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 put a new oxygenator in-line although previous experience had demonstrated consistently that a wet (no meds) ECC would be more than fine to use for several days after priming. Our protocols also supported this position.
Regardless, I thought it would be good practice- in case I ever needed to change one out while on bypass- so I decided to do just that, and at the same time, diagram the process for readers that may be unfamiliar with the Terumo FX series, which through the use of quick-release connectors, has made this process quite simpler.
So here goes …
Get your ducks in a row, so to speak. In other words, be as prepared as possible with every step in the process to minimize the “down time” when separating the old oxygenator out- and replacing a new oxygenator in-line.
Identify every step that you can do BEFORE coming off pump to accomplish the change out.
Most importantly, Identify one team member that you trust and that can assist you (holding lines- etc).
Get Your Ducks in a Row
(click on images to enlarge)
Terumo has developed a quick-connect system that comes in very handy when changing out oxygenators: Faster, cleaner, reduces risk of contamination, eliminates the need to cut most of your lines (all except the cardioplegia 1/4″ line).
The connectors come with sterile caps and the direction of the white release tabs indicate whether the connector has a male or female coupling end.
The new oxygenator is ready for use. Tubing is attached to inlet and outlet ports.
Take the water lines off.
Disconnect the small Oxygenator purge line from the venous reservoir.
Clamp out the Cardioplegia Line.
Divide the line with a #20 knife blade.
Cut your O2 line, and come off CPB IMMEDIATELY.
The Changeout : You Are OFF BYPASS
(click on images to enlarge)
Disconnect the inlet and outlet lines to the Oxygenator (clamp before and after the connectors so as to avoid blood loss) Please note: the lines are NOT touching the floor- the angle makes it look like they are closer than they are.
Explanted Oxygenator (with clamps to avoid a bloody mess).
Seat the new oxygenator into the bracket.
Connect inlet and outlet quick-connections.
Connect cardioplegia line and DON’T forget to hook up the arterial pressure tubing (to the sampling manifold).
Re-Priming & De-Airing
Make sure you have enough volume in your reservoir to re-prime your new oxygenator! Drop extra crystalloid if needed.
De-Air by routing your Q through the recirc line.
MAKE SURE to clamp distal to the purge line (or ALF) and purge air out from all directions through the purge line.
Be aware that a small bolus of air may escape through your cardioplegia line- and make sure to chase it out and de-air the line prior to cardioplgia delivery.
Go Back On Bypass …
Oh yeah- once back on- make sure you hook up your water lines.
Congratulations! That probably took you less than 2 minutes 🙂