go there- it’s already there…

Most of us don’t really “think” as we deal with unexpected catastrophic events. We go into a zone and Pre-Act as opposed to react.

We prioritize a long and complex set of maneuvers to salvage the patient from whatever is in front of us- whether an oxygenator changeout, a cardioplegia failure, a conversion to a VAD, unexpected dissections, decannulations, catastrophic blood loss, and pretty much the most horrific possible-time-limited-death-potential-events.

A Chess Match with Adversity


By Pre-act I mean we use a set of predefined steps that we have either used before, or rehearsed in our minds to find a solution. Or sometimes- a passing thought of how we would deal with a certain event- becomes your “gut” solution.

I trust my instinct. So if I think it’s going to work- it’s usually not a guess. I may have never done it before, but the principals I apply- should be consistent with a significant level of prior experience.

An Example: Need I say More ?

Castle by : Olivier Germay

Hi this is my bypass machine, custom made from 1989 !!! There is only
2 like this…all in my center !!!

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